1. Bryant, Susan G. MSN, RN, CNE, CHSE

Article Content

Novice nursing students learn to collect objective and subjective data to plan and implement care for patients. Evaluation methods for checking health assessment performance in prelicensure nursing students are not well documented in the literature. This article describes how 1 associate degree nursing (ADN) program planned and implemented a method of using volunteer second year (SY) nursing students in combination with genitourinary (GU) partial task trainer models (lifelike models of human body parts) for testing first year (FY) students on performing head-to-toe assessments.



Students in our southeastern US ADN program start to learn focused assessments during the fourth week of the nursing program. Students practice with classmates and are evaluated by demonstrating each system-focused assessment on partners throughout the course. The final skills check-off of the first semester is a complete head-to-toe assessment. Students failing the first time must remediate before a second attempt. Several years ago, students in our program performed physical assessments on manikins for this final check-off, but limitations included lack of motor and verbal responses and decreased realism.


More recently, our FY students have been evaluated by performing assessments on peers from their class at the end of their first 16-week course. There were several drawbacks to this method of testing. The evaluation experience was not standardized, and the second student to be tested had an extra advantage by being present during the first student's check-off. There also was no opportunity for students to demonstrate assessment of the GU system. In addition, there was the potential breach of confidence for students knowing if one of the pair failed the assessment. Because of the disadvantages of testing pairs of nursing students, FY nursing faculty explored the idea of changing the method of evaluating head-to-toe assessments.


Standardized patients, individuals trained to portray patients in health care situations, are hired and trained to act the part of patients and give immediate constructive feedback to students.1-4 We do not currently have a standardized patient program at our community college. Instead, we chose to try having SY students, the seniors in our 2-year nursing program, volunteer as patient actors.


Literature Review

The literature supports use of standardized patients for practice and evaluation of skills and physical assessment in prelicensure nursing programs.3-5 Standardized patients add realism,3,6 provide opportunities to develop communication skills,1,6 and reduce anxiety and stress before students work with real patients.3 Some authors have reported good student outcomes by recruiting nursing alumni,1 prenursing students,2 and community volunteers6 to play the role of patients for assessments.


Patient Actor Recruitment

Both FY and SY faculty planned the testing dates to ensure no conflicts with SY classes, tests, or other activities. About 6 weeks before the planned check-offs, we asked SY faculty to poll their students to assess interest in this volunteer opportunity. We informed them we would award certificates for service, and several SY students volunteered immediately.



Three FY faculty members were scheduled to evaluate the assessments. We planned 30-minute check-off time slots, 3 testing sessions over 2 days, and 3 SY patient actors for each 11/2- to 2-hour session. We planned for the student actors to use their own name and age for simplicity and realism. First year faculty developed 3 simple scripts, including assigned allergies, medications, and family history. We created a paper folder "chart" with name, date of birth, and matching identification armband for each actor. We adapted a standardized patient confidentiality agreement for SY students to agree to keep testing content and performance confidential.


Three days before testing, FY faculty members met with the SY students to prebrief them on roles and expectations. We instructed them to follow the scripts, not disclose their own health conditions and histories, refrain from prompting students being tested, and answer only what they were asked. We also told them to ask for clarification if FY students used medical terminology instead of layperson's terms. All SY students signed the confidentiality agreement stating that they would not discuss the content, performance, or results of FY student testing with any other students.


On the day of testing, we placed a GU partial task trainer model in each examination room on a chair next to the SY student. We covered it with a gown so that it was not immediately visible when the FY students entered the room. We showed these task trainers to the SY students and informed them that the FY students would be expected to examine the models when it was time to examine the GU system.



Three FY students were assigned to each 30-minute time slot and directed to wait in a classroom with a sign-in sheet. Each of the 3 examination rooms had hand sanitizer, alcohol swabs for cleaning stethoscopes, 1 SY patient actor with a script, a GU partial task trainer model, and 1 faculty member evaluating the check-offs. The briefing information we gave to the FY students was that their patient was scheduled for a screening colonoscopy and needed a pre-procedure physical assessment and health history.


Faculty used a check-off sheet for evaluation during observation of the head-to-toe assessment. After each FY nursing student stated he/she was finished with the assessment procedure, the SY patient actor left the room while the instructor gave immediate feedback to the student about the performance according to the check-off sheet. All students finished the assessment during their 30-minute scheduled session, although not all students were successful. Students who failed the assessment worked with the nursing tutor and retested 2 days later.


Student Feedback

The SY students gave verbal feedback that they enjoyed the experience. They also thought it was a good learning opportunity for FY students and was more structured and fairer than testing with student pairs, which they had for their own head-to-toe check-offs during the previous year. The SY students appreciated receiving personalized certificates for volunteer service to add to their student portfolios. A few FY students remarked that it was intimidating to test with upper level students instead of practice partners from their own class.


Faculty Feedback

All FY faculty members agreed that this method of evaluating head-to-toe assessment provided a more realistic situation and improved communication opportunities for students, similar to findings in the literature1,3,6 and compared with testing strategies used in past years. It also allowed for some control of generating abnormal examination findings and incorporated a way for students to demonstrate assessment of the GU system.


Future Considerations

A disadvantage of having SY students act as patients is that there are few to no abnormal physical findings. One way of providing more findings for SY students to assess would be to integrate additional partial task trainer models or manikins with abnormalities or provide stations such as those used in Objective Structured Clinical Exams.5 Developing a formal evaluation for FY students to give feedback on the testing experience should be explored to make improvements.



Faculty members in our ADN program wanted to improve the method of evaluating first semester nursing students' head-to-toe assessment skills. We recruited SY students to volunteer as patient actors in conjunction with GU partial task trainer models. This method provided better standardization, less invasion of privacy, and a more equal testing opportunity for FY students than in previous years. We plan to use this method of head-to-toe assessment skills check-offs with future nursing classes and believe that this strategy may be useful for other prelicensure nursing programs.




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