1. Tutting Words into Action' project:
using roie piay in sidiis training
Debbie Lewis, Marie O'Boyle-Duggan, Jim Chapman, Philip Dee,
Katharina Seiiner and Stevie Gorman
Abstract
Research highlights the need to use experienced role-players with
skilled facilitation to deliver effective communication skills training
(CST) but this is challenging in a large faculty of health. In this
pilot project, students from Birmingham City University*s School
of Acting and role-players from the Learning Disability nursing
programme received role-player training (Phase I) before delivering
26 CST sessions to 520 first year BSc nursing students (Phase 0),
using role-plays based on clinical scenarios in adult, mental health,
learning disability and children's nursing. A pre- and post-session
survey assessed student confidence, with feedback gathered from
role-players, and facilitators. Pre-session confidence levels in students
who participated and observed the role-play were similar, and using
Wilcoxon and Mann Whitney non-parametric tests, a statistically
significant increase in post-session confidence levels was demonstrated
across all four fields of nursing. This increase in confidence applied to
role-play participating students and observers, although role-playing
students gained the largest confidence increase. A Higher Education
Academy Collaborative Grant extended the project in 2012/13.
Key words: Simulation • Communication • Education • Nursing
• Roleplay
T
he Nursing and Midwifery Council (NMC)
educational standards for pre-registracion nursing
(Box 1) highlight communication and interpersonal
skills, across all fields of nursing, as a key feature
of effective nursing practice (NMC, 2011). Such standards
are timely in a challenging healthcare environment, with
shorter hospital stays, more seriously ill patients and
dramatic increases in the elderly population leading to a
renewed emphasis on patient education and self-care in
chronic illness (Department of Health, 2001). Complaints
about a lack of care and compassion in dealing with
patients' concerns are common place (Patients Association,
2012) and there are specific concerns regarding clients
with developmental disability (M.ENCAP, 2012), who
increasingly receive care in general rather than long-stay
facihties (Phillips, 2012).
Debbie Lewis, Marie O'Boylc-Diiggan.Jini Chapman and Philip Dee
are Senior Lecturers; Katharina Seilncr is Third Year Drama Student and
Stevie Gorman is Professional Role-player at Faculty of Health,
Birmingham City University',.
Acceptedfor ptibiicnlion: May 2013
Such care issues heighten the need to develop nursing
students' communication skills to assess patient and carer
needs, establish trust, to demonstrate empathy and to address
the often forgotten, but important, psychosocial concerns (Del
Piccolo et al, 2011). On entering a healthcare environment,
many student nurses are anxious about interacting with
patients and children who may be exhibiting physical aaid
psychiatric conditions of which they have no experience
(Kanieg et ai, 2009). Redesigning a BSc (Hons) programme
at Birmingham Cit>' University's large Faculty of Health
to meet the new NMC educational standards provided an
opportunity to improve communication skills training (CST),
with firmer integration into the curriculum. To supplement
a lecture style teaching session promoting SOLER (Eg?n,
2010) {Box 2), active listening, effective questioning, reflecting
back and paraphrasing, 520 first year students from four
nursing fields participated in a two-hour simulation-based
CST session using drama students and existing role-players
already used in the Learning Disabilities nursing programme.
Phase 1 of the project,'Putting Words into Action', focused on
role-player training and Phase II on session implementation.
What do we know about communication
skills training?
Early Audit Commission (AC, 1993) reports lijik
communication skills to high patient satisfaction, greater
compliance and recovery, although evidence suggests limited
success in obtaining this aim within the NHS (Nursing
Times, 2012). Acquiring these skills and the confidence
to communicate effectively with patients, has been left to
practitioners to gain from experience or by luck. Within pre-
registration nurse education there is evidence of confusion
in deciding what needs to be taught, varying degrees of
provision and a lack of field-specific training (Chant et al,
2002). Few nurses receive training on dealing with issues
related to end-of-life care, diíFicult emotional situations
such as dealing with distress or anger, or communicating
on the telephone, although these are common activities.
When training has been provided there is a tendency towards
mechanistic skills checklists or using counselling models,
which may not be transferable to all practice areas (Boschma
et al, 2010) rather than relational communication, which
may help nurses deal effectively with issues and demonstrate
compassion and empathy. The need to progress from simple
to complex skills throughout the undergraduate programme
is recognised (Boschma et al, 2010), but rarely achieved, and
effective evaluation of CST has also been lacking (Kruijver et
al 2000, Chant et al, 2002).
