Systematic Reviews and Meta Analysis
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Use of Standardized patient in Nursing Education: A Systematic Review

Year 2020, Volume 1, Issue 2, 12 - 37, 21.10.2020

Abstract

Nursing students’ education begins in the classroom prior to clinical training. The use of standardized patient during the education process is an alternative to traditional teaching methods. By enhancing the interaction between classroom and clinics, standardized patients in nursing education may contribute to the learning process by providing a realistic clinical learning experience in the classroom prior to actual clinical education. This systematic review was intended to investigate the studies that have evaluated the outcomes of standardized patient use in nursing education. A literature review was conducted by searching the databases of “CINAHL Plus”, “Medline”, “Health Source: Nurse/Academic Edition ( EBSCO host)”, “Sciences Direct“ and “Google Scholar” through 573 articles. Articles were selected from a pile of full text studies that were written in Turkish or English, released in the last decade (January, 2015 – April, 2015) and found by entering the keywords of “simulated patients”, “standardized patients”, “nursing education”, “simulated patients in nursing” and “standardized patients in nursing”. Of these studies, 22 matching the research criteria were included in this study. A systematic review was carried out according to the recommendations of the Cochrane Collaboration. The selected studies were divided into two groups of which one group evaluated the cognitive abilities and the other evaluated the psychomotor skills of the students. Selected articles were assigned to be used in experimental, quasi-experimental, descriptive and mixed research designs. In 7 of the studies, it has been determined that training with a standardized patient helps students to acquire communication skills. In addition, 7 of the studies reported an increase in students’ satisfaction, self-efficacy, and self-confidence levels after training with a standardized patient. Students evaluated the use of standardized patient in nursing education as a beneficial and positive experience as it provides a realistic case presentation. Although training with standardized patients in nursing education can be expensive and time consuming, it is considered an effective teaching method that contributes to students’ satisfaction, self-efficacy and self-confidence, and improves their communication and motor skills.

