Journal of Nursing Education

Major Article 

Turkish Senior Nursing Students' Communication Experience With English-Speaking Patients

Gulten Guvenc, PhD, RN; Vesile Unver, PhD, RN; Tulay Basak, PhD, RN; Cigdem Yuksel, PhD, RN; Hatice Ayhan, PhD, RN; Gulsah Kok, PhD, RN; Dilek Konukbay, PhD, RN; Gulsah Kose, PhD, RN; Ozlem Aslan, PhD, RN; Sevinc Tastan, PhD, RN; Emine Iyigun, PhD, RN

Abstract

Background:

Simulation has been widely accepted as a valuable learning method in nursing education programs so that nursing students can learn and develop communication skills. The aim of this study was to evaluate nursing students' communication experience with an English-speaking standardized patient in the context of the Rational Administration of Medicines course.

Method:

Involving both quantitative and qualitative research designs, this descriptive study was conducted with 104 nursing students in Ankara, Turkey, from September 2012 to July 2013.

Results:

The majority (98.1%) of the participants stated the necessity of improving their English to communicate with English-speaking patients. Three overarching categories, including seven themes, emerged from the description of nursing students' experience: recognition of emotions, experiences during the simulation, and gains.

Conclusion:

Standardized patient practice emphasized the significance of cultural differences, of knowing and using a foreign language, of communication, and of patient safety. [J Nurs Educ. 2016;55(2):73–81.]

Abstract

Background:

Simulation has been widely accepted as a valuable learning method in nursing education programs so that nursing students can learn and develop communication skills. The aim of this study was to evaluate nursing students' communication experience with an English-speaking standardized patient in the context of the Rational Administration of Medicines course.

Method:

Involving both quantitative and qualitative research designs, this descriptive study was conducted with 104 nursing students in Ankara, Turkey, from September 2012 to July 2013.

Results:

The majority (98.1%) of the participants stated the necessity of improving their English to communicate with English-speaking patients. Three overarching categories, including seven themes, emerged from the description of nursing students' experience: recognition of emotions, experiences during the simulation, and gains.

Conclusion:

Standardized patient practice emphasized the significance of cultural differences, of knowing and using a foreign language, of communication, and of patient safety. [J Nurs Educ. 2016;55(2):73–81.]

Communication between nurses and patients is a main factor in providing high-quality, patient-centered health care services (Hudelson & Vilpert, 2009; Schyve, 2007; Taylor, Nicolle, & Maguire, 2013; Yeo, 2004). If the native languages of patients and the nurses caring for them are different, communication barriers may exist between them. Such gaps negatively affect the quality of health care and lead to problems concerning patient safety (Jacobs, Chen, Karliner, Agger-Gupta, & Mutha, 2006; Segalowitz & Kehayia, 2011; Taylor et al., 2013; Yeo, 2004).

Communication barriers make it difficult for patients to understand the treatment process, and, ultimately, their expectations of the treatment process and the health care process diminish (Amalraj, Starkweather, Nguyen, & Naeim, 2009; Katz, Kripalani, & Weiss, 2006; Ngoh, 2009; Salazar, 2010; Taylor et al., 2013). Such research addresses the effects of communication barriers for both health care staff and patients. The effects of these communication barriers on patients are briefly outlined below. In Yeo's (2004) review, it is stated that as a result of language difficulties, people are discouraged from visiting health care institutions. In a study conducted in Canada, it was found that patients not speaking the formal language in the country in which they lived did not contact the clinics (Belanger, Newhouse, & Peterborough, 2008). Due to language barriers, patients behave more passively in using the health care facilities and have less information about their illnesses. Also, they may be generally less satisfied with the health care they received (Bungartz, Szecsenyi, & Joos, 2011).

Past studies have been generally directed at nurses. Studies on language barriers of nursing students who will become health care professionals in the future are generally related to nursing students who speak English as a second language (Malecha, Tart, & Junious, 2012). The numbers of patients who speak their native language while living in another country is ever increasing, with the effect of globalization. This means that it is important to prepare nursing students in gaining skills to cope with language barriers and to behave according to cultural differences.

Simulation has been widely accepted as one of valuable learning modalities in nursing education programs so that nursing students can improve their language and communication abilities. Simulation is defined as a “technique, not a technology, to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion” (Gaba, 2004, p. i2). Under the context of simulation, the standardized patient modality provides nursing students with an opportunity to improve the safety of medication use and to practice language and communication abilities in a safe setting before working with real patients. Simulation improves students' clinical decision-making skills and makes it possible for students to perceive their efficiency (Ulrich & Mancini, 2014).

