MacLean Sharon, Geddes Fiona, Kelly Michelle, Della Phillip
School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
Nurse Educ Today. 2018 Mar;62:85-90. doi: 10.1016/j.nedt.2017.12.024. Epub 2017 Dec 29.
Simulated patients (SPs) are frequently used for training nursing students in communication skills. An acknowledged benefit of using SPs is the opportunity to provide a standardized approach by which participants can demonstrate and develop communication skills. However, relatively little evidence is available on how to best facilitate and evaluate the reliability and accuracy of SPs' performances.
The aim of this study is to investigate the effectiveness of an evidenced based SP training framework to ensure standardization of SPs. The training framework was employed to improve inter-rater reliability of SPs.
A quasi-experimental study was employed to assess SP post-training understanding of simulation scenario parameters using inter-rater reliability agreement indices. Two phases of data collection took place. Initially a trial phase including audio-visual (AV) recordings of two undergraduate nursing students completing a simulation scenario is rated by eight SPs using the Interpersonal Communication Assessments Scale (ICAS) and Quality of Discharge Teaching Scale (QDTS). In phase 2, eight SP raters and four nursing faculty raters independently evaluated students' (N=42) communication practices using the QDTS.
Intraclass correlation coefficients (ICC) were >0.80 for both stages of the study in clinical communication skills.
The results support the premise that if trained appropriately, SPs have a high degree of reliability and validity to both facilitate and evaluate student performance in nurse education.
模拟患者（SPs）常被用于培训护理专业学生的沟通技巧。使用模拟患者的一个公认好处是有机会提供一种标准化方法，通过该方法参与者可以展示和培养沟通技巧。然而，关于如何最好地促进和评估模拟患者表现的可靠性和准确性，现有证据相对较少。
本研究的目的是调查基于证据的模拟患者培训框架确保模拟患者标准化的有效性。该培训框架用于提高模拟患者评分者间的可靠性。
采用准实验研究，使用评分者间可靠性一致性指标评估模拟患者培训后对模拟场景参数的理解。进行了两个阶段的数据收集。最初的试验阶段，包括两名本科护理专业学生完成一个模拟场景的视听（AV）记录，由八名模拟患者使用人际沟通评估量表（ICAS）和出院指导质量量表（QDTS）进行评分。在第二阶段，八名模拟患者评分者和四名护理教师评分者使用QDTS独立评估学生（N = 42）的沟通实践。
在临床沟通技巧方面，研究的两个阶段组内相关系数（ICC）均>0.80。
结果支持这样一个前提，即如果得到适当培训，模拟患者在促进和评估护理教育中学生表现方面具有高度的可靠性和有效性。