References

  • Barnett, G.V., Hollister, L., Hall, S.(2011), Use of the Standardized Patient to Clarify Interdisciplinary Team Roles. Clinical Simulation in Nursing, 7(5): e169–e173
  • Barrows HS. (1993), An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC Acad Med,68:443-51.
  • Becker K. L, Rose LE, Berg J B, Park H, Shatzer J H (2006),The Teaching Effectiveness of Standardized Patients, Journal of Nursing Education, 45(4):103-111.
  • Beigzadeh, A., Bahmanbijri, B., Sharifpoor, E., & Rahimi, M. (2016). Standardized patients versus simulated patients in medical education: are they the same or different. Journal of Emergency Practice and Trauma, 2(1), 25-28.
  • Beischel, K. P., Hart, J., Turkelson, S., & Churchill, J. (2014). Using a standardized patient to teach fall safety. Clinical Simulation in Nursing, 10(4), e183-e190.
  • Beullens J, Rethans JJ, Goedhuys J, Buntinx, F (1997). The use of standardized patients in research in general practice. Family Practice, 14 (1), 58-62.
  • Bland, A. J., Topping, A., Wood, B. A. (2011). Concept analysis of simulation as a learning strategy ın the education of undergraduate nursing students. Nurse Education Today, 31(7), 664- 70.
  • Bornais J K, Raiger J E,. Krahn R E,. El-Masri M ( 2012).Evaluating undergraduate nursing students' learning using standardized patients Journal of Professional Nursing, 28(5): 291–296.
  • Buxton, M., Phillippi, J. C., Collins, M. R. (2015). Simulation: a new approach to teaching ethics. Journal of Midwifery Womens Health, 60(1), 70-4.
  • Churchouse, C., & McCafferty, C. (2012). Standardized patients versus simulated patients: Is there a difference? Clinical Simulation in Nursing, 8(8), e363-e365. doi:10.1016/j.ecns.2011.04.008
  • Dikici MF, Yarış F. (2007),Ondokuz Mayıs Üniversitesi Tıp Fakültesi klinik beceri eğitiminde standardize ve simüle hasta programı. Türkiye Klinikleri Journal Medical Sciences, 27; 738-743.
  • Fink, M., Linnard-Palmer, L., Ganley, B., Catolico, O., & Phillips, W. (2014). Evaluating the use of standardized patients in teaching spiritual care at the end of life. Clinical Simulation in Nursing, 10(11), 559-566.
  • Flynn K. (2012),The use of standardized patients to minimize anxiety in undergraduate nursing students in the clinical setting. Master of arts in nursing theses:58.
  • Gaba D M.(2004), The future vision of simulation in health care, Quality&Safety Health Care;13(1):2-10.
  • Higgins, J. P., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions (Vol. 4). John Wiley & Sons.
  • Kameg, K. M., Szpak, J. L., Cline, T. W., & Mcdermott, D. S. (2014). Utilization of standardized patients to decrease nursing student anxiety. Clinical Simulation in Nursing, 10(11), 567-573.
  • Karadag, M, Calıskan, N, Iseri, P, (2015). Effects of Case Studies and Simulated Patients on Students’ Nursing Care Plan, International Journal of Nursing Knowledge ( in print) DOI: 10.1111/2047-3095.12080.
  • Kilgore, R. V., Goodwin, M. E., Harding, R. A. (2013). Adding Context to a Simulation Module for Leadership and Management Baccalaureate Nursing Students. Journal of Nursing Education and Practice, 3(9).
  • Kim-Godwin, Y. S., Livsey, K. R., Ezzell, D., & Highsmith, C. (2013). Home visit simulation using a standardized patient. Clinical Simulation in Nursing, 9(2): e55-e61. doi:10.1016/j.ecns.2011.09.003.
  • Kowitlawakul Y, Chow YL, Salam ZH, Ignacio J (2015). Exploring the use of standardized patients for simulation-based learning in preparing advanced practice nurses. Nurse Educ Today. 2015 Jul;35(7):894-9.
  • Kurz J.M, Mahoney, K, Martin-Plank, L., Lidicker, J. (2009), Objective Structured Clinical Examination and Advanced Practice Nursing Students Journal of Professional Nursing, 25 (3): 186–191.
  • Levine A, Swartz M.(2008), Standardized patients: The “other” simulation. J Crit Care ;23: 179–184.
  • Lin ECL, Chen SL, Chao SY, Chen YC ( 2013), Using standardized patient with immediate feedback and group discussion to teach interpersonal and communication skills to advanced practice nursing students. Nurse Education Today,
  • Luctkar-Flude M, Wilson-Keates B, Larocque M (2012), Evaluating high-fidelity human simulators and standardized patients in an undergraduate nursing health assessment course, Nurse Education Today ,32: 448–452.