No studies exist that focus on communication skills and language barriers simultaneously in undergraduate nursing education in Turkey. For that reason, the aim of this study was to determine the communication experiences of nursing students in an education setting, including a simulated patient speaking English.

Method

This descriptive study, involving both quantitative and qualitative research designs, was conducted with 104 nursing students in Ankara, Turkey, from September 2012 to July 2013.

Participants

One hundred eight senior students were enrolled in the nursing school during the academic year 2012–2013. All of the students spoke Turkish as their native language. No sampling procedure was used in the study. All of the students enrolled in the course were included, and 104 volunteered to participate in the study.

Procedure

A course on the rational use of medicines with the standardized patient method was used in the nursing curriculum for the first time in the 2011–2012 academic year (Unver et al., 2013). Nursing programs are taught predominantly in the Turkish language in Turkey. In the school of nursing where the study was conducted, all of the nursing students take a 4-hour professional and general English course per week during their 4-year nursing education program. In the 2012–2013 academic year, one of the scenarios involved a standardized patient who speaks only English to improve the students' communication experience (Table 1).

Case Scenario

Table 1:

Case Scenario

Ethical Considerations

The Institutional Ethics Committee approved the research consent form. Written informed consent was provided by the participants for audio recording of the debriefing sessions.

Instruments and Data Collection

For quantitative data collection, the researchers developed a data collection form. The first part of this form included students' characteristics (Table 2). In preparing the second part of the data collection form, the literature regarding communicating with native language–speaking patients and the steps regarding the rational administration of medicines were considered (Table 3). This form was not a scale and was developed for only this study. At the end of the data collection form, 10 items were included in one question to collect the students' feedback about the scenario used in the case study; the question asked students to tick the boxes that referred to the items gained by taking the course (Table 4). Also, there was an open-ended question seeking students' suggestions about the improving the course (Table 4).

Descriptive Characteristics of Study Participants (N = 104)

Table 2:

Descriptive Characteristics of Study Participants (N = 104)

Nursing Students' (N = 104) Feedback Regarding a Scenario Including an English-Speaking Standardized Patient

Table 3:

Nursing Students' (N = 104) Feedback Regarding a Scenario Including an English-Speaking Standardized Patient

Nursing Students' (N = 104) Reports and Suggestions Regarding the Benefits of Using a Scenario Including an English-Speaking Standardized Patient

Table 4:

Nursing Students' (N = 104) Reports and Suggestions Regarding the Benefits of Using a Scenario Including an English-Speaking Standardized Patient

Qualitative data were obtained from the semistructured debriefing interviews. The questions, which were asked during the debriefing session, are presented in Table 5. The debriefing interviews were audio recorded. In the Rational Administration of Medicines course, 19 scenarios developed by the faculty members were used. Each scenario was related to a specific medication. One scenario involved the treatment and care of a pregnant woman with preeclampsia, who spoke only English (Table 1).

Scenario and Standardized Patient Simulation Debriefing Questions

Table 5:

Scenario and Standardized Patient Simulation Debriefing Questions

The participants were divided into four groups with equal student numbers for this scenario. Each group consisted of approximately 27 students. Approximately five cases were discussed in each group. Intergroup rotations were conducted, and students eventually do all of the scenarios. After the simulation scenarios, students participated in the debriefing session, which lasted for nearly 1 hour. In the process of debriefing, the delta-plus method was used with the following topics: students' feelings in the simulation process, how they feel about themselves, their performance, and their learning objectives for the scenario and take-home messages. The delta-plus method is one of the useful techniques used in debriefing and involves creating two headings, or columns—one titled delta, which is the Greek symbol for change, and the other titled plus. Under the delta column, the participants or the facilitator place all the behaviors and actions they would change or improve on in future, whereas the plus column contains examples of good behaviors or actions (Fanning & Gaba, 2007). A debriefing facilitator can be present, or team members can use this method without a facilitator (Jeffries, 2012).

After the debriefing, the students were asked to complete the data collection tool, which took 10 to 15 minutes.

