Involving patients and relatives by translating their experiences into simulation-based education

Background: Individual patients’ experience is the essence of every clinical encounter (Kneebone, et al. 2016). Co-designing simulation with patients/relatives, clinicians and educators helps to rebalance perspective; indeed, the ASPiH standards state evidence of best practice is that ‘the patient perspective is considered and demonstrated within educational planning’. At a national level public, user and carer participation continues to be a recurrent theme in health policy (DoH, 2001).

Our aim was to ensure that patient and public involvement (PPI) was truly present in simulation-based education (SBE) for undergraduate nurses.

Project description: This project describes how we have co-designed SBE with patients/relatives and have developed a guiding framework.

We met with patients and relatives and captured their accounts of their experiences through reflective conversation and film. We established with them, what they felt were important factors in their care. The educator then developed scenarios with learning outcomes that matched both the patient/relative priorities and the NMC standards. The scenarios were reviewed by clinical facilitators, revised and then shared with the simulated patient (SP) coordinator.

Experienced SPs were selected for the roles, discussion took place between SPs and SP coordinator, to consolidate understanding of role portrayal.

After the event, in which over 100 undergraduate nurses took part, the educator, through closed-loop-communication, completed dialogue with the patients and relatives. This reinforced with them, how through co-design, their experiences and priorities of care, had benefited the students. (See Figure 1: Translating a patient/relative experience into a co-designed simulation).

Summary of results: The scenarios reflected the stories that were shared with us. The patients and relatives were well supported during the sharing of experiences and were exceptionally pleased that the final dialogue took place.

We believe that it was important to work with SPs rather than engage the actual patient and relative within the simulation. The SPs involved were asked to complete an evaluation of their role as ‘patient proxy’; specifically, their ability to portray the role accurately, remain at a ‘safe distance’ and be objective in the debrief – whilst providing feedback on the eight ‘real’ patient/relative priorities.

Recommendations: By working with our framework, translating patient/relative experiences into scenarios for SBE can be achieved. This can be done with care, low risk, ethically and meaningfully. We have used our framework for forthcoming SBE, will be presenting to wider faculty and plan to disseminate to other organisations in order to maximise impact.