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xviPREFACEof using standardized patients in undergraduate and graduate coursesfor faculty to integrate this method in their own programs.Nurse educators are challenged to provide innovative and meaningful educational opportunities to enhance the cultural competencyof nursing students. Marianne R. Jeffreys, Lenore Bertone, Jo-AnnDouglas, Vivien Li, and Sara Newman, in chapter 2, describe a multidimensional strategy for learning and teaching cultural competence ingraduate nursing education. The strategy involves an innovative fieldtrip experience. The authors provide background information about thestrategy development, implementation, and evaluation, including anempirically supported model to guide cultural competence education—the Cultural Competence and Confidence model. Four case exemplarsdemonstrate how this strategy is applied in clinical nursing educationat the graduate level. The strategy also could be used with prelicensurestudents.Faculty teaching in undergraduate nursing programs are continuallychallenged to find meaningful clinical experiences for their students. Asstudent enrollments increase and patients’ lengths of stays decrease, thischallenge is becoming even more difficult. In chapter 3, Jayne Kendleand Linda Zoeller describe a service learning clinical experience. “TimeOut” is a pediatric respite care experience in which nursing studentsprovide respite care in the home for families with children who havespecial needs. The authors describe the benefits of this type of clinicalexperience for nursing students, guidelines for students and families,program evaluation, and outcomes of the program. Tools used to evaluatestudent learning are shared with readers.Mentoring is a voluntary partnership in which an individual withknowledge and experience, a mentor, acts as a role model for a student ornurse with less experience over an extended period of time. Mentoring isa valuable component of a nursing student’s education, but instrumentsfor assessing the characteristics and outcomes of mentoring in nursingeducation are lacking. In chapter 4, Mary-Anne Andrusyszyn, Carroll L.Iwasiw, Dolly Goldenberg, and their research team of Cathy Mawdsley,Barbara Sinclair, Charlene Beynon, Cathy Parsons, Kristen Lethbridge,and Richard Booth describe the first phase of a 3-year research studyon a formal mentoring program for beginning baccalaureate nursingstudents in Canada. The authors present how they developed and pilottested questionnaires to assess the outcomes of this mentoring programand share the mentor pretest with readers.

PREFACExviiChapters in Part II of the Annual Review address some of the challenging aspects of teaching in nursing. We begin this part with a chapterby Susan Luparell on student incivility and dealing with rude, unprofessional, and inappropriate behaviors among nursing students. The purpose of her chapter is to share some of the mistakes she made and thelessons she learned in dealing with difficult or challenging student situations as a nurse educator. Strategies to prevent and address this type ofincivility are suggested. A national survey of nursing faculty confirmedthat educators are confronted with problematic student behaviors in astonishingly high numbers. Read this chapter before encountering thesestudent behaviors in your own teaching.Issues such as competitiveness, lack of support, and workplaceviolence affect academics’ individual development and their ability toeffectively take on new educational initiatives. In chapter 6, Nel Glassshares the experiences of women nurse academics who participated in apostmodern feminist, ethnographic study that involved four countries(Australia, New Zealand, the United Kingdom, and the United States)over an 8-year period (1997-2004). Dr. Glass explores the competitiveuniversity cultures and the hope and optimism nurse academics desperately want to maintain. Their comments reflect a new emerging discourse of nurses in academia and reveal their interpersonal experiencesof working in an academic setting.In chapter 7, four nursing faculty from The University of Louisianaat Lafayette describe their experiences during fall semester 2005 afterHurricane Katrina hit the Gulf Coast. Gwen Leigh explains how facultymanaged their personal challenges. Jill Laroussini tells how she balanced resourcefulness and flexibility while maintaining academic commitments. Sudha C. Patel and Ardith L. Sudduth describe their strategies for helping students cope. The authors share how they respondedto a state of crisis while maintaining their educational commitments tostudents.Ruth Neese, Gene Majka, and Geneiva Tennant, in chapter 8, explore the implications of three global challenges: (1) the brain drain ofeducated professionals migrating from less to more developed countries,(2) the shortage of nursing faculty, and (3) the relationship of literacyand nursing students. The authors describe the global nature of thesechallenges for nursing education, explain how American educators areaffected by them, and offer local strategies teachers can use to meetthese global challenges. Beyond raising the consciousness of U.S. nurse

