Using Standardized Patient Simulation in Undergraduate Nursing Education: A Scoping Review

Published:November 15, 2022DOI:


      • Using the policies and/or procedures will be helpful for standardized patient simulations.
      • There is currently a lack of evidence of safety practice and higher-level outcomes.
      • The experiences of facilitators and standardized patients are sometimes forgotten.



      To explore the evidence related to how standardized patient simulations are used in undergraduate nursing education according to the NLN (National League for Nursing)/Jeffries Simulation Framework for Simulated Participant Methodology.


      This review used the Preferred Reporting Items of Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR). Three data sources were used, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, and PubMed. Peer-reviewed studies published between January 2016 to March 2022 were searched across three data sources. Full-text articles were reviewed using ATLAS.ti software.


      The search identified 196 articles, and 13 articles were included. The lack of safety application, standardized patient hiring, using higher-level outcomes, using policies and procedures, and experiences of students, facilitators, and standardized patients were identified as gaps in the literature.


      While conducting standardized patient simulations in nursing is growing, it is necessary to ensure that the experience is theoretically grounded. Using procedures for implementing the standardized patient simulation method may help design higher quality and efficient learning experiences.


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        • Arksey H.
        • O'Malley L.
        Scoping studies: Towards a methodological framework.
        International Journal of Social Research Methodology: Theory and Practice. 2005; 8: 19-32
        • Bani-Issa W.
        • Tamimi M.A.
        • Fakhry R.
        • Tawil H.A.
        Experiences of nursing students and examiners with the objective structured clinical examination method in physical assessment education: A mixed methods study.
        Nurse Education in Practice. 2019; 35: 83-89
        • Blumling A.
        • Kameg K.
        • Cline T.
        • Szpak J.
        • Koller C.
        Evaluation of a standardized patient simulation on undergraduate nursing students’ knowledge and confidence pertaining to intimate partner violence.
        Journal of Forensic Nursing. 2018; 14: 174-179
        • Byrne D.
        Evaluating cultural competence in undergraduate nursing students using standardized patients.
        Teaching & Learning in Nursing. 2020; 15: 57-60
        • Byrne D.
        • Overbaugh K.
        • Czekanski K.
        • Wilby M.
        • Blumenfeld S.
        • Laske R.A.
        Assessing undergraduate nursing students’ attitudes toward the dying in an end-of-life simulation using an ACE.S unfolding case study.
        Journal of Hospice and Palliative Nursing. 2020; 22: 123-129
        • Cant R.P.
        • Cooper S.J.
        Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review.
        Nurse Education Today. 2017; 49: 63-71
        • Coleman D.
        • McLaughlin D.
        Using simulated patients as a learning strategy to support undergraduate nurses to develop patient-teaching skills.
        British Journal of Nursing. 2019; 28: 1300-1306
        • Cowperthwait A.
        NLN/Jeffries simulation framework for simulated participant methodology.
        Clinical Simulation in Nursing. 2020; 42: 12-21
        • Donovan L.M.
        • Mullen L.K.
        Expanding nursing simulation programs with a standardized patient protocol on therapeutic communication.
        Nurse Education in Practice. 2019; 38: 126-131
        • Gamble A.S.
        Simulation in undergraduate paediatric nursing curriculum: Evaluation of a complex “ward for a day” education program.
        Nurse Education in Practice. 2017; 23: 40-47
        • Guimond M.E.
        • Foreman S.E.
        • Werb M.
        Evaluation of an unfolding obstetric experience simulation in an undergraduate nursing program.
        Nurse Education Today. 2019; 79: 124-128
        • Hickerson K.
        • Hawkins L.A.
        • Hoyt-Brennan A.M.
        Sexual orientation/gender identity cultural competence: A simulation pilot study.
        Clinical Simulation in Nursing. 2018; 16: 2-5
        • Jeffries P.
        The NLN Jeffries simulation theory.
        Lippincott Williams & Wilkins, United States2021
        • Johnson K.V.
        • Scott A.L.
        • Franks L.