  • Mackey S, Tan K.K, Ignacio J., Palham S., Dawood R.B., Liaw S.Y. ( 2014). The learning experiences of senior student nurses who take on the role of standardised patient: a focus group study. Nurse Education Practice;14(6):692-7.
  • May, W, Park, J.H., Lee,J.P.,( 2009). A ten-year review of the literature on the use of standardized patients in teaching and learning: 1996–2005. Med. Teach. 31 (6),487–492. Metcalfe SE, Hall VP, Carpenter A. (2007),Promoting coolaboration in nursing education: The development of regional simuulation laboratory. J Prof. Nurse;23:180-183.
  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med, 6(7), e1000097.
  • Ndiwane, A., Koul, O., & Theroux, R. (2014). Implementing standardized patients to teach cultural competency to graduate nursing students. Clinical Simulation in Nursing, 10(2), e87-e94.
  • Oh PJ, Jeon KD, Koh MS. (2015),The effects of simulation-based learning using standardized patients in nursing students: A meta-analysis. Nurse Educ Today. 2015 May;35(5):e6-e15.
  • Rauen CA. (2004),Simulation As A Teaching strategy for nursing education and orientation in cardiac surgery. Crit Care Nurs Quarterly;24(3):46-51
  • Rhodes LM Curran C. (2005),Use of the human patient simulator t o teach clinical judgment skills in a baccalaureate nursing program. Computer, Informatics. Nursing;23(5): 256-262.
  • Robinson-Smith, G., Bradley, P., & Meakim, C. (2009). Evaluating the use of standardized patients in undergraduate psychiatric nursing experiences. Clinical Simulation in Nursing, 5(6):e203-e211. doi:10.1016/j.ecns.2009.07.001.
  • Rutherford-Hemming, T., & Jennrich, J. (2013). Using standardized patients to strengthen nurse practitioner competency in the clinical setting. Nursing Education Perspective, 34(2), 118-121.
  • Ryan C A, Walshe N, Gaffney R, Shanks A, Burgoyne L, Wiskin C M (2010), Using standardized patients to assess communication skills in medical and nursing students, BMC Medical Education, 10:24:1-8.
  • Ryan CA, Walshe N, Gaffney R,Shanks A, Burgoyne L,Wiskin CM . (2010),Using standardized patients to assess communication skills in medical and nursing students. BMC Med Educ;10 (24):1–8.
  • Sarıkoç G, Özcan CT, Elçin M .(2016), An Innovative Practice in Psychiatric Nursing Education: Standardized Patients Dokuz Eylül University Nursing Faculty journal 2016, 9(2), 61-66.
  • Sarmasoglu S, Dinç L, Elçin M.(2015) Using Standardized Patients in Nursing Education: Effects on Students' Psychomotor Skill Development. Nurse Educ. 2015 Jun 20. [Epub ahead of print]
  • Schram, A. P., & Mudd, S. (2015). Implementing standardized patients within simulation in a nurse practitioner program. Clinical Simulation in Nursing, 11(4), 208-213.
  • Sharpnack, P. A., Goliat, L., & Rogers, K. (2011) Using standardized patients to teach leadership competencies. Clinical Simulation in Nursing, 9(3), e95-e102.
  • Shin, H., Ma, H., Park, J., Ji E. S., Kim, D. H. (2015). The effect of simulation courseware on critical thinking in undergraduate nursing students: multi-site pre-post study. Nurse Education Today, 35(4), 537- 42.
  • Theroux, R., & Pearce, C. (2006). Graduate students’ experiences with standardized patients as adjuncts for teaching pelvic examinations. Journal of the American Academy of Nurse Practitioners, 18(9), 429-435.
  • Titzer, J. L., Swenty, C. F., Hoehn, W. G. (2012). An Interprofessional Simulation Promoting Collaboration and Problem Solving Among Nursing and Allied Health Professional Students. Clinical Simulation in Nursing, 8(8), 325-333.
  • Vu NV, Barrows H S. (1994). Use of standardized patients in clinical assessments: recent developments and measurement findings. Education Research, 23: 23-30.
  • Webster, D. (2014). Using standardized patients to teach therapeutic communication in psychiatric nursing. Clinical Simulation in Nursing, 10(2), e81-e86.
  • Whiting, P., Savović, J., Higgins, J. P., Caldwell, D. M., Reeves, B. C., Shea, B., ... & Churchill, R. (2016). ROBIS: a new tool to assess risk of bias in systematic reviews was developed. Journal of clinical epidemiology, 69, 225-234.
  • Zavertnik, J. E., Huff, T. A; Munro, C. L, (2010). Innovative Approach to Teaching Communication Skills to Nursing Students. Journal of Nursing Education ,49.2 : 65-71.

