One of the consistent challenges in nurse education is the lack of coordination between theory and practice. Students often encounter difficulties in the practical implementation of theoretical knowledge. The distance created between theory and practice complicates the learning process and the lack of understanding of nursing terms and concepts affects professional integration (Kim et al, 2013). The current pressures on the NHS, limited placement capacity, and reduced clinical opportunities have given rise to an increased need for simulated learning environments to bridge these gaps. This has been recognised by the updated Nursing and Midwifery Council (2023) permanent standard, allowing up to 600 simulated practice learning hours. The standard identifies that simulated practice learning enables students to build confidence and skills in a range of situations that may be infrequently encountered in practice.
With an increasing focus on patient safety, and direct supervision in clinical practice becoming more challenging, the role of simulation to complement or replace clinical placements is becoming increasingly important. Evidence suggests that simulation can enable the workforce to acquire skills more efficiently than relying on opportunities to gain these skills as part of routine clinical practice. Simulation provides a variety of practical opportunities and enables participants to make immediate decisions and reflections. It is also seen as offering an important route to safer care for patients (Aggarwal et al, 2010). Simulation embraces technical and operative skills as well as non-technical skills (such as communication), and cognitive ability (such as decision making, managing uncertainty) and can be delivered using a variety of modalities.
The term standardised patient or simulated patient (SP) refers to a person trained to portray a patient in a realistic way. SPs interact with learners in education and assessment contexts to provide authentic experiences and feedback on episodes of care. Often SPs are recruited from the community and have no professional acting experience. SPs can be lay persons, real patients (former patients with the lived experiences of being a patient, or patients with a chronic, but not disabling disease), who are trained to follow predefined scenarios. In healthcare simulation, SPs are part of an educational team, focused on fulfilling the learning objectives of a simulation activity. SPs act as proxies for patients, taking on physical and emotional roles enabling opportunities for students to fine-tune professional skills, gain self-confidence, rehearse ‘real-life’ situations, and practise active listening (Nestel et al, 2018). The students learn to become patient-centered, develop an increased awareness of patient feelings and concerns, and identify ways of responding appropriately in a variety of settings. Although SPs have been represented in healthcare simulations for many years the development of this methodology has been driven by the objective use of structured clinical examinations and the NMC's future nurse proficiencies.
Studies suggest that simulated learning with SPs is valuable in replicating authentic verbal and practical interactions with a patient in practice (Coleman and McLaughlin, 2019). Students are able to immerse themselves in authentic situations and receive valuable feedback specific to their learning outcomes. They can respond to SPs through verbal and non-verbal communication, optimising para-verbal skills. The safe environment and enhanced sense of security helps to boost students' self-esteem and confidence and promote deeper learning. Feedback from the students who have experienced simulations with SPs is very positive. Students enjoy these simulations, finding that it gives a richer experience similar to clinical placements and an opportunity to reflect in action in a safe environment, including feedback from SPs.
The limited availability of SPs may provide resourcing challenges and variability in learning experiences among students. The concept of ‘role fit’ whereby SPs are required to fit a specific demographic, culture, personality, or experience may be challenging if the SPs available do not meet the scenario descriptors.