Data Analysis

The quantitative data were analyzed using SPSS® for Windows, version 17.0. In the analysis, descriptive statistics, namely frequency and percentage, were used. The qualitative data were analyzed using the phenomenological data analysis method developed by Colaizzi (1978). Colaizzi's phenomenological data analysis consists of seven steps. These steps are to:

  • Read all of the participants' descriptions of the phenomenon under study.
  • Extract significant statements that pertain directly to the phenomena.
  • Formulate the meaning of these significant statements.
  • Categorize the formulated meanings into clusters of themes.
  • Integrate findings into an exhaustive description of the phenomenon being studied.
  • Validate the exhaustive description by returning to some of the participants to ask them how it compares to their experiences.
  • Incorporate any changes offered by the participants into the final description of the essence of the phenomenon.

According to the analysis process, three field experts read the transcribed data. In the analysis, statements were categorized into concepts, which were then formulated into significant entities. All similar concepts were grouped under themes and categories (Table 6). When any disagreement appeared in regard to the themes and categories, the authors discussed them until agreement was reached.

Categories, Themes, and Subthemes That Resulted From Interviews With Senior Nursing Students

Table 6:

Categories, Themes, and Subthemes That Resulted From Interviews With Senior Nursing Students

Findings

All participants were female, and their mean age was 21.04 ± 0.31 years (range = 20 to 22 years). The majority (68.3%) of the participants had graduated from a high school where English language classes were offered. More than one fourth of the participants (27.9%) reported that they had encountered a patient who speaks English in clinical practice. Nearly all of the students (93.3%) stated that they felt inadequate in treating such patients (Table 2).

Table 3 shows the views of the participants regarding the rational administration of medicine course. Nearly all of the students (95.2%) stated that the course raised their awareness of the possibility that they may interact with a patient who speaks English. As a result of taking the course, the majority of students (87.5%) found that communicating with a patient who speaks English is not easy. Nearly all of the participants (98.1%) stated that they recognized the necessity of improving their knowledge of English.

Table 4 demonstrates the reports of the participants concerning the benefits of using the patient scenario and use of a standardized patient in the rational use of medicines course. Nearly half of the participants (52.9%) stated that they recognized the significance of learning a foreign language. Of the participants, 37.5% remarked that they had a deficiency in foreign language knowledge. The majority of participants (80.8%) stated that they had the goal of improving their English. It was found that nearly one third of the students (29.8%) suggested the use of the standardized patient scenarios in other courses.

Table 6 presents the qualitative findings obtained from the debriefing sessions in the study.

Category 1: Recognition of Emotions

The data obtained showed that the use of the standardized patient scenario made it possible for the participants to recognize their emotions, which either decreased or increased motivation for communication. Therefore, these emotions were grouped under the themes of positive emotions and negative emotions.

Theme 1: Negative Emotions. Most of the students reported negative emotions, such as anxiety, insufficiency, and helplessness, before the implementation of the new simulation modality using a standardized patient, which reduced their motivation.

Subtheme 1: Anxiety. Nearly all of the participants stated that they experienced anxiety before the simulations. The reasons for anxiety were as follows: “inability to express herself and not being understood by the patient,” “insufficiency in nationally and professionally representing herself,” and “insufficient personal performance.” The following participant statement exemplified this situation:

My anxiety doubled since the patient was pregnant and we did not speak the same language. In addition, the patient had preeclampsia. If I could not communicate with the patient, she would get worried, which might lead to distress in the baby. (Student 3)

Another student stated that communication barriers seemed to risk patient safety:

I thought that I should be more careful since I do not speak… English well. I may misguide the patient if I thought that I could manage the situation using my English. For instance, if I wrongly say you should take the medicine at 1x3 [three doses, one time per day] instead of at 3x1 [one dose three times per day], there might be very serious results that I do not even want to think about. (Student 4)

Subtheme 2: Insufficiency. Most of the students reported that the major reason for anxiety was their feeling of insufficiency. Major categories of insufficiency reported by the participants are “insufficiency regarding English grammar,” “insufficiency regarding pronunciation,” and “insufficiency regarding the command of English to meet professional needs.” It was also found that a feeling of shame accompanied their feeling of insufficiency, as seen in the following student statement:

I was afraid of saying anything wrong; I am not good at [the] English language, because it is not my native language. (Student 8)

Another participant stated that at the beginning of the simulation she did not feel any insufficiency, but a question from the patient increased her anxiety:

I knew that the patient had preeclampsia and [I] knew what to do. Although I could not speak English very well, I thought I was capable with regard to what to do. (Student 3)

Subtheme 3: Helplessness. The students reported that they experienced the feeling of helplessness because their ability to treat the patient was seriously limited due to communication barriers. The following statement shows this helplessness:

Communication barriers make it impossible to communicate. Therefore, my intention to do something for the patient was not enough…. Although you know what to do, it is not enough without communicating it to the patient. (Student 7)

Theme 2: Positive Emotions. Some of the students reported positive emotions, such as trust and happiness, before the implementation. Such emotions increased their motivation.