638 British Journal ofNurîing, 2013.Vol 22. No tl

2. EDUCATION AND TRAINING
In the UK and elsewhere, health practitioners' CST
education has been informed by research including randomised
controlled trials. Maguire et al (1996) demonstrated the value
of using simulated patients to promote open questioning to
elicit psychological as well as physical concerns, and to reduce
giving advice prematurely Fallowfield et al (2002, 2003) used
video-recorded simulations, highlighting the longevity of
role-play-based CST. No skills attrition was seen 12-15 months
post-training in participants who had previously shown skills
improvement. Such experiential learning promotes the
personal involvement of students stimulating feelings and
the cognitive aspects of communication following the cycle
of learning. This was developed by Kolb (1984), whereby
simulation of a skill with debriefing is followed by reflection
in order to inform practice and aid performance (Aldridge
and Wanless, 2012). Although recent national initiatives have
focused on oncology and palliative care staff (Connected,
2012) using role-play in CST is becoming more common
place for staff working with chronic diseases such as heart
failure (Wilkinson et al, 2008) and with learning difficulties
(O'Boyle-Duggan et al, 2012). In addition to practicing
key skills, such training promotes the value of therapeutic
communication moving between the patients physical and
psychological needs, which may be neglected in practice
(Kruijver et al, 2001). It may also raise awareness of blocking
behaviours when professionals ignore discussion of emotional
or challenging issues despite receiving cues from patients that
they would welcome the opportunity to discuss fears. The
additional time needed to make reasonable adjustments for
clients with complex communication needs, such as those
with learning difficulties, is required by the Equahty Act
(2010), and is an area of deficiency highlighted by MENCAP
(2012). Practitioners often cite a lack of time to communicate
effectively with such patients (Hemsley et al, 2011), though
the use of good skills is not necessarily more time consuming
(Fallowfield et al, 2003).
Phase I—^Training role-players
Simulated patients and carers for role-play may be laypersons,
staff or other students. Often in CST, such as the nationaUy
accredited Connected (2012) programme, professional actors,
specifically trained for working with health practitioners, help
teach practitioners how to interact with clients during clinical
encounters. Tliis allows a teachable moment to be created,
giving students constructive feedback on their performance
in a supportive environment. Although used for some time in
medical education (Rees et al, 2003), using professional actors is
prohibitively expensive for large cohorts of nursing students so
in this project alternative options were sought.
Using inhouse pilot funding Phase I increased the pool
of role-players within the faculty by training four third year
students from Birmingham City University's School of Acting
and three existing role-players from the learning disabilities
field of nursing. The group participated in a two-day role-
3 player training programme {Box 3) to standardise practice
I and provide a common level of training for all role-players.
Í Already well-versed in aspects of communication, such as
g observing non-verbal behaviours, being attentive, hstening
e and responding to cues, finding a common language with the
Box I. Nursing and Midwifery Council (NMC) Standards for Pre-Registration
Nursing (NMC, 2010)
Nurses must be able to:-
• Communicate safely and effectively
• Build therapeutic relationships taldng into account differences, capabilities and needs
• Be able to engage in, maintain, and disengage ffom 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
Box 2. SOLER—A modei of non-verbal behaviours conveying attention (tgan, 2GI0)
Square-on position facing towards the patient
Open position
Leaning towards the interviewee
Eye contact
Relaxed position
Box 3. Role-player training programme
I What is the job of a professional role-player? How does it differ from stage and
screen acting?
I Naming the skills - What skills do we want to promote?
I The value of care, compassion and empathy? How can students demonstrate it'
I What do you need to do as a communication skills training (CST) role-player?
D Preparing for role-play
D Using pre-written scenario
• Giving constructive feedback
D The value of a lay person's perspective
D Establishing a suitable playing level
D Flexibility and improvisation
I Practising role-plays and giving feedback
I Role-playing sensitive issues and self-care strategies
drama students proved easier than anticipated. The training
included identifying key communication skills, practicing
role-plays and giving feedback in role including viewing
videos of best and worst practice to generate discussion. The
role-player training was also useful in developing written
scenarios based on commonly occurring issues (Box 4).When
written initially these did not include suflîcient demographic
information for reahstic re-enactment by actors—with
medical and nursing jargon also a barrier to understanding
the scenario. Redesigning them in collaboration with, the
role-players included discussion of differing playing levels
related to difEculty and identifying a degree of challenge
suitable for first-year nursing students, although in practice
the skill and confidence exhibited between nursing groups
varied widely. CST often involves exploration of emotional
issues such as serious illness, disabilities and end-of-life care,
so role-player training included the value of giving sensitive
feedback, adequate debriefing and self-supportive strategies
such as withdrawing from topics close to personal difficulties.
