Effects of Learning via Psychiatric Standardized Patients on Nursing students’ Knowledge and Self - Confidence in Therapeutic Communication: A pilot Study

Abstract

Introduction The teaching and learning process of practicum courses in mental health and psychiatric nursing is different from other nursing fields. Nursing students need to use themselves as therapeutic tools through therapeutic communication, helping psychiatric patients understand their problems and develop their own problem-solving skills. This makes it impossible to learn and practice these skills through models in the learning resource center of nursing (LRC) like other nursing fields. Learning by using psychiatric standardized patients is an active learning approach. It involves individuals trained in role-playing to act as if they were actual patients, allowing nursing students to engage in communication and interaction with them. This approach stimulates students to be enthusiastic about learning, motivates them to pursue knowledge, and enables them to practice therapeutic communication skills. Students apply their knowledge in actual practice with psychiatric standardized patients with symptoms that resemble actual patients in a safe environment. Nursing students can actively participate in the learning process and practice nursing care on their own. They can repeat their practices multiple times without causing harm to actual patients, gradually developing confidence in their nursing practice. 

Objectives This study aimed to: 1) compare knowledge and self-confidence in therapeutic communication within the experimental group before and after the program; 2) compare knowledge and self-confidence in therapeutic communication between the experimental group and the comparison group; and 3) compare the mean differences in knowledge and self-confidence in therapeutic communication between the experimental group and the comparison group. 

Design This study employed a quasi–experimental design with a two–group pretest and posttest. It was based on Kolb’s experiential learning theory, which explains that the learning process involves the transformation of experience through four stages: 1) concrete experience, 2) reflective observation, 3) abstract conceptualization, and 4) active experimentation. These stages develop a learning cycle, which influences both knowledge and self-confidence in therapeutic communication. 

Methodology This study comprised 60 undergraduate nursing students who completed the mental health and psychiatric nursing course during the 2023 academic year. According to the inclusion criteria, participants were purposively selected and assigned to either an experimental or comparison group, with each group consisting of 30 students. The comparison group received learning through therapeutic communication videos and content briefs by the instructor, while the experimental group received learning through the use of psychiatric standardized patients. The program included 1) the teaching plan utilizing psychiatric standardized patients, 2) psychiatric standardized patients, 3) the standardized patient reality evaluation form, 4) scenarios for standardized patients, and 5) the observation form for therapeutic communication with psychiatric standardized patient. Data collection instruments included 1) a questionnaire on therapeutic communication knowledge and 2) an assessment of self-confidence in therapeutic communication. Data were collected simultaneously from both the control and experimental groups. The data were then analyzed using descriptive statistics, Paired t-test and Independent t-test, and Mann Whitney U test. 

Results Most participants in both the experimental and comparison groups were female (90.00% and 93.30%, respectively). The cumulative GPAs were not significantly different between the experimental (M = 3.19, SD = 0.35) and comparison group (M = 3.24, SD = 0.30), and the average GPAs for mental health and psychiatric nursing course were not significantly different (M = 2.62, SD=0.47; M = 2.63, SD=0.43, respectively). After the program, the experimental group showed knowledge (M = 13.10, SD = 2.23) higher than before the program (M = 10.83, SD = 1.64) with a statistical significance (t = -11.949, p<.001). Additionally, self-confidence in therapeutic communication in the experimental group (M = 20.97, SD = 2.87) was higher than before the program (M = 13.17, SD = 4.11) significantly (t = -17.357, p<.001). After the program, the comparison group had knowledge in therapeutic communication (M = 14.23, SD = 1.83) higher than the experimental group (M = 13.10, SD = 2.23) with a statistical significance (t = -2.149, p = .036); however, the mean difference in knowledge between the experimental and comparison groups was not significantly different (Z = -1.580, p > .05). After the program, the experimental group had self-confidence in therapeutic communication (M = 20.97, SD = 2.87) higher than the comparison group (M = 19.17, SD = 1.90) with a statistical significance (t = 2.866, p = .006) and the mean difference was greater than the comparison group (t = 4.088, p < .001). 

Recommendation The results of this study indicate that learning with psychiatric standardized patients and using videos along with content briefs are equally effective in promoting knowledge in therapeutic communication. However, learning with psychiatric standardized patients was more effective than using videos with content briefs in enhancing nursing students’ confidence in therapeutic communication. In the teaching and learning process, nursing instructors and other related personnel can utilize psychiatric standardized patients to help develop self-confidence in therapeutic communication before practicing in real situations.