Nursing students at Virginia Commonwealth University receive classroom information on interacting with family members of hospitalized patients; however the students do not have an opportunity to practice these skills prior to real life encounters during the clinical portion of the courses. By simulating communication between nurses and patents’ family members, the student can practice their communication skills. The student can be directly involved in his or her own learning, build on his or her current skill level, benefit from structured feedback about the effectiveness of the skill, demonstrate the learned behavior, and gain confidence in his or her communication abilities.
Researchers in the recently published article by Lorin, Rho, Wisnivesky, and Nierman (2006) demonstrated improvement in communications skills of medical students using a formal teaching session and a simulated practice session with a “standardized family member” (actors playing an established role). The funding from the Center for Teaching Excellence Grant allowed School of Nursing faculty to replicate the research study with sophomore nursing students. The Standardized Family Members (SFMs) were paid professionally trained actors provided by Eastern Virginia Medical School for $3000. Data management for the research project was provided by the School of Nursing Center for Biobehavioral Clinical Research for $500. Researchers obtained IRB expedited approval.
The objective of the project was to assess the effectiveness of a learner-centered, simulation intervention designed to improve the communication skills of the pre-professional nursing students.
At the beginning of the semester, twenty sophomore nursing students enrolled in Technologies of Nursing (Nursing 202) volunteered to participate in a 30 minute instructional session presenting a framework for communication and guidelines on how to use this framework when communicating with family members. This intervention group was then divided into smaller groups of 5-6 students each and allowed to role play for one hour with a standardized family member. The students practiced the communication skills presented in the training session and were given informal feedback and couching during the practice sessions. During the semester, didactic information on communication was presented to all Nursing 202 students. At the end of the semester, the twenty interventional students and twenty one volunteers (control group) were evaluated on communication skills with family members. Each individual student was given the same scenario and asked to communicate information about a patient to a SFM. Faculty from the School of Nursing, blinded to the intervention and control groups, graded the interaction using a standardized tool adapted from the research article by Lorin, et. al.(2006). The assessments were videotaped and inter-rater reliability was tested. A one-way multivariate analysis of variance was used to compare control and intervention groups on standardized grading tool scores. The mean and standard deviation for each group was determined in each of the four domains (introduction, gathering information, imparting information, and clarifying goals and expectations) as well as the summative score of all four domains. Demographic information was used for group descriptions and comparisons.
The standardized grading tool, developed by Lorin et. al., (2006) and modified for this project, evaluated a framework for communication skills that including four teaching domains: introduction, gathering information, imparting information, and clarifying goals and expectations. The intervention group performed better than the control group in all four tested domains related to communication skills, and the difference was statistically significant in the domain of gathering of information (p= 0.0257).. The intervention group benefited from the instructional intervention that included practicing with the SFM. The process of communicating with families involves an array of skills from simple skills of data acquisition to more complex skills such as negotiating goals of care. The finding that differences in scores between groups were greatest in the simpler skill of information gathering and imparting than in the more complex aspects of the interaction, may indicate that sophomore nursing students are not yet developmentally ready to accomplish these higher level skills.
Communication is a core competency for nursing. This study provides an innovative approach to meet the needs of assessing this core competency. Providing students with a simulated learning environment in which to practice enhances communication skills, and use of an SFM in student evaluation enhances objectivity and rigor of assessments by providing controlled testing conditions. More opportunities for this method of education should be evaluated, and if effective, adopted into the curriculum. This study provides initial information about a SFM-based teaching strategy to enhance communication skills of pre-professional nursing students. This project also provides a foundation on which future systemic investigation into learner-centered teaching methods for clinical skills can be based.
A data-based manuscript of the research project, funded by the Center for Teaching Excellence, is being submitted for publication in a peer-reviewed nursing journal.
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