Nursing Students’ Perceptions of Small-Group Standardized Patient Simulations to Enhance Therapeutic Communication Skills

OBJECTIVE: Therapeutic communication is essential to nursing practice, yet many pre-licensure nursing students report discomfort applying these skills in clinical settings. Standardized patient (SP) simulation offers a controlled environment for practicing communication, yet qualitative research describing students' perceptions of these experiences remains limited. This study explored undergraduate nursing students' perspectives on small-group, communication-focused SP simulations within a psychiatric-mental health nursing course. METHODS: As part of a larger program evaluation, six in-person focus groups were conducted with 47 Bachelor of Science in Nursing students following participation in two series of SP simulations across nine scenarios. Discussions were audio-recorded, transcribed, and analyzed using inductive thematic content analysis. An audit trail and team debriefing supported rigor and consistency. RESULTS: Three themes emerged. First, students reported that SP simulations increased their comfort and confidence in therapeutic communication, providing a safe space to practice navigating emotionally charged conversations and building rapport. Second, the simulations evoked ambiguity regarding the psychiatric-mental health nurse's role, as students struggled to differentiate therapeutic communication from psychotherapy and acknowledged real-world time constraints that limit such interactions. Third, students identified high-quality, instructive feedback, particularly during debriefing, as essential to learning and expressed a desire for more structured guidance from SPs and faculty. CONCLUSIONS: Communication-focused SP simulations effectively enhance therapeutic communication skills among pre-licensure nursing students. To optimize learning, faculty should intentionally clarify nursing role boundaries and strengthen debriefing structures. Findings highlight the importance of targeted feedback and instructional support in maximizing the educational value of SP-based simulation.