Feedback after the two days highlighted the benefits of
integrating actors and clinicians with exisdng faculty
role-players, valuing the opportunity of seeing drama students'
Britishjournal of Nursing, 2013, Vol 22, No 11 639

3. Box 4. Role-play scenarios
Adult nursing
I After a ward round responding to patient's request 'What does palliative mean?'
I Responding to a shocked and distressed patient after a consultation in an
outpatient ciinic
I Helping an irritable and aggressive older patient who is unlikely to be able to
return home
I Approaching a relative of a large extended family who are staying on the ward
beyond normal visiting times
Mental health
I Approaching a patient having found a half-empty whisky bottle under their bed
I Helping an aggressive, bed-bound patient who has been moved from another
ward and is suffering nicotine withdrawal
I Dealing with an approach from a patient to meet up with them for a drink after
their discharge from ihe ward
Children's nursing
I Discussing the care of a baby with a cold v^nth her anxious and socicOIy isolated mother
I Gaining dialogue with a withdrawn adolescent patient with cystic fibrosis after the
death of their close friend
Learning disabilities
I Assessing pain in a patient with moderate learning difficulties and limited speech
who wants to return to her home
I Managing a patient in casualty with autism and limited speech wlx) wants to
remove a head dressing
Box 5. Pendleton s Rules for Feedback (Garala et al, 2007)
I The student participating in the roIe-pIay has the opportunity to talk first and is
encouraged to discuss positive points
I The participating student has the opportunity to suggest alternative strategies to
improve their performance
I The observing group are invited to provide feedback but again positive points are
required first
I The facilitator and group can provide constructive feedback on the areas identified
with care taken to ensure comments are not given in a negative manner
Box 6. Survey items—Pre- and post-assessment of confidence
Nominal data
I Branch of nursing
I Participant and/or observer
Ordinal data—Quantification of confidence In:-
I Approaching patients to explain a nursing procedure
I Ability to use key skills e.g. SOLER, open questioning, eliciting patient concerns
I Exploring patient cues
I Identifying patient and relative concerns
I Explaining professional boundaries to patients and relatives
I Handling strong emotions such ¿is anger or distress
I Communicating with specific patient groups e.g. learning disabilities, children,
those with mental health issues or dementia
skills in action and drama students highlighting the benefits
of clinicians' experience in role-playing clients with mild,
moderate and severe learning diíFiculties.
Phase II—Implementing the Xommunlcation 2
Skills' sessions
In Phase 11, 26 two-hour sessions were delivered before the
first year students' first clinical placement, with volunteer
faculty lecturers as faciÜtators. A lesson plan and written
facilitator guidance was provided before the session, along
with session ground rules and feedback strategy. Workshop-
style training for facilitators was offered to promote competent
facilitation of each session, as recommended by Byland et al
(2009). Due to time pressures and the experience of many
lecturers, this was not taken up, but a facilitators' guidance
sheet was well received. Informally, facilitators also contacted
project team members for advice and tips particularly with
regard to obtaining role-play participant volunteers in less
confident groups.
Ground rules and the feedback strategy were reinforced
at the start of each class with an emphasis on active
non-judgmental participation from facilitators, role-players,
student volunteers and observers alike. Giving individual
feedback during role-plays was based on Pendleton's Rules
{Garala et al, 2007) (ßo.- 5), a strategy widely used in medical
education to give constructive feedback on performance.
This helped focus on the students' positive achievements
before constructive suggestions for improvement, helping
to avoid humiliation, and generating a supportive learning
environment to encourage student participation. Ea:h
session included two facilitators and one role-player, with
field-specific groups of between nine and 20 students. Explicit
within the ground rules was a student's right to withdraw
from the class if a role-play topic was too closely related to
a personal difficulty, though this happened rarely. An initial
ice-breaking exercise, which deliberately incorporated an
element of surprise, was popular and useful in gaining active
participation in the quieter groups.
How successful were the sessions?
