This document summarizes a project to develop communication skills training for nursing students using simulation. Actors were trained to portray patients in scenarios covering topics like end-of-life care, distress, and communication challenges. Students participated in 2-hour sessions before clinical placements. Evaluations found both participants and observers significantly increased confidence in communication skills. Students, actors, and facilitators provided positive feedback on the sessions' benefits. Publications resulted from the project, which aimed to meet standards for nursing communication competencies.

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Putting Words into Action: Using Simulation
to Develop Key Communication Skills: An
HEA Collaborative Project
Debbie Lewis, Jim Chapman, Marie
O’Boyle-Duggan and Sue Lawrence

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What are we trying to achieve?
To develop communication skills sessions in a BSc (Hons.) to meet the NMC (2010)
Standards for Pre-Registration Nursing.
Nurses must be able to:-
• Communicate safely and effectively
• Build therapeutic relationships taking into account differences, capabilities and
needs
• Be able to engage in, maintain, and disengage from therapeutic relationships
• Use a range of communication kills and technologies
• Use verbal, non-verbal and written communication
• Recognise the need for an interpreter
• Address communication in diversity
• Promote well-being and personal safety
• Identify ways to communicate and promote healthy behaviour
• Maintain accurate, clear and complete written or electronic records
• Respect and protect confidential information

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What has gone before?
• Evidence of confusion in what needs to taught,
varying degrees of provision and a lack of Field
specific training (Chant et al, 2002).
• Few receive training on dealing with end-of-life
care issues, dealing with anger and distress or
communicating by telephone.
• Using skills checklist and counselling models may
not be transferable in all practise areas.
• Effective evaluation and a progression from
simple to complex skills has been lacking.

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Research Evidence
Building on key research evidence:
Maguire et al (1996)
Fallowfield et al (2002, 2003)
Wilkinson et al (1998, 2002, 2008)
[Bit about LD here?/Marie]

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Phase I – Training Actors
Pilot funding via the Centre for Health and Social
Care Research for:
• Four 3rd year students from Birmingham
School of Acting.
• Three existing actors from Learning Disabilities
nursing.
• They also helped
design scenarios linked
to clinical practice.

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Clinical Scenarios
Field specific but each session aimed to include all Fields.
Adult Nursing
After a ward round responding to patient’s request ‘What does palliative mean?’
Responding to a shocked and distressed patient after a consultation in an
Outpatient Clinic.
Helping an irritable and aggressive older patient who is unlikely to be able to
return home.
Approaching a relative of a large extended family who are staying on the ward
beyond normal visiting times.
Mental Health
Approaching a patient having found a half empty whisky bottle under their bed.
Helping an aggressive, bed bound patient who has been moved from another
ward and is suffering nicotine withdrawal.
Dealing with an approach from a patient to meet up with them for a drink after
their discharge from the ward.

7. Clinical Scenarios
Children’s Nursing
Discussing the care of a baby with a cold with her anxious and
socially isolated mother.
Gaining dialogue with a withdrawn adolescent patient with a
cystic fibrosis patient after the death of their close friend.
Learning Disabilities
Assessing pain in a patient with moderate learning difficulties
and limited speech who wants to return to her home.
Managing a patient in casualty with autism and limited
speech who wants to remove a head dressing.

8. Phase II - Delivery of Sessions
• Delivery of 26 two hour sessions [October
cohort] before the first year’s students first
clinical placement.
• Groups size varied from 9 to 20 students.
• A lesson plan included an introductory
PowerPoint with suggested ground and
feedback rules and guidance for facilitators.

9. Systematic Evaluation
• Actor training was evaluated.
• Representative sample of 300 students [290
returned, reduced to 271 by ‘missing data’]
completed anonymous Pre- and Post-session
quantative confidence survey adding
comments.
• Facilitators and actors were asked to
contribute to the evaluation process.

10. Quantitative Data Analysis
0
5
10
15
20
25
30
35
1 2 3 4 5 6 7 8 9 10
Pre-session
Post-session

11. Quantitative Data Analysis
• 82 students participated in sessions and 196
observed giving feedback. Data analysis indicated
that both participants and observer’s confidence
increased after the sessions building on existing
Faculty knowledge (O’Boyle-Duggan, 2012).
• Larger ‘effect size’ for participants statistically
significant increase across nursing Fields.

12. Qualitative Feedback
Student feedback:
• “Talk to them and ask questions – will allow them
to open up. This session taught me to concentrate
solely on patient and relatives and them
expressing their concerns”.
• “Need practice to gain confidence and become
more competent”.
• “Really good to engage with a ‘real-life’ situation:
very beneficial to the care we will provide”.

13. Actors Feedback
• “I guess all of us have been in a situation where we
have been misunderstood by a nurse or doctor and it is
a great feeling to see all of these talented young people
really try to get to the bottom of a problem...”
• “Personally, I loved working as a role-player. It gave me
a chance to work a little more on my improvisation
skills and respond immediately to whatever the student
nurse came up with in the scenario. They seem to have
fully understood in theory how to approach a patient
and were very keen to try out everything they had
learned”.

14. Facilitator Feedback
• The session pack was well received with
informal discussions on ways of gaining
student participation.
• It was suggested the sessions may have
helped students in a gaining good scores in an
OSCE exam shortly after the Communication
Skills Simulation sessions.
• Smaller groups sizes were requested but
practically this is difficult.

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Publications
LEWIS D., O’BOYLE-DUGGAN M., CHAPMAN
J., DEE P., SELLNER K., GORMAN S. (2013)
‘Putting Words into Action Project’: using role
play in skills training. B J Nurs. Vol. 22 (11): 638-
644.

16. References
Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R (2002) Efficacy of a
Cancer Research UK communication skills training model for oncologists: a
randomised controlled trial. Lancet. Vol.359 Feb 22, pp.650-656.
Fallowfield L, Jenkins V, Farewell V, Solis-Trapala, I (2003) Enduring impact of
communication skills training: results of a 12-month follow–up. Br J Cancer.
89, 1445-1449.
O’Boyle-Duggan M, Grech J, Brandt R (2012) Effectiveness of live simulation of
patients with intellectual disabilities. J Nurs Edu. Vol 51(6): 335-342.
Maguire P, Booth K, Elliott C, Jones B (1996) Helping health professionals
involved in cancer care acquire key interviewing skills – the impact of
workshops. Eur J Cancer. Vol. 32A (9) 1486-1489.
Nursing and Midwifery Council (2011) Standards of Proficiency for Pre-
registration Nursing Education. Available from:- http://www.nmc-
uk.org/Educators/Standards-for-education/Standards-of-proficiency-for-pre-
registration-nursing-education/. Accessed on 24.7.12
Wilkinson S, Linsell I, Perry R, Blanchard K (2008) Communication skills
training for nurses working with patients with heart disease. British Journal of
Cardiac Nursing. 3 (10): 475-81.