Document Type
Dissertation
Date of Degree
5-11-2026
Primary Advisor
Dale Lupu
Abstract
Background: In nursing education, learning is a blend of didactic knowledge and experiential skills acquisition. Simulation provides an interactive learning experience where the student can take on the nursing role and care for a simulated patient. This simulation experience can be enhanced by utilizing a simulated participant (SP) actor to enhance realism and provide an opportunity to practice skills, such as communication, empathy, or physical interventions. Existing guidance on best simulation practices, such as the Healthcare Simulation Standards of Best Practice, lack specificity on how to evaluate the SP within a healthcare simulation scenario. Similarly, the literature on simulation evaluation is virtually silent on the evaluation of the SP in nursing simulations.
Study Objectives: The purpose of this study was to describe how simulated participants are evaluated in simulation centers at nursing schools in the United States, including the criteria used to evaluate SPs, and the barriers and facilitators to such evaluations.
Methods: This study employed a sequential, explanatory, mixed-methods design. Quantitative data was collected via a Qualtrics survey. The survey collected descriptive data of respondents’ simulation centers, their simulation and SP processes and practices, and the practices used to evaluate their SPs. Data were analyzed in SPSS, and quantitative data informed the development of the semi-structured interview guide. Qualitative data included semi-structured interviews with participants who completed the survey and indicated a desire to participate, as well as those recruited through snowball sampling.
Results: Survey respondents were included in the study if they worked at a school of nursing in the United States and used SPs in their simulation scenarios. There were 55 respondents to the survey. Approximately half of all respondents (56.2%) hold at least one simulation certification (CHSE, CHSE-A, CHSOS, or other). Approximately half of centers held an accreditation from SSH (23.6%), INACSL (10.9%), or other (16.4%). Only 24 centers (43.6%) reported evaluating their SPs. Among those who evaluate, 66.7% use a tool, but only 37.5% report using a validated one. SP evaluations are often conducted by the SP educator, faculty, or SP peer, but in some cases, a student or other simulation staff member provides the evaluation. The frequency of evaluations varies from once a month (4.2%), once a semester (16.7%), or once a year (12.5%). Interview results confirmed survey data, with interviewees reporting inconsistent frequency of evaluations and a lack of routine processes for evaluations. There was a lack of definition across interviewees of what an evaluation entailed, with some centers considering evaluation to be informal feedback given between scenarios, and others using formalized evaluations utilizing a checklist and documented in the simulation center records. Five key criteria for SP evaluation emerged from the interviews: authenticity of performance, adherence to role, quality of feedback, professional behaviors of the SP, and ability to meet learning objectives. Key facilitators to SP evaluation were having the right resources, such as staffing and financial support, systems-level supports, such as accreditation standards and policies, and individual-level supports like simulation knowledge and faculty buy-in. Lack of resources, like time and staffing, limited system- support, and individual-level attributes such as knowledge deficit in simulation pedagogy all presented barriers to evaluating SPs.
Conclusions: Three key interventions are proposed as a result of this study. One, evaluation of SP in nursing simulation needs to be clearly defined, and should be part of future addenda to the standards of best practice. Two, simulation centers should outline the expectations for evaluating their SPs. Professional organizations can develop example implementation guidelines for SP evaluations. Three, the simulation and simulated participant communities should collaborate to develop and validate a tool for the evaluation of SPs that covers the five factors of authenticity, role adherence, feedback quality to learner, professionalism, and ability to meet learning objectives.
Recommended Citation
Nicklas, Amanda C., "Assessing the Actors: A Mixed-Methods Exploration of Simulated Participant Evaluation in Nursing Education" (2026). Doctor of Philosophy in Translational Health Sciences Dissertations. Paper 48.
https://hsrc.himmelfarb.gwu.edu/smhs_crl_dissertations/48
Open Access
1
Comments
©2026 by Amanda C. Nicklas. All rights reserved.