xviiiPREFACEeducators about how these global situations impinge on their professional lives, the chapter offers suggestions for action at the local, national,and international levels.Benchmarking involves identifying processes or practices fromother institutions and then using them to help an organization improvesimilar processes or practices. Benchmarking answers questions suchas: “How are we doing in comparison with other schools” and “Whois using the best practices and what can we learn from them?” DianeM. Billings, in chapter 9, reviews four types of benchmarking practices,steps that are common to most benchmarking activities, and how tointegrate benchmarking into education practices in a school of nursing.This is a good chapter to read to learn about benchmarking and its usein nursing education programs.In Part III of the ARNE, chapters shift to initiatives that enhancelearning and student development; some of these rely on new technology and others focus on guided assessment. We begin Part III witha chapter by Ramona Nelson on student support services essential in adistance education program. Distance education has become an increasingly effective tool in meeting the educational needs of students seekingdegrees in nursing. A quality, online education program requires a welldesigned curriculum as well as a wide range of student support services.Examples of key student support services include academic advising,bookstore services, financial aid, and library services. This chapter describes required online student support services, explains how theseonline services can be structured, and identifies resources for developing them.In chapter 11, Linda Felver and Catherine Van Son describe theeducational innovations they developed as part of their Older Adult Focus Project, intended to increase the ability of nurses to provide carefor older adults. As part of that project, they created materials to buildinto an existing online baccalaureate program for registered nurses. Theyalso developed a stand-alone CD-ROM to assist nursing students andnurses to increase their abilities in working with older adults and toassist educators who want to infuse older adult content into existingcourses or teach it as a separate course. They describe the development process they used, which can be adapted to other educationalsettings.Chapter 12 describes how to use a course management system(CMS) to enrich student learning and enhance teaching. A CMS is

PREFACExixa web-based “frame” through which faculty can communicate withstudents; distribute information; and facilitate the exchange of ideas,information, and resources. Linda M. Goodfellow explains how to use aCMS to manage courses taught in a school of nursing, describes innovative ways of using a CMS in both a traditional and virtual classroom,and examines the significant role of a CMS in nursing education.In chapter 13, Janice M. Jones, Kay Sackett, W. Scott Erdley, andJohn B. Blyth describe how to develop electronic portfolios (or ePortfolios). By preparing an ePortfolio, students can communicate their accomplishments and competencies, have an opportunity to work withtechnology, and demonstrate their ability to use information technologyas a tool. The authors describe their project to prepare nursing studentsfor professional practice by using a technology-based format showcasingstudents’ talents and skills in the form of ePortfolios. In addition, the advantages and disadvantages of implementing ePortfolios are discussed,and the authors share many of their tools with readers.In chapter 14, Paulette Demaske Rollant reviews the literatureon predictors and tools to identify students at risk for failure on theNCLEX-RN . In this chapter, she presents interventions she has usedover the years to successfully prepare students for the licensure examination and for taking other tests in nursing programs. These simpleinterventions can be used by faculty to prepare students to be successfultest takers in nursing programs.The goal of the ARNE is to keep you updated on innovations andnew ideas in nursing education. We hope you agree that volume 5 metthat goal. We appreciate the hard work of the authors who, as teacherscholars, so generously share their innovations for the benefit of educators everywhere. A heartfelt thanks to you for reading and recommending the Annual Review of Nursing Education to other nurse educators!Marilyn H. Oermann, EditorKathleen T. Heinrich, Associate EditorREFERENCEHu, W. (2006, April 16). “New York leads politeness trend? Get outta here.” The NewYork Times, p. 1.

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Part IClinical Nursing Education:New Directions in Assessmentand Clinical Experiencesfor Students

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Chapter 1Standardized Patients in Nursing EducationLouise Sherman Jenkins and Kathy SchaivoneEducators in nursing face multiple challenges in planning effectivelearning experiences and providing constructive, objective evaluation of knowledge and skills in learners. Competition for clinicalsites, increasing complexity and acuity levels of patients in clinical settings, and heightened levels of public concern about patient safety arekey among factors that mandate learners in health professions demonstrate clinical competence prior to entering the actual clinical setting.Integration of standardized patients (SPs) into learning experiences canhelp educators overcome some of these barriers to effective clinical teaching and evaluation. This sophisticated form of simulation allows learnersto practice skills with a real person in a safe and controlled environment.Having these simulated patients highly trained to portray focused scenarios allows for consistency of experiences across learners and strengthensthe reliability of the evaluation process. Consistency of clinical experience and evaluation of learners is maintained through the use of trainedSPs portraying scenarios tailored specifically to the objectives of theencounter.At the University of Maryland School of Nursing, high value isplaced on the integration of simulation into nursing curricula, beginning in the classroom, extending through laboratory experiences withvarious types of simulation incorporating various types of models ranging from simple to exceedingly complex (Morton & Rauen, 2004).This chapter was accepted on April 6, 2006.3

