Making the Case for a Change in Patient Education Techniques: Moving Toward Scenario and Simulation-Based Approaches.

Patient education has an important role in nursing. Historically, nurses were trained to provide patient education on disease and self-management using knowledge-transfer resources (Wittink & Oosterhaven, 2018). As health profession education models move toward simulation, patient education may also benefit from greater use of simulation. Simulation is a teaching method that assesses both knowledge and skill levels by placing the learner in a problemsolving scenario. Using simulation in patient education may enhance the patients’ ability to self-manage chronic disease by having them demonstrate problem-solving skills, which can illuminate gaps in knowledge, understanding, and application that can be addressed. This recommendation for greater use of simulation in patient education is supported by the results of a study (Edmiston et al., 2023a, 2023b) in which advanced heart failure patients were assessed concerning three self-management components: knowledge, ability, and problem-solving in a scenario. The people with advanced heart failure consistently scored adequate or high in heart failure knowledge; however, they performed poorly in heart failure self-management ability and problem-solving in a scenario. The patients seemed to have general heart failure self-management knowledge, such as how often to weigh themselves and the causes of heart failure but could not apply that knowledge to problem solve in a scenario about heart failure symptoms. There was a discordance among heart failure self-management knowledge, ability, and decision-making in this sample of people with advanced heart failure. General adult learning theory and principles (Bloom et al., 2001; Kennedy & Parish, 2021) emphasize a hierarchy of learning that builds on knowledge with understanding, followed by application skills. Patients are often given written reading material and are expected to read, understand, and apply the material to their chronic condition. Patients may be quizzed on chronic disease self-management (e.g., How often do you weigh yourself? How much sodium can you have each day?). However, a gap remains between patients’ self-management knowledge, understanding, and application, which results in inadequate self-management and readmissions for fluid overload or other symptoms. Patients must be able to apply knowledge and understanding for effective self-management of chronic disease. Simulation can help bridge this gap. A small number of studies have shown that patient education using scenarios and simulation are successful. Koulas et al. (2021) developed and tested virtual patient scenarios for people with rheumatic disorders and received the “best imaginable” positive reviews from participants. In a randomized controlled trial of people with type 2 diabetes, participants randomized to the group who received simulation education in addition to basic diabetes self-management education had superior glycosylated hemoglobin, fasting plasma glucose, and postprandial blood glucose level improvements at 6 months (Ji et al., 2019). Pennecot et al. (2022) piloted a Simulation in Therapeutic Patient Education intervention with adults diagnosed with diabetes and diabetes educators where the intervention included a pre-briefing, hypoglycemia simulation, and a debriefing. Participants found that both its perceived usefulness and satisfaction were high (Pennecot et al., 2022). Developing simulation and scenariobased assessment tools for patient education can assist nurses in assessing patients’ self-management knowledge, understanding, and application of skills for many chronic conditions across the life course. Prioritizing the use of simulation approaches to patient education may improve self-management of chronic conditions. Nursing can partner with medicine in this practice 1173754 CNRXXX10.1177/10547738231173754Clinical Nursing ResearchEdmiston et al. editorial2023