As nursing schools are continuously challenged to find appropriate clinical sites for their students, instructors are often presented with the opportunity to develop innovative clinical activities to meet course objectives (Jefferies, 2005). In response to limited clinical sites for student clinical rotations, an unfolding, role-playing activity was developed, depicting an adolescent patient from the beginning of her first pregnancy throughout her prenatal course, delivery, and post-partum care (Cant & Cooper, 2010). Students interacted with this patient through a series of role-playing scenarios, as well as an already existing interprofessional high-fidelity simulation. Students also had the opportunity to play the role of the patient during these case scenarios.
The role-playing scenarios focused on providing patient education, elements of motivational interviewing, and anticipatory guidance. By interacting with the adolescent patient through multiple scenarios, students were able to integrate a chronological context in their prioritization of needs and plan of care for the patient. The following course objectives were addressed by the clinical activities of the scenarios:
- Use the nursing process, based on standards of nursing practice, to carry out a plan of care that is agreed upon with the patient and family.
- Use critical thinking in the application of theory and evidence to support nursing practice.
- Demonstrate effective communication and collaboration skills in working with the patient, her family, and other members of the health care team.
- Demonstrate awareness of the current issues in the health care of women and the roles of the professional nurse in these areas.
During the first interaction, students were tasked to admit the patient; complete the documentation, pertinent assessments, and health history interview; and provide appropriate patient education. The patient, called Cassie Jones, was an 18-year-old primigravida with a history of anxiety, hypertension, and tobacco use. Students playing the patient were provided with a script, but they were also challenged to conjure appropriate questions of their own. After the students were provided with a few minutes to prepare, they split into patient–nurse pairs and proceeded with their interview and assessment. The instructor remained in an observational role while the students conducted their interviews.
Students playing the patient were provided with a check-off list of key points so that specific feedback could be provided to their nurse counterpart. The students were allowed 30 minutes to conduct their interview and provide applicable patient education. A debriefing occurred following the session. Students were asked to share what went well, what was challenging, and what they would do differently if given the opportunity to repeat the scenario again. Students playing the role of the patient in each scenario were encouraged to express how they felt receiving the information during the session.
In subsequent role-playing activities, the students educated Cassie on her new diagnosis—gestational diabetes. Patient-centered care and clear communication served as the main focus for this encounter. At the mid-semester point, students participated in three high-fidelity simulations depicting Cassie’s delivery and immediate postpartum care as an inpatient. These were high-fidelity scenarios, focused on evidenced-based practices, teamwork, and communication. Near the end of the semester, students encountered Cassie during a 6-week postpartum visit, where she had symptoms of postpartum depression. Finally, students helped to support Cassie with therapeutic communication during a 1-year follow up appointment, when she returned with a miscarriage.
The scenarios served the purpose of linking content from other courses, such as psychiatric–mental health, into the women’s health arena.
Students provided feedback via an online survey at the end of all activities. The feedback was positive, as students enjoyed the small groups and felt challenged by the topics. Students believed that the role-playing scenarios provided an opportunity for them to work with topics not typically seen in their clinical environment in the hospital. Students also appreciated the opportunity to conduct a full interview and gained a greater appreciation for the challenges of providing patient-appropriate education.
- Cant, R.P. & Cooper, S.J. (2010). Simulation-based learning in nurse education: systematic review. Journal of Advanced Nursing, 66, 3–15. doi:10.1111/j.1365-2648.2009.05240.x [CrossRef]
- Jeffries, P.R. (2005). A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives26, 96–103.