Subtheme 1: Trust. The majority of the students stated that because the simulation was not a real intervention, their anxiety was reduced, their self-confidence increased, and learning became easy. An exemplary statement is as follows:

At the beginning, I experienced anxiety, but it was not a real intervention, just a learning environment. It was good for us to have such an experience before dealing with real cases. (Student 1)

Some of the students reported that having this experience in a safe learning environment before handling real cases made them aware of their capabilities. They described this experience as a safe practice:

This practice was an opportunity for me to recognize what I could do and to eliminate my insufficiencies through getting feedback from my friends and teachers following the implementation. If I meet such a case in the future, I think I will feel more comfortable. It is fortunate that my first experience was controlled. (Student 4)

Subtheme 2: Happiness. A minority of students who were confident in speaking English reported their happiness about the practice, as exemplified by the following statement:

I like the possibility of dealing with an English patient. The environment in which I used my English knowledge made me excited and happy. (Student 9)

Category 2. Experiences During the Simulation

Theme 1: Challenges. Nearly all of the students stated that they felt some negative emotions, and they mentally prepared themselves to develop some strategies to cope with these emotions. They also indicated that they used the problem-solving strategies that they had learned in their previous courses. The following statement is an example of such reports:

First, I was challenged because I did not know what to do. I was confused more and became anxious, given that the patient was pregnant. Later, I remembered the steps of the problem-solving strategies I had learned before in the courses. I can say that these steps worked and made me comfortable. (Student 3)

Theme 2: Solutions. The participants reported that they tried to solve the problems through the use of body language, materials, getting help, and informing the patient.

Subtheme 1: Using body language. The solutions developed by the students included using body language to avoid language-related problems, reading the mimes and gestures of the patient, and getting help from a friend. In addition, students used drawings, materials, and numbers to avoid medicine-related errors. Several student comments included:

  • I should find ways to help the patient. For instance, the use of body language, mimes, and gestures. (Student 7)
  • I thought that I could inform the patient using simple pictures. I drew sunrise and sunset. And if you draw a picture of a watch and of a tablet, you can tell the dosage of the medicine to the patient who should take it four times per day (Figure). (Student 6)
Figure

Figure.

Sunrise and sunset picture to aid with medicine administration.

It was found that the majority of the students used body language in communicating with the patient. In addition, half the students stated that it was an effective way to communicate. A related statement is:

I could read the body language of the patient, and she could read mine. It helped us to understand each other better. (Student 5)

Subtheme 2: Using materials. Another method used by the students in the standardized patient scenario was the use of materials. The students reported that they used materials most when they perceived any threat to the patient's safety. They used the materials mostly to inform the patient about the medicine. According to two students:

  • I wrote the name of the medicine on the board and tried to draw its picture. For instance, while informing the patient about the dosage, I tried to use numbers in English. I used both body language and the presentation of the material, because the patient should perfectly understand this information. (Student 2)
  • I was unable to afford the risk of a misunderstanding in the message about the medicine. Therefore, I used my watch and showed it to the patient. (Student 3)

Subtheme 3: Getting help. Some of the students obtained help from a friend who knew the English language better when they could not manage to communicate with the patient. It was found that such students have higher levels of desire to learn English, as seen from the following student comment:

When I could not fully understand the question asked by the patient, I got help from my friend. Both of us tried to talk to the patient. I had the responsibility to help the patient. I want to speak English in the near future. (Student 2)

Category 3. Gains

All of the students reported that they experienced a type of gain from this simulation. These gains are grouped into three categories: language use, cultural differences, and patient safety.

