Actors help nurses hone skills
By Julie Rausch
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WSU nursing student Charlene Chandler visits with WSU theater student Kitti Seavey, who is playing "Tiffany Graham," a patient seeking birth control pills during a simulated appointment. A cooperative venture with the University of Kansas School of Medicine-Wichita allows students in WSU's graduate family nurse practitioner program to be evaluated using actors in simulated scenarios. |
A nurse inside an exam room at the University of Kansas School of Medicine-Wichita is doing a functional assessment on a patient to evaluate his ability to live alone. After the assessment she tells the patient that he seems to be fine. She asks if he has any questions or concerns and gives him general health recommendations.
The nurse leaves the room with a sigh of relief. A crucial portion of her Wichita State midterm test is over.
The nurse is a student in WSU’s graduate family nurse practitioner program. The patient, "Alfred McFall," who is really Herb Mendenhall, stays in the exam room to complete an evaluation on the student.
Mendenhall is a standardized patient, a term used for an actor who portrays a patient with specific problems. His job is to follow a prepared script and play a convincing character. In addition to role-playing with nursing students, SPs also help area medical students and residents with their communication skills and interpersonal techniques.
Mendenhall, a retired teacher and principal, has been part of the standardized patient program at KUSM-Wichita for about two years.
Some of the SPs are recruited from WSU’s theater department, the Center for Performing Arts or volunteer services at area hospitals. Most of the SPs are people from the community who have heard about the program by word of mouth, says Jackye Feldman,
SP coordinator and teaching associate in KUSM-W’s department of family and community medicine. Feldman earned her master’s degree in nursing at WSU and is an advanced registered nurse practitioner.
The SP program began about three years ago with a federal grant. Currently it is funded through KU and contracts such as WSU’s program.
Feldman says she has a pool of about 45 SPs that she uses fairly often and another 55 people she uses occasionally.
Eileen Hawkins, WSU School of Nursing family nurse practitioner coordinator, says WSU’s family nurse practitioner program has been using standardized patients for midterms and finals for about a year.
Family nurse practitioners (or ARNP for advanced registered nurse practitioners) are trained to treat acute care problems and stable chronic conditions. They practice in medical clinics or doctors’ offices in collaboration with physicians.
Students in the master’s program, all veteran registered nurses, do clinical rotations for a total of 720 hours in clinics and doctors’ offices during three semesters prior to graduation.
Before using the SP program at KUSM-W, Hawkins would travel to cities throughout Kansas to evaluate students’ performances during medical appointments. In addition to the challenges of traveling to evaluate
13-20 students, each appointment was different. For example, one student might see a person with an ear infection and another might see a patient with diabetes and congestive heart failure. Because each situation was different, there wasn’t a common way to evaluate the students, says Hawkins.
With SPs, cases are presented the same way every time for each student so the comparisons are uniform.
When the nursing students come in for exams, it keeps Feldman hopping. She coordinates which students and patients go in each of four exam rooms, and she videotapes each encounter from the control room. During the midterm, each student visits two patients.
In cases where the nurse needs to order lab tests, Feldman listens through earphones to what they are going to order, and she has pre-determined results ready to hand them at the door. The nurses then discuss the "results" with their patients.
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Cassandra Muff, a student in WSU’s graduate family nurse practitioner program, rubs her fingers together to test the hearing of retired teacher Herb Mendenhall, aka patient Alfred McFall, during a simulated appointment as part of her midterm exam. |
As with a real medical appointment, nurses don’t know what to expect when entering the exam room. They have a chart with basic medical information such as name, age, height, weight, blood pressure, medications and information from when the patient was last seen. If the blood pressure varies from the last visit, that’s something the nurse should pick up on, says Hawkins.
Also, if, for example, the nurse asks a patient to read an eye chart, the SP may be scripted to produce a magnifying glass. The nurse would be expected to tell the patient not to use the magnifier for the testing.
Also, some SPs are assigned to be problem patients who argue with the nurse or who don’t want to listen, says Feldman.
Most of the "patients" are 17 years and older, however in a few cases some have been as young as 12 months.
"The work is sporadic — it’s as we need them," Feldman says.
SPs are paid $12 per hour during training and $15 per hour when they see nursing students and doctors in training.
"I look for people who are enthusiastic about helping students learn," Feldman says. "They need to have a good memory, be articulate and to have the desire to provide feedback to the students."
SPs train for about 10-15 hours before working with nurses and medical students. Feldman works with them on method acting. For example, the SPs have a lot of personal facts to memorize, but they are taught not to give rote answers. She works with them to remember to maintain whatever ailment they have during an examination, such as a tremor or dizziness.
Sometimes Feldman puts makeup on SPs to simulate bruises. If the scenario calls for an invasive procedure such as a pelvic exam or a heart abnormality, the SP hands the nurse a card, which has either a normal reading or a problem, and the nurse talks to the patient about the finding.
After the exams, Hawkins views the tapes to evaluate how the students performed. For this midterm the emphasis was on communication and interpersonal skills. As part of the evaluation, students also view their patient encounters with Hawkins individually.
"Students can see for themselves what their strengths are and what they need to work on," Hawkins says.
The SPs play a key role as teaching aides, Hawkins says.
Giving good feedback is most important because it tells the student how the patient felt about the student’s style of treatment, Feldman says. The evaluations show such things as whether the nurse talked down to the patients. Did she listen to them and give them a chance to answer? Did she answer their questions? Did she act professional but warm? Was her handshake warm or limp? Did she make the patient feel comfortable?
"When the students see the SP checklist evaluation in combination with viewing the tape, they can see themselves through the eyes of the patients," Feldman says.