Student evaluations
Evidence suggests CST is poorly evaluated (Chant et al, 2002),
so a systematic approach to session evaluation was taken to assess
the effectiveness of this method in teaching students. Students
were asked to voluntarily complete an anonymous pre- and
post-session survey quantifying their level of confidence in
cominunicating with patients in practical nursing activities
and emotional issues. Of approximately 520 first-year students
who participated in the CST, a representative sample of
300 completed the evaluation exercise at the start and end
of the teaching sessions. In total, 290 surveys were returried
at the close of the session with 82 students able to take part
in the role-play (identified here as participants) and a further
196 students observing and giving feedback to move the
role-play to a satisfactory resolution (observers).Twelve students
did not give their identifying group in the questionnaire.
Students were asked to add their field of nursing, namely
adult, mental health, learning disabilities or children's nursing.
Ignoring'missing' data in the form of incomplete surveys, 271
completed questionnaires were returned.
Survey data focused on the students' level of confidence
before and after the teaching sessions using a Likert scale linked
to seven variables such as explaining a nursing task, responding
to patients verbal and non-verbal cues, explaining professional
boundaries, dealing with strong emotions and communicating
with patients with specific issues such as dementia and learning
disability {Box 6). On the survey, students were also given
640 British Journal of Nursing, 2013,Vol 22, Nc 11

4. EDUCATION AND TRAINING
the opportunity to add additional comments which were also
collated.Written feedback on the sessions from the role-players
and the facilitators was also requested.
Quantitative analysis
Statistics were gathered using a 10-point Likert scale measuring
confidences across various themes within the questionnaire,
both before and after the CST. Though there are no
standardised values of acceptable levels of confidence, such
statistical techniques have been used to assess communication
competence in delivering clinical skills (SookYoo et al, 2010)
and it is a technique commonly used by CST specialists
(Wükinson et al 1998, 2008). A useful visualisation of the
pre- and post-session confidence scores for the survey as a
whole is shown in Figure Í. As the data is at an ordinal level
rather than interval or ratio (Polit and Hungler, 1999) the
median scores allow a quick comparison of pre- and post-
confidence scores to determine if there are any areas of
immediate interest. Table 1 illustrates that for the pre-session
questions, there was a lower general level of confidence among
the students (median=6) compared to the same students post-
session (median=8) suggesting both role-play participants and
observers benefited from the teaching session.
As the data was ordinal in nature, non-parametric inferential
tests were used to demonstrate if these differences were
'real' and unlikely to be due to chance. The WOcoxon test
(see Table 1) revealed a statistically significant increase in
confidence following the teaching session with Z=-13.091,
p<0.0005, and with a large effect size (r=0.56).The effect
sizes have been calculated and interpreted according to
Cohen (1988) using the recommended groupings (0.1=small
effect; 0.3=medium effect; 0.5=large effect). Table 1 shows
the Wilcoxon test results when applied across the fields,
illustrating that this global picture is essentially rephcated in
aUfields.All differences have a p-value well below 0.05 (i.e.
below 5%) and are therefore statistically significant.
Quantitative analysis was helpful in identifying that both
participants and observers benefit firom the CST sessions
which, building on previous faculty research, added to existing
knowledge (O' Boyle-Duggan et al, 2012) {Table 2). All
differences seen are statistically significant with the exception
of the learning disability participant group, as only four surveys
were returned in this group. Applying the Wilcoxon test it can
be shown that, variable-by-variable, there is an improvement
in confidence comparing pre-session and post-session. Splitting
the data into the two groups of participants and observers.
Appendix 1 also demonstrates the amount of improvement
in confidence (the 'effect size') is generally larger in the
participant group compared to the observer group.This may be
explained as the act of participation possibly leading to a greater
sense of'ownership' in the topic of communication, whereas
observers may feel less engaged in the session. To establish if
this difference between participants and observers is 'real' and
not due to chance, the Mann Whitney statistical test was used
3 to give a 'between groups' comparison. This illustrated a small
1 positive effect size between observers and participants (ranging
J fi-om r=0.132 to r=0.219) and as the statistical significance (p)
2 is less than 0.05 in most cases the differences between these
o two groups is very unlikely to be due to chance.