Theme 1: Gains About Language Use. For nearly all of the students, their recognition of their English language deficiencies motivated them to learn English. To achieve this goal, students stated that they were planning to attend a course teaching the English language. The following student statement reveals these intentions:

Previously, I met with a foreign patient in the hospital, and it was difficult for me to express myself. In this course, I understood the significance of knowing a foreign language for nurses and the necessity for me to learn better English. (Student 6)

Theme 2: Gains About Cultural Differences. Nearly all of the participants indicated that cultural differences, in addition to linguistic differences, are significant. The following student statements exemplify this perspective:

  • I talk to the patients in a formal way. In English, there is only one pronoun that is used for both the second-person singular and plural. In Turkish, there are two different pronouns for them. So I felt that I did not know how to show my respect to the patient in English. I used imperatives in communicating with the patient, such as “Just be patient, you should relax.” However, I wonder how such statements are regarded in her culture. (Student 3)
  • I am aware that although body language is universal, there are certain cultural differences. I wondered whether or not the patient felt safe. (Student 10)

Theme 3: Gains About Patient Safety. Nearly all of the students indicated that this simulation experience improved their awareness of patient safety. The following student statement exemplifies this gain:

Communication is very important. For instance, without knowing whether or not the patient is allergic to any medicine, how can I give it to the patient? I always get help from someone who speaks English fluently. In dealing with this patient, I got help from my friend, who knows English better than me. (Student 12)

Discussion

The study findings are based on the nursing students' experience concerning a patient who speaks English. English is the preferred second language at many nursing schools in Turkey. Although the native language of Turkey is Turkish, nurses may care for patients who speak a foreign language.

The nursing students who participated in the study experienced both positive and negative emotions about the communication with a patient who speaks English. It was found that for the students who did not have any prior experience with such a patient or whose knowledge of English was not sufficient, the communication barriers led to anxiety about personal performance and the safety of the patient and also led to a feeling of helplessness. Malecha et al. (2012) stated that the most common sources of stress for foreign-born nursing students were language barriers and a perceived lack of knowledge of the foreign-born student's host culture. In the school where the current study was conducted, no foreign nursing students are currently enrolled; however, nurses may encounter individuals who speak a different language during their clinical education, although this is rare. Nursing students may not be aware of the possibility that during their education they may encounter patients speaking a foreign language.

The current study concludes that the use of the standardized patient method is an effective technique through which to teach nursing students to cope with such problems, which they are likely to experience during their clinical practice. Therefore, related education programs should be expanded to cover such topics to highlight the significance of language barriers in health care services. Studies have shown the influence of simulation on reducing anxiety and improving self-confidence in communication situations (Anderson & Nelson, 2015; Kameg, Mitchell, Clochesy, Howard, & Suresky, 2009; Szpak & Kameg, 2013).

Language barriers do not only cause feelings of anxiety, in-sufficiency, and helplessness in the students but also compromise patient care. The language differences, cultural differences, and low health literacy can combine to create a triple threat to effective communication, especially in cases when individuals providing and receiving treatment and care are not proficient in each other's language (Schyve, 2007). Research has confirmed that language differences and communication barriers cause poor communication (Bischoff & Hudelson, 2010; Jacobs et al., 2006; Johnstone & Kanitsaki, 2006). In turn, these communication-related problems lead to a poor therapeutic alliance and poor health outcomes and also negatively affect both patient satisfaction and safety (Divi, Koss, Schmaltz, & Loeb, 2007; Jacobs et al., 2006; Johnstone & Kanitsaki, 2006; Ninez, Ponce, William, Cunningham, & Richard, 2006).

Nearly all of the participants indicated the significance of being aware of cultural differences. The participants reported that not only language differences but also cultural differences make an individual a foreigner. Similarly, some studies suggested that cultural differences have negative effects on communication (Schyve, 2007; Tortumluoglu, Okanli, Ozyazicioglu, & Akyil, 2006). Globalization has led to increased movement of individuals between countries and increased the possibility of health care staff having to provide treatment and care services for patients from various cultures. Therefore, it is important for students to be aware that body language and other communication methods, such as mimicking, used to eliminate language barriers vary from culture to culture. In Leininger's (2002) transcultural care theory, it is stated that to improve the quality of health care, people's philosophy of life, their worldview, traditions, languages, and social status should be considered. The current authors recommend increased emphasis on cultural elements that influence care in the nursing curriculum.

It was also found that nearly all of the students used various problem-solving strategies to cope with anxiety about communication with a patient who speaks English or about the risk of compromising patient safety. The strategies most frequently used by students to reduce communication barriers included body language, reading the mimes and gestures of the patient, trying to speak English, using and interpreting body language, and receiving help from a friend who speaks English. To solve such problems, research on communication barriers indicates that various strategies are used in hospitals, including employment of health care staff that has a good command of the foreign language in question, employment of translators, providing foreign language courses for the staff, and offering foreign language units within the health care institutions (Hudelson & Vilpert, 2009; Jacobs et al., 2006; Segalowitz & Kehayia, 2011; Yeo, 2004). The standardized patient intervention has positive effects on the attempts of the students to use English and on improving their recognition of the significance of various communication techniques.

