Guide for Integrating Standardized/ Simulated Patients with Intellectual and Developmental Disability in Nursing Curriculum

Guide for Integrating Standardized/Simulated Patients with Intellectual and Developmental Disabilities in Nursing Curriculum

Download PDF version

Many people with an intellectual and developmental disability (IDD) can participate in simulations for the education of nursing students and other health care professionals. Although several terms have been used to describe this role (standardized patients, simulated patients, standardized patient educators, standardized patient consultants, standardized participants, and expert patients), this discussion uses “standardized patients” as it is the most commonly used term.

Identifying individuals with an IDD and other disabilities as standardized patients or expert patients conveys an important message to students in health care professions, as individuals with a disability are the experts on how they live on a daily basis with their disability (VanPuymbrouck et al., 2017). Simulations conducted with standardized patients promotes diversity, equity, and inclusion (Derya et al., 2022) efforts; inclusion of individuals with IDD and other disabilities also promotes accessibility.

The purposes of inclusion of individuals with IDD in the education of nursing and other health care professions students include:

• Giving students the opportunity to meet individuals with IDD so that they become comfortable interacting with and being around them
• Providing students the opportunity to learn and use effective communication skills with those with IDD
• Enabling students to identify modifications needed in conducting health assessments of persons with IDD
• Allowing students to experience authentic responses from persons with IDD during their interaction

Although not all individuals with an IDD, similar to people without disability, are able to comfortably interact with even a small group of students, many are able and willing to do so with training. Individuals with actual disability, IDD or other types of disability, should be included in patient simulations rather than individuals pretending to have these disabilities.

Only individuals with an actual disability can provide authentic lived experiences and responses. Including them acknowledges their expertise and autonomy, and their contributions to the education of tomorrow’s health care professionals. Individuals with an IDD and other disabilities who have been professionally trained as actors are ideal candidates for the role but are not always available. Establishing contacts and collaboration with disability-related organizations and agencies can be helpful in identifying and recruiting individuals with an IDD who would be interested in improving health care by being part of a simulation with health care students. 

All individuals who will participate as standardized patients, including those with an IDD, should receive training to prepare them to participate in the role (Lewis et al., 2017). Identifying a common health condition (e.g., appendicitis; earache; respiratory infection) and training the persons with an IDD in the role as standardized patient to report symptoms is one option. Another option is to have individuals with an IDD respond to nursing students’ questions about their preferences for communication method, what makes them feel comforted and safe during a hospital stay, what they want nurses and other health care providers to know about them, and how they exhibit pain and discomfort.

If a family member or other caregiver typically accompanies the person with an IDD to health care visits, it would be appropriate to include them in the simulation, but with the person with an IDD rather than the accompanying person as the focus of the interview and questions. Persons who are nonverbal have been successful in simulations following training about the simulation sessions in which they participated (Eddey et al., 1998).

Providing opportunities for persons with an IDD to practice the case and receive feedback about their performance is important. If a previous recording of a scenario is available, viewing of this recording may be helpful for persons with an IDD or other disabilities to gain perspective on what is expected of them (Smeltzer, Mariani, & Meakim, 2017).

Individuals with an IDD should be provided an opportunity to give feedback to students following the simulation and interaction. How to provide effective feedback should be part of the training they receive, using a checklist or rubric. An opportunity for them to practice giving feedback along with encouragement and support is essential.  Although many individuals with an IDD may be reluctant to provide negative feedback, they should nevertheless be given the opportunity to do so.

The following checklist can serve as a guideline to assist individuals with IDD to provide feedback on whether the nurse/health care provider:

• Spoke to me directly rather than to my family member or support person
• Sat at eye level or in a position that was comfortable for me to interact
• Asked me about my communication preference
• Used active listening techniques
• Made eye contact with me
• Treated me respectfully and as an adult rather than as a child
• Asked about my disability and how it affects my current life situation
• Did not assume that my disability is the reason for my health care visit
• Asked me first if I need assistance, rather than just taking action

Inclusion of individuals with an IDD in simulations provides them with an opportunity to contribute to improving the health care that they and others with an IDD and other disabilities often experience. Like others SPs serving in simulations, individuals with an IDD should receive compensation for their participation. Thoughtful planning is needed, though, to ensure that the experience is a positive one for all involved.

References

Derya, U. Y., Azim, A., & Sibbald, M. (2022). The role of standardized patient programs in promoting equity, diversity, and inclusion: A narrative review. Academic Medicine, 97(3):p 459-468, March 2022.  https://doi.org/10.1097/acm.0000000000004447 

Eddey, G. E., Robey, K. L., &  McConnell, J. A. (1998). Increasing medical students' self-perceived skill and comfort in examining persons with severe developmental disabilities: The use of standardized patients who are nonverbal due to cerebral palsy. Academic Medicine, 73(Suppl.): 106-108.

Lewis, K.L., Bohnert, C.A., Gammon, W.L., Hölzer, H., Lyman, L., Smith, C., Thompson, T. M., Wallace, A., & Gliva-McConvey, G. (2017). The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Advances in Simulation, 2, 10. https://doi.org/10.1186/s41077-017-0043-4

Long-Bellil, L. M., Robey, K. L., Graham, C. L., Minihan, P. M., Smeltzer, S. C. & Kahn, P. (2011). Teaching medical students about disability: The use of standardized patients. Academic Medicine, 86(11). 1163-1170. https://doi.org/10.1097/acm.0b013e318226b5dc

Minihan, P. M., Bradshaw, Y. S., Long, L. M., Altman, W., Perduta-Fulginiti, S., Ector, J., . . . Sneirson, R. (2004). Teaching about disability: Involving patients with disabilities as medical educators. Disability Studies Quarterly, 24(4). https://doi.org/10.18061/dsq.v24i4.883

Smeltzer, S. C., Mariani, B., & Meakim, C.H. (2017). Integration of disability in nursing education with standardized patients with disabilities (PWD) into nursing curricula. In S. H. Campbell, & K. M. Daley (Eds.), Simulation scenarios for nursing educators (3th ed.). New York, NY: Springer Publishing.

VanPuymbrouck, L., Heffron, J. L., Sheth, A. J., The, K. J., & Lee, D. (2017). Experiential learning: Critical analysis of standardized patient and disability simulation. Journal of Occupational Therapy Education, 1 (3). https://doi.org/10.26681/jote.2017.010305

Author Information

Suzanne C. Smeltzer, EdD, RN, ANEF, FAAN
Professor Emerita and Research Professor

Colleen Meakim, MSN, RN, CHSE-A, ANEF
Director, Second Degree Track

Bette Mariani, PhD, RN, ANEF, FAAN
Vice Dean for Academic Affairs and Professor

Kathryn M. Reynolds, MSN, RN, PNP
Clinical Assistant Professor

M. Louise Fitzpatrick College of Nursing, Villanova University

© Colleen Meakim, MSN, RN, CHSE-A, ANEF; Suzanne C. Smeltzer, EdD, RN, ANEF, FAAN; Bette Mariani, PhD, RN, ANEF, FAAN; M. Louise Fitzpatrick College of Nursing, Villanova University, 2024.