Hemşirelik Eğitiminde Standardize Hasta Kullanımı: Sistematik İnceleme

Year 2020, Volume 1, Issue 2, 12 - 37, 21.10.2020

Abstract

Hemşirelik öğrencilerinin beceri öğretimi sınıfta başlayıp klinik uygulamayla devam eden bir süreci kapsar. Bu eğitim sürecinde Standardize hasta kullanımı geleneksel öğretim yöntemlerine alternatif olan bir yaklaşımdır. Standardize hasta kullanımı sınıfla klinik arasındaki engeli kaldırarak, öğrencinin gerçek klinik ortama gitmeden önce sınıf ortamında gerçekçi bir klinik öğrenme deneyimini yaşayarak öğrenmesine katkı sağlamaktadır. Bu sistematik inceleme, hemşirelik eğitiminde standardize hasta kullanımının sonuçlarını değerlendiren çalışmaları sistematik olarak incelemek amacıyla planlanmıştır. Çalışmanın evrenini Aralık 2014 -Nisan 2015 tarihinde “CINAHL Plus”, “Medline”, “Health Source: Nurse/Academic Edition( EBSCO host)” “Sciences Direct “ veri tabanları ile “Google Scholar” kaynaklarından taranarak ulaşılan 573 makale oluşturmuştur. İnceleme “Simulated Patients”, Standardized Patients”,“ “nursing education” ,“Simulated Patients in nursing” ve “Standardized Patients in nursing” anahtar kelimeleriyle son on yılda yayınlanmış (Ocak 2005- Nisan 2015), yayın dili Türkçe ya da İngilizce olan ve tam metni bulunan makaleler seçilmiştir. Bu makalelerden araştırma kriterlerini karşılayan toplam 23 çalışma incelemenin örneklemini oluşturmuştur. Hemşirelik eğitiminde standardize hasta kullanımına ilişkin çalışmaların sistematik incelemesi, bilişsel becerileri ve psikomotor becerileri değerlendiren araştırmalar olarak iki grup altında gerçekleştirilmiştir. Çalışmaya dahil edilen makalelerde deneysel, yarı deneysel ve tanımlayıcı ve mix araştırma tasarımlarının kullanıldığı saptanmıştır. Araştırmaların 8’inde, iletişim becerilerinin kazandırılmasında standardize hasta ile eğitimin etkili olduğu belirlenmiştir. Ayrıca 7 araştırmada da standardize hasta ile eğitimden sonra öğrencilerin, memnuniyeti, öz etkililik ve öz güven düzeylerinde artma saptanmıştır. Öğrenciler standardize hasta ile çalışmayı gerçekçi vaka sunumu nedeniyle yararlı ve olumlu deneyim olarak algılamışlardır. Hemşirelik eğitiminde standardize hasta ile çalışma pahalı ve zaman alıcı bir eğitim yöntemi olmasına karşın öğrenciye iletişim ve motor becerilerinin kazandırmasının yanı sıra öğrenci memnuniyeti, öz etkililik ve öz güvenin de gelişmesine katkı sağlayan bir öğrenme yöntemi olduğu görülmektedir.