Nearly all of the participants reported that the simulation practice in which standardized patient scenarios were used enabled them to recognize the risks concerning patient safety. The anxiety experienced by the nursing students was related to patient safety. The nursing students employed some techniques to avoid medicine-related mistakes, such as drawing pictures, using materials, and using numbers to express the dosage of the medicine. The literature also suggests that simulation-based nursing education has positive effects on avoiding errors and on improving patient safety (Hemming & Jennrich, 2013; Sears, Goldsworthy, & Goodman, 2010; Ulrich & Mancini, 2014). The ultimate goal of education in this context is to fill the gap between the theoretical knowledge and practical experience of students and to enable them to provide patient safety and high-quality health care services. The use of the standardized patient scenario was a good opportunity to give students a chance to appreciate how to provide safe nursing care to a patient who speaks English.

Simulated communication experiences have been gained by using various methods such as high-fidelity manikins, student actors, or standardized patients—static cases in which the individual responds to a recorded video narration (Anderson & Nelson, 2015). It was found that the method of the standardized patient provided the students with an opportunity to integrate their theoretical knowledge with practice. It also enabled them to feel safe and facilitated their learning. In using standardized patients, benefit is gained from real-time responses to questions, and even their physical presence—to physically interact with them. In addition, in the analysis of the students' emotions about the standardized patient scenarios, most of them felt like a nurse with full responsibility for the patient. This finding suggests that the standardized patient scenarios presented the students with a realistic experience.

This study has some limitations in terms of generalizing. The study findings represent only one nursing school in Turkey. Therefore, the study results cannot be generalized. In addition, the participants' performance anxiety may be a factor in communication during simulation. However, this study revealed the significance of the communication barrier around the health care services provided by nurses.

Conclusion

Standardized patient practice provided nursing students with an opportunity to meet and care for a patient who speaks English. In addition, this practice emphasized the significance of cultural differences, of knowing and using a foreign language, and of patient safety. The gains achieved through the standardized patient practice improved the motivation of the students to develop their abilities, as well as their awareness. In addition, this study contributed to improving the students' sensitivity regarding cultural differences. Designing research studies to cover subjects that improve nursing students' communication skills will make it possible for patients from different cultures to obtain higher quality health care services. This innovative teaching strategy and its evaluation may provide important contributions for the body of knowledge in nursing education.

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Case Scenario

Description Case Scenario
In this scenario, a patient whose native language is not Turkish is admitted to the labor ward with a diagnosis of severe preeclampsia. As a nursing student, you are expected to administer medication and educate the patient about preeclampsia. Learning objectives   Communicate with a patient whose native language is not Turkish   Calculate and administer the medication   Explain drug–drug, drug–food, drug–herbal product interaction   Explain magnesium sulfate treatment principles in pregnant women   Pay attention to patient safety principles during the medication administration process A 38-year-old patient in her first pregnancy is admitted to the labor ward at 37 weeks of gestation, complaining of a severe headache, bouts of dizziness, and blurred vision. Her blood pressure is 170/115 mm Hg, urine dipstick testing indicates 3+ of protein and there is edema of both ankles to the midcalf. Laboratory results showed normal hematocrit and liver transaminase levels and a mildly decreased platelet count. She stated that her headache is worsening. She is examined by obstetrician and found to be hyperreflexic. The obstetrician decided to start magnesium sulfate to relieve severe symptoms of preeclampsia. You read one of the obstetrician's order as: Treat with intravenous magnesium sulfate (see below) Magnesium sulfate loading dose (4 g)   Draw up 8 mL of 50% magnesium sulfate (4 g) and dilute with 12 mL normal saline (0.9%) to give a total volume of 20 mL Give all 20 mL (4 g) slowly over 10 to 20 minutes (e.g., via syringe driver at 60 mL/hour) Following loading dose, start a continuous maintenance infusion

Descriptive Characteristics of Study Participants (N = 104)

Characteristic M SD
Age (years) 21.04 0.31

n %

Learning a foreign language in high school
  English 71 68.3
  Other languages 33 31.7
Caring for a patient who speaks English in clinical practice
  Yes 29 27.9
  No 75 72.1
Feeling inadequate while working with patients who speak English
  Yes 97 93.3
  No 7 6.7

