Nurses and pharmacists play a critical role in our country’s health care system. Since the start of the COVID-19 pandemic, in which the profession was stretched to its absolute limits, it has become even more clear that educating and training future nurses are of the upmost importance.
At South Dakota State University’s College of Nursing, faculty are always looking for ways to improve student learning outcomes, whether that be through simulation, clinicals or classroom instruction. Nursing simulations are an essential tool in training and are especially important in providing students with hands-on learning experiences.
A key to simulations is to create scenarios that mirror real-world situations as much as possible. To create as realistic scenarios as possible, faculty in the Healthcare Simulation Center added a new element to their simulations: actors and actresses byway of SDSU’s Theatre Department.
Collaborating for success
At the beginning of the semester, students involved in theater productions at SDSU learned of a new opportunity to utilize their acting skills. The one credit activity course involved participating in the College of Pharmacy and Allied Health Professions and the College of Nursing’s Healthcare Simulation Center scenarios over the course of the semester.
“I thought it sounded like kind of a cool opportunity,” said Hannah Hetland, a junior double majoring in Spanish and global studies with a minor in dance. “I was like, ‘Sure, I’ll sign up.’”
Hetland, a Mitchell native, had experience acting as she worked in a number of SDSU-led productions, but she had never done something like this.
To prepare for her first simulation, Hetland and the other “standardized patients (SPs),” watched a number of instructional videos and toured the HCSC. Prior to her first simulation, the SPs were sent a packet with their schedule and patient information.
“Prior to, we know what the topic of the simulation is, what the medical history is like and a list of questions with what our answers should look like,” Hetland explained. “A couple of days before your sim, you meet with one of the nursing faculty and they go through some sample questions and coach you a little bit.”
Because simulations are supposed to mirror real situations as much as possible, SPs are also supposed to dress in specific wardrobes with hair and makeup done to resemble the simulation patients character as much as possible.
“It definitely feels like acting with the preparation and everything,” Hetland said. “Even though we don’t have an official script with specific lines, we have basic information that we need to memorize and prep for.”
Simulating different healthcare situations
Simulations for the College of Nursing takes place on the third floor of Wagner Hall, where the HCSC is located. Led by director Alyssa Zweifel, an assistant professor in the College of Nursing, simulations occur throughout the semester for nursing students to familiarize themselves with real-world scenarios.
“Simulations are important because they give our students hands-on learning in a safe, real-world setting,” Zweifel explained. “Experiential learning is key to higher education nursing programs and simulations are one of the best tools we have.”
This semester was the first time that theater students would be involved in the simulations. In previous year’s simulations, either fifth-year nursing students, nursing faculty or mannequins would play the role of the SPs. Both students and faculty agree that theater students enhance the realism of the situations, which in turn, leads to better practice for the students.
“This semester is really focused on communication with patients,” said Kylie Msick, a junior from Omaha, Nebraska. “It’s a lot easier to communicate with a real person.”
“You can actually see how their face is changing and how they’re actually sounding, whereas a mannequin is just robotic,” said Mahala Anderson, a junior from Rochester, Minnesota. “It’s really nice having a real person to gauge off.”
The HCSC incorporates a few different scenarios for simulations throughout the semester. One of the scenarios, referred to as the metabolism simulation, involved the theater students playing the role of a 74-year-old with diabetes. Nursing and pharmacy students practiced engaging with the patient while the theater students honed their acting skills—a “win-win” for all of the parties involved.
Another scenario involved working with a younger patient character who had a developing drug addiction. This particular simulation involved three scenes: a consultation, a follow-up appointment and a treatment plan discussion.
For this scenario, Hetland had to really get into the mindset of her character. This meant evasive eye contact and answering questions on her character’s drug use. The next scene required a slight wardrobe change for Hetland, with smeared makeup and a more disheveled look.
“My character was showing the regression of drug addiction,” Hetland explained. “I had my hair super messy.”
All of these slight changes and nuances create a more authentic scenario, which leads to more genuine learning experiences for the students.
“Not knowing (the theater student actors), it kind of helps asking those tough questions,” Anderson said. “We don’t know who this person is, it could be the real her or she could just be acting—it makes it more authentic.”
The final scene lasted for about half an hour and involved the nursing team going over a treatment plan for the patient’s now full-blown drug addiction. In the scene, the nursing team explained to the patient how to use Narcan, what resources were available to her and what her options were.
“That scene got a little intense because it was about 30 minutes of them being like, ‘Hi, you have a drug addiction. You might overdose,’” Hetland said. “When it was done after four hours straight of that simulation, I was like, ‘Wow, I can smile again.’”
For the nursing students, the simulations can also reach that “intense level,” but those situations lead to great practice for their future clinicals and careers.
“The really hard part about mental health (type simulations) is we have to ask the hard questions,” Msick said. “The conversation flows really well until you get to (for example) the suicidal ideation questions. That’s always awkward.
“I don’t know why I feel awkward because when I go to the doctor and they ask me, I don’t feel awkward,” Msick explained. “But I feel really awkward when I’m asking.”
According to Zweifel, the simulations are designed for the students to practice getting comfortable with those “awkward” questions and figuring out what language works and what doesn’t. This semester, the students have also been focusing on the nonverbal reactions of their patients.
“Practicing these skills in a simulated safe learning environment set's our students up for success with real patient encounters,” Zweifel said.
“We’re working on noticing the patients’ nonverbals, their tendencies, which you are obviously not going to get with mannequin,” Msick said. “That’s another benefit of having a real patient.”
For the SPs, the simulations are a great time for them to work on their improv acting. Prior to the simulation, SPs are given some guidance on what their character is like and how they should answer their questions, but there is also some space for them to explore their own character and create some of their own nuances—all of which is invaluable acting practice.
“There’s a little bit of an improv activity too because sometimes students will ask questions that you aren’t necessarily prepared for,” Hetland said. “You have to try and come up with an answer on the spot that aligns with the information you are given.”
For the nursing students, experience in the simulations is valuable practice time but watching other students’ simulations are also very valuable. The students work in groups and while two to three nursing students are participating in a simulation at a time, the rest of the group will be watching live in a debriefing room. After the simulation is complete, a faculty member facilitates student reflection time where students discuss what went well and what could have been improved.
“I’ve learned a lot just from watching the simulations,” Msick said. “There’s one student in our clinical group who always says the right things, so I’ve actually learned how to ask questions and go into those awkward conversations just from watching. You can kind of learn what works and what doesn’t just from watching.”
“We really encourage student led reflection in our debriefing sessions,” Zweifel said. “That is really the time when some of the best learning happens.”
For Msick, the biggest takeaway from this unique collaboration is the importance of patient interaction.
“Understanding not only the nonverbals that I give off as a nurse, but what the patient’s nonverbals were as well,” Msick said. “That’s really important to pick up on.”
For Anderson, the realistic nature of the scenarios were very helpful in her training to become a nurse.
“I really like being able to work with the theater students because I didn’t know them and wasn’t able to gauge how they actually act,” Anderson said. “It made the scenario feel very real.”