References

  • Barnett, G.V., Hollister, L., Hall, S.(2011), Use of the Standardized Patient to Clarify Interdisciplinary Team Roles. Clinical Simulation in Nursing, 7(5): e169–e173
  • Barrows HS. (1993), An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC Acad Med,68:443-51.
  • Becker K. L, Rose LE, Berg J B, Park H, Shatzer J H (2006),The Teaching Effectiveness of Standardized Patients, Journal of Nursing Education, 45(4):103-111.
  • Beigzadeh, A., Bahmanbijri, B., Sharifpoor, E., & Rahimi, M. (2016). Standardized patients versus simulated patients in medical education: are they the same or different. Journal of Emergency Practice and Trauma, 2(1), 25-28.
  • Beischel, K. P., Hart, J., Turkelson, S., & Churchill, J. (2014). Using a standardized patient to teach fall safety. Clinical Simulation in Nursing, 10(4), e183-e190.
  • Beullens J, Rethans JJ, Goedhuys J, Buntinx, F (1997). The use of standardized patients in research in general practice. Family Practice, 14 (1), 58-62.
  • Bland, A. J., Topping, A., Wood, B. A. (2011). Concept analysis of simulation as a learning strategy ın the education of undergraduate nursing students. Nurse Education Today, 31(7), 664- 70.
  • Bornais J K, Raiger J E,. Krahn R E,. El-Masri M ( 2012).Evaluating undergraduate nursing students' learning using standardized patients Journal of Professional Nursing, 28(5): 291–296.
  • Buxton, M., Phillippi, J. C., Collins, M. R. (2015). Simulation: a new approach to teaching ethics. Journal of Midwifery Womens Health, 60(1), 70-4.
  • Churchouse, C., & McCafferty, C. (2012). Standardized patients versus simulated patients: Is there a difference? Clinical Simulation in Nursing, 8(8), e363-e365. doi:10.1016/j.ecns.2011.04.008
  • Dikici MF, Yarış F. (2007),Ondokuz Mayıs Üniversitesi Tıp Fakültesi klinik beceri eğitiminde standardize ve simüle hasta programı. Türkiye Klinikleri Journal Medical Sciences, 27; 738-743.
  • Fink, M., Linnard-Palmer, L., Ganley, B., Catolico, O., & Phillips, W. (2014). Evaluating the use of standardized patients in teaching spiritual care at the end of life. Clinical Simulation in Nursing, 10(11), 559-566.
  • Flynn K. (2012),The use of standardized patients to minimize anxiety in undergraduate nursing students in the clinical setting. Master of arts in nursing theses:58.
  • Gaba D M.(2004), The future vision of simulation in health care, Quality&Safety Health Care;13(1):2-10.
  • Higgins, J. P., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions (Vol. 4). John Wiley & Sons.
  • Kameg, K. M., Szpak, J. L., Cline, T. W., & Mcdermott, D. S. (2014). Utilization of standardized patients to decrease nursing student anxiety. Clinical Simulation in Nursing, 10(11), 567-573.
  • Karadag, M, Calıskan, N, Iseri, P, (2015). Effects of Case Studies and Simulated Patients on Students’ Nursing Care Plan, International Journal of Nursing Knowledge ( in print) DOI: 10.1111/2047-3095.12080.
  • Kilgore, R. V., Goodwin, M. E., Harding, R. A. (2013). Adding Context to a Simulation Module for Leadership and Management Baccalaureate Nursing Students. Journal of Nursing Education and Practice, 3(9).
  • Kim-Godwin, Y. S., Livsey, K. R., Ezzell, D., & Highsmith, C. (2013). Home visit simulation using a standardized patient. Clinical Simulation in Nursing, 9(2): e55-e61. doi:10.1016/j.ecns.2011.09.003.
  • Kowitlawakul Y, Chow YL, Salam ZH, Ignacio J (2015). Exploring the use of standardized patients for simulation-based learning in preparing advanced practice nurses. Nurse Educ Today. 2015 Jul;35(7):894-9.
  • Kurz J.M, Mahoney, K, Martin-Plank, L., Lidicker, J. (2009), Objective Structured Clinical Examination and Advanced Practice Nursing Students Journal of Professional Nursing, 25 (3): 186–191.
  • Levine A, Swartz M.(2008), Standardized patients: The “other” simulation. J Crit Care ;23: 179–184.
  • Lin ECL, Chen SL, Chao SY, Chen YC ( 2013), Using standardized patient with immediate feedback and group discussion to teach interpersonal and communication skills to advanced practice nursing students. Nurse Education Today,
  • Luctkar-Flude M, Wilson-Keates B, Larocque M (2012), Evaluating high-fidelity human simulators and standardized patients in an undergraduate nursing health assessment course, Nurse Education Today ,32: 448–452.
  • Mackey S, Tan K.K, Ignacio J., Palham S., Dawood R.B., Liaw S.Y. ( 2014). The learning experiences of senior student nurses who take on the role of standardised patient: a focus group study. Nurse Education Practice;14(6):692-7.