30
25
10
Pre-session
Post-session
Figure 1. Response frequencies totalled for all seven questions pre-session and all seven questions
post-session (no other splitting of data)
Table 1. Pre- and post-session Wiicoxon Test of ali measures of confidence
Branch
Mental
health
Learning
disabiiity
Child
Adult
N
31
11
57
171
Median
pre-
session
6
6
6
6
Median
post-
session
7
7
7
8
Z
-3.798
-2.803
-6.263
-10.463
P
<0.0005
0.005
<0.0005
<0.0005
r
0.48
(medium)
0.60 (large)
0.59 (large)
0.57 (large)
Tabie 2. Pre- and post-session of aii measures of confidence (median) across
fieids for observers and participants
Nursing
Branch
Mental
health
Learning
disability
Child
Aduit
Observer
pre-session
6
6
6
6
Observer
post-session
7
8
7
8
Participant
pre-session
6
6
6
6
Participant
post-session
7
7
8
8
Qualitative analysis
Qualitative analysis in this project -ivas limited and this has
been highlighted as an area for future project development
using a Higher Education Academy Collaborative Grant.
Students were encouraged to add free text comments to the
survey and although the number of free text comments was
small they were predominately positive, focusing on the value
of this style of learning. As one student notes:
'Talk to them and ask questions—will allow them
to open up. This session taught me to concentrate
solely on patient (sic.) and relatives and them
expressing their concerns'.
Other comments were similarly positive, with only one
respondent suggesting the session had not been helpful.
Students also highlighted the need for repeated practice, with
one student noting:
'Need practice to gain confidence and become
more competent'.
British Journal of Nursing, 2013, Vol 22, No 11 641

5. Appendix 1. Pre- and post-session Wilcoxon Tests for observer and
participant groups for ail fieids dispiaying effect size
Variables
NProcedures &v
NProceduresPost
KeySkillsAbility &v
KeySkillsAbilityPost
ExplorPtCues ßv
ExplorPtCuesPost
PtRelConcerns &.
PtRelConcernsPost
ProfessBoundaries &.
ProfessBoundariesPost
StrongEmotions &.
StrongEmotionPost
ComsConfSpecGroups &.
ComsConßpecGroupsPost
Observer Effect Size, r
0.460
(medium)
0.464
(medium)
O.5Í5
(large)
0.46 i
(medium)
0.448
(medium)
0.362
(medium)
0.399
(medium)
Participant Effect Size, r
0.510
(large)
0.478
(medium)
0.552
(large)
0.508
(large)
0.441
(medium)
0.398
(medium)
0.398
(medium)
Box 7. Facilitator competencies (Byiand et al, 2009)
Single occuiTence items
I Makes introductions
I Estabiishes rules of roie-piay
I Normalises anxiety
I Allows time for reading/discussing role-play
I Discusses the patient's potential needs
Maintaining a iearner-centred environment
I Invites learner's feedback first
I Stays focused on the learner's need's and agendas
I Elicits learning goals
I Assesses if learning needs are met
Managing the role-play
I Gives the actor direction
I Ensures the learner understands the starting point
Faciiftating Feedback
I Facilitates a balance of positive and constructive feedback
I Invites positive feedback first
I Reinforces specific communication skills
I Uses video playback to reinforce learning
Involving the group
I Invites all group members to give feedback
I Involves all group members in addressing challenges or solving problems
time
I Allocates time equally among learners
Using a predominately quantitative survey to collect
qualitative data was largely unfruitful and other qualitative
research techniques such as in-depth interviewing or focus
groups will be used in future to collect a more detailed
analysis of the students' CST experience. Specifically
identifying what aspects of the CST were actively used
in clinical practice would be helpful along with a greater
understanding of the communication issues nursing
students encounter both inter-professionally and with
patients, clients and carers. More information may also help
the development of CST across all three years of the BSc
Nursing programme.
Facilitator feedback
Feedback collated from facilitators and role-players suggestí;d
the ground rules and feedback strategy was helpful in
protecting all participants in the sessions from unnecessary
stress and emotional burden. Guidance in the form of a
session pack was well received and informal conversations
with project team members did take place to clarify
teaching issues. Gaining student cooperation was easier when
facilitators stressed that students were not being required to
act, only to 'be themselves', thereby fulfilling their role as
a student nurse. Though the art of enlisting volunteers was
recognised as a skill that facilitators can develop. Facilitators
did suggest the CST may have improved students in
their performance in other fields such as in an Objective
Structured Clinical Examination (OSCEs) held shortly
after the sessions. This is perhaps unsurprising as verbal and
non-verbal communications skills are recognised as a critical
component of patient consultations (Collins et al, 2011), and
in nursing even practical procedures require communication
competence (SookYoo et al, 2010).