4CLINICAL NURSING EDUCATIONDuring the late 1990s, the University of Maryland Schools of Nursing and Medicine were using SPs on a limited basis with students. Atthat time, the SPs were contracted from another university with an established program. A thorough needs assessment conducted by bothschools indicated that the education and evaluation of students couldbe expanded and enhanced if the campus had its own SP program.Both schools agreed a strong collaborative relationship in this endeavorwould have rich mutual benefits for the learners, the two schools, andthe University of Maryland academic health science campus. In late2000, the SP program began operation as the Clinical Education andEvaluation Laboratory, a joint venture of the Schools of Nursing andMedicine.This chapter contains a definition of SPs, a general discussion ofintegrating SP encounters into nursing curricula, and background information of the origins and evolution of the SP’s role in medical andnursing education. Turning attention to the SP laboratory, the physicalenvironment is described as well as the operation of the facility. In thesection about SP encounters, we describe various models for SP encounters, explicate the role of the educator, discuss case writing andevaluation of learners, training of SPs, and the process of the actual SPencounter. Learner performance and the role of the SP, the learner, andthe educator are described. Also included is a discussion of how learnersand educators evaluate the SP encounter, and how SPs are evaluated,as well as how the SP program is evaluated. Finally, implications foreducators using SPs in nursing are discussed. Throughout the chapter,we offer general information about using SPs and our experiences in theClinical Education and Evaluation Laboratory to discuss the approachesused in these various areas.BackgroundWhat Is a Standardized Patient?The Association of Standardized Patient Educators defines a SP as “a person trained to portray a patient: This can be for instruction, assessment,or practice of communication and/or examining skills of a health careprovider” (Gliva-McConvey, 2006). Training of SPs is key and shouldresult in:

STANDARDIZED PATIENTS IN NURSING EDUCATION5.a person who has been carefully coached to simulate an actual patient soaccurately that the simulation cannot be detected by a skilled clinician. Inperforming the simulation, the SP presents the gestalt of the patient beingsimulated; not just the history, but the body language, the physical findings,and the emotional and personality characteristics as well (Barrows, 1987).Standardized patients are lay people/actors who are employed by acenter or laboratory, carefully trained to simulate a particular “case” orscript, and—in many cases—provide feedback to the learner on theirperformance.Integrating Standardized Patient Encounters Into Nursing CurriculaStandardized Patient encounters can be integrated into the curriculumfor instruction and practice of skills, to evaluate learners, for programevaluation, faculty development, and research. Standardized Patient encounters allow for repeated experiences in which the learner can attendto the critical aspects of the situation and improve performance in response to patient outcomes, feedback, or both. There are characteristicsof SP encounters that lend themselves to effective integration into nursing education.The learner is an active participant in the experience rather thana passive observer. Because these encounters take place in the safe andpredictable environment of a laboratory, errors are educational experiences rather than patient disasters. In a clinical setting, the experiencesof learners are often uneven and controlled by the availability and condition of patients. In SP encounters, the behavior, presentation, andresponses by the patient are determined by the case, and the patientsare trained to adhere to that training. The sessions are flexible in that theycan take place at the convenience of the educator and learners. Throughthis methodology, educators can do direct comparisons of learner competence and efficiently use their time by observing multiple learners inone setting. The SP evaluations are responsive to real differences in performance due to case control. Learners can receive immediate feedbackand debriefing from SPs and educators.During SP sessions in which the learner is challenged with advancedclinical management of complex patient problems, educators are able toview the continuum of a student’s ability to take a history, complete anappropriate physical examination, plan for appropriate interventions,

6CLINICAL NURSING EDUCATIONand use some basic care measures with the SP. Through the integrationof SP encounters in the curriculum, universal competencies that are thefoundation of skills needed for effective clinician—patient interactionscan be taught and assessed. Ideally, a decision to integrate SP encountersinto a course or program would occur during development of the course.Doing so allows for careful identification of cognitive, psychomotor, andaffective knowledge and skills to be specified in the learning objectives.Integrating an SP encounter(s) into the curriculum serves as a focal pointfor the development and integration of competency-based skill evaluation. Standardized Patient encounters can also be added into existingcourses and programs as an innovative teaching strategy as well as anassessment strategy. In addition, the SP encounter offers an opportunityto use knowledge and skills attained in an appropriate context.Origin and Evolution of the RoleOver 40 years ago, Dr. Howard Barrows—a neurologist wanting to betterassess the clinical skills of his students—became the “father” of simulatedpatients as he employed and trained actors who were readily availablein southern California to work with his students. Using cases of actualneurology patients as templates for the scenarios the actors would portray, a detailed script was developed to determine the exact detail ofeach case to be presented. Thus, these simulated “patients” were trainedto present the same signs, symptoms, history, emotional state, and, insome cases, physical examination findings to students.This approach allowed Dr. Barrows to present the same “patient”multiple times for his students. He could then observe each student withthe simulated patient in a safe and controlled environment and ass

Professor, ADN Program Chemeketa Community College Salem, Oregon Richard L. Pullen, Jr., EdD, RN Assistant Director of Associate Degree Nursing Program Professor of Nursing Amarillo College Amarillo, Texas Suzanne P. Smith, EdD, RN, FAAN Editor-in-Chief, Journal of Nursing Administration & Nurse Educator Bradenton, Florida Helen J. Streubert .