DRAFT: This module has unpublished changes.

The Meaning of Communication: New York SIM Center Experience 

Kelita Raphael 

CUNY School for Professional Studies

November 26th, 2017





The New York SIM Center Standardized Patient Experience is a experience that I will never forget. It was an invaluable tool designed to help nursing students discover skills in regards to assessment, observation and communication. As a working nurse, I developed habits in terms of assessment that are in need of refinement. Oftentimes, I second guess my clinical judgement and reasoning in patient encounters. Through this Standardized Patient Experience, I have developed the confidence to be assured in my skills as a nurse and in my ability to advocate and sympathize with the patient’s needs. 


In my first encounter, my pre-data displayed a patient experiencing a persistent headache with nasal congestion. My goal was to perform a focused neurological assessment with questions geared towards discovering the cause of the headaches. Throughout the assessment, the patient was noted with cognitive impairments, such as forgetting her age, date of birth and children, as well as family history of stroke and brain tumor. This shift during the assessment required me to adapt to the conversation, asking questions and seeking data that would determine the root cause of the change in memory and cognition. The second patient encounter had a patient experiencing unexplained shortness of breath. My goal was to perform a focused respiratory assessment. During the interview, it was discovered that patient had begun to smoke, her mother recently died and a coworker was attacked. She also had a history of anxiety and expressed a lack of people to talk to. My new goal became to provide education and resources to quit cigarette as well as emotional supports and referrals to psychology and psychiatrist to help with her burgeoning anxiety. 


During these encounters, I used a variety of communication skills such as eye contact, open ended questions, empathy, silence and therapeutic touch. Using open ended questions was successful because it gave the patient the freedom to express herself and divulge information useful for determine her clinical problems and health history. Using empathy worked well because it allowed the patient to develop comfort with me throughout the interview and truly feel that she had an advocate on her side during the interview. We established a non-judgmental zone where information could be confidentially and openly shared and the patient could sense that. During points in the interview, especially the first one, I was repetitive in asking certain questions and obtaining information from the patient. My hesitancy in the first interview caused me to bypass certain clinically relevant information that could have helped in developing the plan of care. I gained insight into observing the patient and picking up on the nonverbal cues. Having the same actress for the first and second interviews allowed me to pick up on the changes in posture, facial expression and eye contact in each encounter. This affected my approach to each patient encounter and determined the methods I would use to obtain appropriate and relevant patient information. 


My greatest challenge during the Standardized Patient Experience was my nerves. I let my nerves get the better of me and even throw me off during parts of my assessment. Near the end of my Patient Experience, I realized I forgot to check the heart rate because of nerves. Also, a lack of mental organization threw me off during the first patient experience. I allowed going through my mental checklist to impact diving into certain information that was clinically relevant. In my second interview, I mentally organized myself in a way that optimized the use of time and allowed me to obtain the most relevant clinical information possible. 


One of the most meaningful things I learned during the Standardized Patient Experience is that I am my own worst critic. Immediately after my first patient encounter, I exclaimed “I did a horrible job!” When I discussed with the Standardized Patient, I divulged my feelings on how I did during the Experience. She told me “We can easily see the flaws in our own work and not the great things we’ve accomplished.” She helped me to realize that confidence, the ability to “fake it until you make it”, is key in patient encounters. The patient must see that they have someone who is competent, self-assured and knowledgeable working alongside them. The image I present as the nurse will impact the entire patient relationship. My patient stated that I have a calm and caring nature that surrounds me which allowed her to want to open up to me, knowing she wouldn’t be judged. During the interviews and after, she sensed that she had a patient advocate in me when I left the room. By having the confidence in one’s skills, I will be able to see myself the way my patients see me and have the confidence to know that I am providing them with the best quality care.   


The Standardized Patient Experience can help me throughout my clinical practice as a rehabilitation nurse. Upon assessment, I should take the time to observe the non-verbal cues that the patient presents in order to determine how to approach the patient best. I should also use communication skills such as empathy, eye contact and use of open ended questions to facilitate conversation during assessment interviews. Finally, the experience taught me to be adaptable to patient encounters. At times, patients can present with a clinical change in health status and what is seen may not be the full story. I have to be adaptable and develop assessment skills that will help me to determine what is going on with the patient to find the best possible solution.


All in all, the New York SIM Standardized Patient Experience is one I will stay with me for a very long time. It helped me to become a better clinician and a better nurse. I am able to have confidence in my nursing judgment and skills, looking to my strengths as a nurse instead of my weaknesses. It taught me the value and importance of communication in patient encounters. The skills I have developed in the Standardized Patient Experience will serve as an added resource in cultivating and developing my skills as a nurse. Participating in this experience helps me to see that the education I receive at CUNY SPS and beyond will ensure and foster continued professional development. 


DRAFT: This module has unpublished changes.