  • May, W, Park, J.H., Lee,J.P.,( 2009). A ten-year review of the literature on the use of standardized patients in teaching and learning: 1996–2005. Med. Teach. 31 (6),487–492. Metcalfe SE, Hall VP, Carpenter A. (2007),Promoting coolaboration in nursing education: The development of regional simuulation laboratory. J Prof. Nurse;23:180-183.
  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med, 6(7), e1000097.
  • Ndiwane, A., Koul, O., & Theroux, R. (2014). Implementing standardized patients to teach cultural competency to graduate nursing students. Clinical Simulation in Nursing, 10(2), e87-e94.
  • Oh PJ, Jeon KD, Koh MS. (2015),The effects of simulation-based learning using standardized patients in nursing students: A meta-analysis. Nurse Educ Today. 2015 May;35(5):e6-e15.
  • Rauen CA. (2004),Simulation As A Teaching strategy for nursing education and orientation in cardiac surgery. Crit Care Nurs Quarterly;24(3):46-51
  • Rhodes LM Curran C. (2005),Use of the human patient simulator t o teach clinical judgment skills in a baccalaureate nursing program. Computer, Informatics. Nursing;23(5): 256-262.
  • Robinson-Smith, G., Bradley, P., & Meakim, C. (2009). Evaluating the use of standardized patients in undergraduate psychiatric nursing experiences. Clinical Simulation in Nursing, 5(6):e203-e211. doi:10.1016/j.ecns.2009.07.001.
  • Rutherford-Hemming, T., & Jennrich, J. (2013). Using standardized patients to strengthen nurse practitioner competency in the clinical setting. Nursing Education Perspective, 34(2), 118-121.
  • Ryan C A, Walshe N, Gaffney R, Shanks A, Burgoyne L, Wiskin C M (2010), Using standardized patients to assess communication skills in medical and nursing students, BMC Medical Education, 10:24:1-8.
  • Ryan CA, Walshe N, Gaffney R,Shanks A, Burgoyne L,Wiskin CM . (2010),Using standardized patients to assess communication skills in medical and nursing students. BMC Med Educ;10 (24):1–8.
  • Sarıkoç G, Özcan CT, Elçin M .(2016), An Innovative Practice in Psychiatric Nursing Education: Standardized Patients Dokuz Eylül University Nursing Faculty journal 2016, 9(2), 61-66.
  • Sarmasoglu S, Dinç L, Elçin M.(2015) Using Standardized Patients in Nursing Education: Effects on Students' Psychomotor Skill Development. Nurse Educ. 2015 Jun 20. [Epub ahead of print]
  • Schram, A. P., & Mudd, S. (2015). Implementing standardized patients within simulation in a nurse practitioner program. Clinical Simulation in Nursing, 11(4), 208-213.
  • Sharpnack, P. A., Goliat, L., & Rogers, K. (2011) Using standardized patients to teach leadership competencies. Clinical Simulation in Nursing, 9(3), e95-e102.
  • Shin, H., Ma, H., Park, J., Ji E. S., Kim, D. H. (2015). The effect of simulation courseware on critical thinking in undergraduate nursing students: multi-site pre-post study. Nurse Education Today, 35(4), 537- 42.
  • Theroux, R., & Pearce, C. (2006). Graduate students’ experiences with standardized patients as adjuncts for teaching pelvic examinations. Journal of the American Academy of Nurse Practitioners, 18(9), 429-435.
  • Titzer, J. L., Swenty, C. F., Hoehn, W. G. (2012). An Interprofessional Simulation Promoting Collaboration and Problem Solving Among Nursing and Allied Health Professional Students. Clinical Simulation in Nursing, 8(8), 325-333.
  • Vu NV, Barrows H S. (1994). Use of standardized patients in clinical assessments: recent developments and measurement findings. Education Research, 23: 23-30.
  • Webster, D. (2014). Using standardized patients to teach therapeutic communication in psychiatric nursing. Clinical Simulation in Nursing, 10(2), e81-e86.
  • Whiting, P., Savović, J., Higgins, J. P., Caldwell, D. M., Reeves, B. C., Shea, B., ... & Churchill, R. (2016). ROBIS: a new tool to assess risk of bias in systematic reviews was developed. Journal of clinical epidemiology, 69, 225-234.
  • Zavertnik, J. E., Huff, T. A; Munro, C. L, (2010). Innovative Approach to Teaching Communication Skills to Nursing Students. Journal of Nursing Education ,49.2 : 65-71.

Details

Primary Language English
Subjects Nursing
Journal Section Research Articles
Authors

Mevlüde KARADAĞ (Primary Author)
YÜKSEK İHTİSAS ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ
0000-0003-3258-6459
Türkiye


Nuriye YILDIRIM ŞİŞMAN
DÜZCE ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ
0000-0003-3745-3751
Türkiye


Nurcan ÇALIŞKAN
GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ
0000-0002-4611-2230
Türkiye

Publication Date October 21, 2020
Published in Issue Year 2020, Volume 1, Issue 2

Cite

APA Karadağ, M. , Yıldırım Şişman, N. & Çalışkan, N. (2020). Use of Standardized patient in Nursing Education: A Systematic Review . Cerrahi Ameliyathane Sterilizasyon Enfeksiyon Kontrol Hemşireliği Dergisi , 1 (2) , 12-37 . Retrieved from https://dergipark.org.tr/en/pub/caseh/issue/57416/785363