Education Innovation
Sim man
By Joni Moths Mueller
 How valuable is a crisis? When it’s a simulation, it can be priceless.
That’s just one lesson learned when the College of Nursing stages mock patient emergencies that call nursing students into action. Using human patient simulator manikins that have complex health issues, personal complications and even anxious family members in tow offers authentic scenarios that push students to put the pieces together — and no patient gets hurt.
It all takes place in a simulation lab designed to look like a hospital room, with bedside monitors that show an active EKG stream and an intercom nearby to call for help if the patient goes into cardiac arrest. Four television cameras are positioned around the bed to capture the interaction between the patient and the student nurse. Students in an adjoining room watch the scenario unfold. Later they discuss what happened and how the student nurse handled each turn in her patient’s
evolving health crisis.
A manikin, Sim Man, gives the exercise a realistic feel. The manikin speaks and his chest rises and falls. Thanks to technology, his blood pressure and heart rate can be programmed to reflect distress. Students can listen and actually hear lung and bowel sounds. They can defibrillate or catheterize, set up an IV or push medications.
“We create an environment and give the manikin a personality and a story and have the students participate in the story,” explains Mary Paquette, M.S.N., R.N., director of the Simulation Technology and Learning Resource Center in the College of Nursing. “It’s interactive, and we can incorporate all the dimensions of care. Nurses need to know technical skills, but it’s all about that man or that woman in the bed. With these manikins we can present something that’s more much like what students will face as nurses in the real world.”
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| “We create an environment and give the manikin a personality and a story and have the students participate in the story. It’s interactive, and we can incorporate all the dimensions of care.” |
Today the manikin is an 87-year-old female admitted with a fever of unknown origin. She is dehydrated and can’t catch her breath. When the nursing student enters her hospital room, the manikin starts hollering, first for her husband who has been dead for 10 years and then for her cat. A hysterical daughter arrives just as the nursing student is trying to calm the patient and assess what’s going on. An instructor working from a neighboring room controls the manikin’s breathing and dialog to lead the student through a true-to-life interaction with this seriously ill patient.
“We want to know their thought processes and how they handle the twists in a care scenario. We create a realistic environment that is safe for the student to practice uncommon, complex and high-risk procedures,” explains Paquette. The goal is to determine whether the student synthesizes what he sees in the patient with what he learned in class.
Paquette works with nursing faculty members to create these scenarios. Each one is written to test a particular lesson or skill and may include an ethical dilemma or a personal crisis. The more complex scenarios are played out with advanced students, but freshmen also like this opportunity to get in the sim lab and think like a nurse.
Diane Dressler, M.S.N., R.N., clinical assistant professor of nursing, leads students through a case with a female patient undergoing an exploratory laparotomy for abdominal pain. The patient, Mrs. Strong, has no known chronic medical problems or abnormalities other than obesity. She smokes a pack of cigarettes a day. She is on hormone replacement therapy and takes a daily multivitamin. She has been on bed rest for the past week because of pain.
The surgical procedure goes well in this scenario — a tumor is removed from Mrs. Strong’s left ovary and her doctor awaits the final pathology report — but on post-operative day three, Mrs. Strong is experiencing shortness of breath and chest pain. Her vital signs begin to deteriorate, and the nursing student is charged with outlining a new plan of care given the patient’s changing condition.
“She is going to need frequent assessment because she has a lot going on,” Dressler tells her students. “The more acutely ill your patient is, the more important it is to get in there and check everything as soon as possible.”
Paquette and Dressler add layers of complexity to the case with each passing minute to reflect what a nurse will face in practice. Afterward, during the debriefing, the real power of simulation shows.
“Students become more reflective on their practice,” Paquette says. “They see what they did well and where mistakes were made. With a good facilitator driving the process, it is absolutely invaluable.”
What’s most important in the whole exercise, Dressler says, is that students think critically about a patient situation. Although the simulation lab is a made-up environment, it frees students to role-play a real drama. And that’s as close as classroom instruction can come to demonstrating the often-crucial minutes in patient care. “Nurses have to be able to analyze, to think on their feet, to prioritize what to do next for the patient,” Dressler says. That’s what the sim lab allows her to teach.
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