        Impact of standardized patients on first semester nursing students self-confidence, satisfaction, and communication in a simulated clinical case.
        SAGE Open Nursing. 2020; 6 (2377960820930153)
        • Kim E.
        • Kim S.S.S.
        • Kim S.S.S.
        Effects of infection control education for nursing students using standardized patients vs. peer role-play.
        International Journal of Environmental Research and Public Health. 2021; 18: 1-14
        • Kucukkelepce G.E.
        • Dinc L.
        • Elcin M.
        Effects of using standardized patients on nursing students’ moral skills.
        Nursing Ethics. 2020; 27: 1587-1602
        • Lavoie P.
        • Cossette S.
        • Pepin J.
        Testing nursing students’ clinical judgment in a patient deterioration simulation scenario: Development of a situation awareness instrument.
        Nurse Education Today. 2016; 38: 61
        • Lewis K.L.
        • Bohnert C.A.
        • Gammon W.L.
        • Hölzer H.
        • Lyman L.
        • Smith C.
        • Thompson T.M.
        • Gliva-McConvey G.
        The association of standardized patient educators (ASPE) standards of best practice (SOBP).
        Advances in Simulation. 2017; 2: 1-8
        • Lioce L.
        • Lopreiato J.
        • Downing D.
        • Chang T.P.
        • Robertson J.M.
        • Anderson M.
        • Spain A.E.
        • the Terminology and Concepts Working Group
        Healthcare simulation cictionary - second edition.
        (2020) Agency for Healthcare Research and Quality, 2020
        • Lubke J.
        • Britt V.
        • Paulus T.M.
        • Atkins D.
        Hacking the literature review.
        Reference and User Services Quarterly. 2017; 56: 285-295
        • Martinez A.J.S.
        Implementing a workplace violence simulation for undergraduate nursing students: A pilot study.
        Journal of Psychosocial Nursing & Mental Health Services. 2017; 55: 39-44
        • Mitchell A.M.
        • Riccelli A.
        • Boucek L.
        • Puskar K.R.
        • Hagle H.
        • Lindsay D.
        Effect on dental hygiene students of a substance use simulation conducted with nursing students.
        Journal of Dental Education. 2018; 82: 469-474
        • Nielson M.H.
        • Warren L.
        • Graham D.
        Promoting collaboration in undergraduate nursing students.
        Journal of Nursing Education. 2019; 58: 657-660
        • Oh P.J.
        • Jeon K.D.
        • Koh M.S.
        The effects of simulation-based learning using standardized patients in nursing students: A meta-analysis.
        Nurse Education Today. 2015; 35: e6-e15
        • Olasoji M.
        • Huynh M.
        • Edward K.
        • Willetts G.
        • Garvey L.
        Undergraduate student nurses’ experience of mental health simulation pre-clinical placement: A pre/post-test survey.
        International Journal of Mental Health Nursing. 2020; 29: 820-830
        • Oliveira
        • Prado
        • Kempfer S.S.
        • Martini J.G.
        • Caravaca-Morera J.A.
        • Bernardi M.C.
        Experiential learning in nursing consultation education via clinical simulation with actors: Action research.
        Nurse Education Today. 2015; 35: e50-e54
        • Ozkara San E.
        • Maneval R.
        • Gross R.E.
        • Myers P.
        Transgender standardized patient simulation: Management of an oncological emergency.
        Journal of Transcultural Nursing. 2019; 30: 627-635
        • Pascucci R.C.
        • Weinstock P.H.
        • O'Connor B.E.
        • Fancy K.M.
        • Meyer E.C.
        Integrating actors into a simulation program: A primer.
        Simulation in Healthcare. 2014; 9: 120-126
        • Pfeiffer K.M.
        • Wands L.
        Setting the stage for psychiatric mental health nursing education: Outcomes of a simulated patient pilot program.
        Clinical Simulation in Nursing. 2021; 59: 75-80
        • Ross M.E.T.
        • Bryan J.L.
        • Thomas K.L.
        • Asghar-Ali A.A.
        • Pickens S.L.
        Elder abuse education using standardized patient simulation in an undergraduate nursing program.
        Journal of Nursing Education. 2020; 59: 331-335
        • Rudolph J.W.
        • Simon R.
        • Dufresne R.L.
        • Raemer D.B.
        There's no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment.
        Simulation in Healthcare. 2019; 1: 49-55
        • Rutherford-Hemming T.
        • Alfes C.M.
        • Breymier T.L.
        A systematic review of the use of standardized patients as a simulation modality in nursing education.
        Nursing Education Perspectives. 2019; 40: 84-90