There was no formal assessment of the facilitators'
competence though evidence suggests this can be a key factor
in ensuring effective CST (Byiand et al, 2009). Facilitation
competencies have been designed for CST {Box 7} with
standards being taught, reinforced, and reassessment advocated
to maintain the quality of training. It is acknowledged that
some skills are more easily acquired than others, such as
making introductions, giving the actor direction and inviting
learner feedback first. More difficult tasks include discussing
the patient's potential needs, summarising learning and
involving group members in solving problems. Regular peer
review with individual feedback is also recommended (Byiand
et al, 2009). In the light of this evidence, promoting facilitator
competencies and prompting feedback between facilitators
may be a useful development in future CST sessions.
Role-player feedback
The role-players' feedback stressed the satisfaction they felt
in using their acting expertise to help health professionals
develop key skills for clinical practice. A drama student
commented:
*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...'
It was also helpful to their own development with one
role-player noting:
*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*.
Although some role-players already working in learning
disabilities nursing had clinical experience, most role-players
642 British Journal of Nursing, 2013,Vo! 22, No 11

6. EDUCATION AND TRAINING
had not and were therefore able to give a lay person's view
of the participating student's performance. This can be very
useful in highlighting to nursing students unhelpful aspects
of communication in clinical practice, such as the use of
jargon, as well as promoting discussion on issues such as the
use of touch, the individuality of emotional responses and
what may be as a compassionate and empathie approach.
Negative comments from role-players related to the problems
of drama students and clinical staff balancing role-playing
sessions with the requirements of academic courses or chnical
practice. Although seven role-players were initially trained
this proved inadequate to meet the needs of a large faculty of
health. Since the initial 26 sessions, the majority of the drama
students have undertaken additional CST sessions within the
faculty, expanding the repertoire of their work. This may be
a useful bridge between university and their employment.
Practical issues and recommendations
for the future
In a large faculty of health, adding experiential sessions to the
curriculum has the capacity to increase lecturers' workloads,
though this did not prove to be a barrier to implementing
changes. A coordinator—the role undertaken here by a
lecturer—is also needed to contact role-players, organise
their attendance and ensure they arrive in the classroom in
good time. The long-term benefits of the session to students
also need to be assessed. Some debriefing is usually required
between facihtator and role-player before and after the
session. If, as happened occasionally, an actor was unable to
attend at short notice another lecturer or one of the two
facilitators undertook the acting role. Although this was
appreciated by facihtators, the actors were considered by
the .facilitators as more effective. There were costs incurred
including the role-player training and an hourly rate paid to
the role-players. Initially funded as a pilot project, the project
has been successful in attracting an HEA Grant Collaborative
Grant to develop the initiative. Working in collaboration
with a primary care trust and two hospices it is hoped to
develop first-year nursing CST sessions and pilot sessions,
with increasing complexity in the second and final years—
perhaps video-recording role-plays to promote reflection.
Such a vision is supported by Waters and Whyte (2012) who
also suggest communication skills should be taught with
increasing levels of complexity throughout the three years
of nurse training.
Conclusion
Using role-players within CST is a productive way of
introducing student nurses across allfieldsto communication
skills that may assist them in clinical practice. It appears, in
addition, to be a useful way of exposing students to issues
more commonly encountered in other fields, enhancing
their repertoire of skills. Notably, the scenarios highlighted
the commonality of mental health and emotional issues as
3 well as the need to assist patients with learning difficulties,
1 and making reasonable adjustments to ensure care equality.
^ The latter may be particularly pertinent in view of the
2 rising concern of care of people with learning difficulties,
o particularly at the end of hfe. Drama students acting as
KEY POINTS
I Research indicates effective communication si<iils training (CST- recuüres
experiential iearning using roie-play and skiiied faciiitation, including constructive
feedback for students
I Large student numbers and financiai constraints can nnai<e the integration of
experiential communication training in a iarge facuity of heaith challenging
lUsing drama students to undertake the roie of patients and cara-s is
cost-effective and mutually beneficial
I Using pre-written scenarios focusing on commonly occurring issues in
adult, mental health, learning disabilities and children's nursing can raise
students' awareness of the range of communication issues they will encounter
in clinical practice
I Statistical analysis of confidence levels suggests the differences bet»veen
pre- and post-session scores have statistical and clinical significance across all
fields x)f nursing
role-players are a cost effective means of providing such
teaching and it appears to be a useful addition to their own
portfolio. Providing a structure for such sessions is helpful
in providing a protective and supportive environment with
success perhaps improving performance in OSCE style
examinations. Such teaching should be integrated into ail
three years of a nursing programme, although further research
is needed to assess the benefits of such teaching in chnicsl
practice and on patients. D Q
Conflict of interest: none
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