Nursing Students' (N = 104) Feedback Regarding a Scenario Including an English-Speaking Standardized Patient

Statement Disagree Undecided Agree



n % n % n %
In this course, I recognized that I may come across patients who speak English. 2 1.9 3 2.9 99 95.2
In this course, I recognized that communicating with foreign language speaking patients is not easy. 4 3.9 9 8.7 91 87.5
In this course, I recognized that I should learn about different cultures. 4 3.9 15 14.4 85 81.7
In this course, I recognized that I should improve my English. 1 1 1 1 102 98.1
The course made me think and communicate “like a real nurse” when providing information about medications. 7 6.7 9 8.7 88 84.6
The course was different than the usual practical courses for me. 4 3.9 6 5.8 94 90.4
The course provided a fun and positive training atmosphere. 1 1 10 9.6 93 89.4
The course showed how I could apply my theoretical knowledge to practice. 1 1 11 10.6 92 88.5
The course made it easier for me to become proficient in the subject. 4 3.9 17 16.3 83 79.8
The course made me better prepared for clinical work. 9 8.7 18 17.3 77 74
I would recommend that the same procedure be used for other courses. 2 1.9 6 5.8 96 92.3

Nursing Students' (N = 104) Reports and Suggestions Regarding the Benefits of Using a Scenario Including an English-Speaking Standardized Patient

Gains of the Coursea n %

I will make a plan to improve my English. 84 80.8
I understood the significance of learning a foreign language. 55 52.9
I recognized my deficiencies in foreign language use. 39 37.5
I understood the significance of communication. 15 14.4
I understood that my nonverbal communication techniques should be improved. 10 9.6
I recognized the fact that it is possible for me to encounter foreign patients. 5 4.8
This practice enabled me to use my theoretical knowledge. 4 3.9
This practice enabled me to control my excitement. 3 2.9
I understood the significance of different cultures. 2 1.9
I understood that having a translator is necessary. 1 1

Suggestions From the Students n %

Provision of the cases involving foreign patients in other courses 31 29.8
Year-long practice 17 16.3
Practice-based foreign language courses 10 9.6
More cases in the simulation 6 5.8
Better organization of the course 2 1.9

Scenario and Standardized Patient Simulation Debriefing Questions

What did you feel when coming across a patient who speaks a foreign language?
Which difficulties with patient communication did you experience in training about the medication?
How did you cope with these difficulties you experienced in training with patient communication?
What interactions and interventions were performed, and were they all appropriate?
What knowledge, skills, or attitudes displayed in this simulation would be useful in the clinical setting?
Were there any safety issues with the patient or the environment?
Is there anything else you would like to discuss?
What did you learn from this experience?

Categories, Themes, and Subthemes That Resulted From Interviews With Senior Nursing Students

Category Theme Subtheme
Recognition of emotions Negative emotions Anxiety, insufficiency, helplessness
Positive emotions Trust, happiness
Experiences during the simulation Challenges Using body language, using materials, getting help
Solutions
Gains Gains about language use
Gains about cultural differences
Gains about patient safety
Authors

Dr. Guvenc is Associate Professor and Lecturer, Dr. Unver is Associate Professor, Dr. Basak is Lecturer, Dr. Yuksel is Lecturer, Dr. Ayhan is Lecturer, Dr. Kok is Lecturer, Dr. Konukbay is Lecturer, Dr. Kose is Lecturer, Dr. Aslan is Associate Professor, Dr. Tastan is Associate Professor, and Dr. Iyigun is Associate Professor, Gulhane Military Medical Academy, School of Nursing, Department of Obstetrics and Gynecology, Gulhane Askeri Tip Akademisi, Hemsirelik Yuksek Okulu, Ankara, Turkey.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank all of the students who participated in the study and the students and school staff involved in the standardized patient case.

Address correspondence to Gulten Guvenc, PhD, RN, Associate Professor and Lecturer, Gulhane Military Medical Academy, School of Nursing, Department of Obstetrics and Gynecology, Gulhane Askeri Tip Akademisi, Hemsirelik Yuksek Okulu, 06010 Etlik, Ankara, Turkey; e-mail: gguvenc@gata.edu.tr.

Received: May 11, 2015

Accepted: November 12, 2015

10.3928/01484834-20160114-03

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