        • Schams K.
        • Snyder A.
        • Zeller D.
        • Caywood K.
        Learning together: Combining undergraduate and graduate simulated learning for practicing physical assessment Skills.
        Nursing Education Perspectives. 2020; 41: 177-179
        • Shin H.
        • Ma H.
        • Park J.
        • Ji E.S.
        • Kim D.H.
        The effect of simulation courseware on critical thinking in undergraduate nursing students: Multi-site pre-post study.
        Nurse Education Today. 2015; 35: 537-542
        • Slater L.Z.
        • Bryant K.D.
        • Ng V.
        Nursing student perceptions of standardized patient use in health assessment.
        Clinical Simulation in Nursing. 2016; 12: 368-376
        • Smeltzer S.C.
        • Ross J.G.
        • Mariani B.
        • Meakim C.H.
        • Bruderle E.
        • de Mange E.P.
        • Nthenge S.
        Innovative approach to address disability concepts and standardized patients With disability in an undergraduate curriculum.
        The Journal of Nursing Education. 2018; 57: 760-764
        • Soccio D.A.
        Effectiveness of mental health simulation in replacing traditional clinical hours in baccalaureate nursing education.
        Journal of Psychosocial Nursing and Mental Health Services. 2017; 55: 36-43
        • Speeney N.
        • Kameg K.M.
        • Cline T.
        • Szpak J.L.
        • Bagwell B.
        Impact of a standardized patient simulation on undergraduate nursing student knowledge and perceived competency of the care of a patient diagnosed with schizophrenia.
        Archives of Psychiatric Nursing. 2018; 32: 845-849
        • Charnetski M.
        • Jarvill M.
        • Standards Committee, I. N. A. C. S. L.
        Healthcare simulation standards of best practiceTM operations.
        Clinical Simulation in Nursing. 2021; 58: 33-39
        • Decker S.
        • Alinier G.
        • Crawford S.B.
        • Gordon R.M.
        • Jenkins D.
        • Wilson C.
        • Standards Committee, I. N. A. C. S. L.
        Healthcare simulation standards of best practiceTM the debriefing process.
        Clinical Simulation in Nursing. 2021; 58: 27-32
        • Molloy M.A.
        • Holt J.
        • Charnetski M.
        • Rossler K.
        • Standards Committee, I. N. A. C. S. L.
        Healthcare simulation standards of best practiceTM simulation glossary.
        Clinical Simulation in Nursing. 2021; 58: 57-65
        • Svellingen A.H.
        • Søvik M.B.
        • Røykenes K.
        • Brattebø G.
        The effect of multiple exposures in scenario-based simulation—A mixed study systematic review.
        Nursing Open. 2021; 8: 380-394
        • Swift M.C.
        • Stosberg T.
        • Foley A.
        • Brocksmith E.
        Nursing program outcome improves with interprofessional simulation.
        Journal of Allied Health. 2020; 49163A
        • Tamaki T.
        • Inumaru A.
        • Yokoi Y.
        • Fujii M.
        • Tomita M.
        • Inoue Y.
        • Tsujikawa M.
        The effectiveness of end-of-life care simulation in undergraduate nursing education: A randomized controlled trial.
        Nurse Education Today. 2019; 76: 1-7
        • Torkshavand G.
        • Khatiban M.
        • Soltanian A.R.
        Simulation-based learning to enhance students’ knowledge and skills in educating older patients.
        Nurse Education in Practice. 2020; 42
        • Tricco A.C.
        • Lillie E.
        • Zarin W.
        • O'Brien K.K.
        • Colquhoun H.
        • Levac D.
        • Straus S.E.
        PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation.
        Annals of Internal Medicine. 2018; 169: 467-473
        • Uslu Y.
        • Kocatepe V.
        • Unver V.
        • Sagır O.
        • Karabacak U.
        Hybrid simulation in triage training.
        International Journal of Caring Sciences. 2019; 12: 1626-1637
        • Webster D.
        Lights, camera, action: Lessons learned from a nursing and theater collaboration.
        Journal of Nursing Education. 2019; 58: 369-371
        • Yang F.
        • Wang Y.
        • Yang C.
        • Zhou M.H.
        • Shu J.
        • Fu B.
        • Hu H.
        Improving clinical judgment by simulation: A randomized trial and validation of the Lasater clinical judgment rubric in Chinese.
        BMC Medical Education. 2019; 19: 20
        • Yilmazer T.
        • Tuzer H.
        • Inkaya B.
        • Elcin M.
        The impact of standardized patient interactions on nursing students’ preventive interventions for pressure ulcers.
        Journal of Tissue Viability. 2020; 29: 19-23