Simulation delivers dose of reality
When the phone slammed down, a nursing student learned a life lesson.
“The student was totally shocked,” says Nancy Shirley, PhD, RN. “She said, ‘She hung up on me.’ Yep, that’s exactly what someone would do when you are telling them when you are coming into their home, and they say it’s not the right time.”
Students must understand, Shirley says, that patients being treated at home are always in charge.
“This is not a room where you have just stripped them of all their clothing, and you’ve put them into a sterile environment in a hospital setting, and you can do whatever you want whenever you want. This is their home,” she says.
Shirley, who recently retired and is a former associate professor of nursing at the Creighton University Health Sciences Campus – Phoenix, helped guide the nursing program’s simulation program, which employs manikins so sophisticated they can cry, give birth, and emit internal sounds that emerging nursing students learn to recognize and understand.
The program also features “standardized patients” — actors playing the part of patients, or perhaps the parents of patients. In all cases, these substitutes for the real thing help students absorb the do’s and don’ts of patient care before entering the room of a real patient in a real hospital setting.
The “patient” who hung up on the nursing student was Shirley herself, playing an elderly woman who was unable or unwilling to have a nurse visit her with just five minutes notice. She needed 90 minutes notice, she says, and hung up when the nursing student persisted.
In reality, both student and professor were in the Virginia G. Piper Charitable Trust Health Sciences Building in Phoenix, where simulated home visits are conducted in an apartment specially reserved for the purpose.
“Experiencing simulated home visits in such a realistic space is important,” Shirley says. “One of the things that we know is desperately needed in nursing education is learning how to talk to people. You need to know how to ask questions, how to decrease patient anxiety, so we do some of that with role-playing.”
An Investment in Simulation Training
All told, Shirley says, Creighton has invested in simulation training.
“We have a state-of-the-art simulation program here,” she says. “We have manikins that can give birth. We have child manikins that can produce tears. We have high-fidelity simulated body parts — whether it’s just an arm or some other part of the body — just really a cream-of-the-crop program.”
Lea Ann Palmer, RN, MSN, coordinator of Creighton’s nursing simulation lab in Phoenix, says the manikin program is indeed highly sophisticated.
“We have some very high-tech, high-fidelity manikins for all disciplines to practice on,” she says. “We have a lot of technology available to us. All of our debrief rooms are outfitted with a screen and the ability to watch simulation.”
The repetition that high-fidelity manikins permit is invaluable, Palmer says.
“Students can see when they have made a mistake, or done something wrong, and then redo it, and redo it, and do it again and again and again, so that they build up the muscle memory, which really is the best way for them to learn a lot of their skills and habits. They don’t really get that in a clinical setting.”
Nor is it always just about the manikin/patient, Palmer says.
“In pediatric care, the manikin can be the child, but a standardized patient — a real person — will play the parent and give my students feedback on what it was like to be the parent, explain how they were made to feel, how well the child was cared for.
“These standardized patients are a great resource. They give our students feedback they can’t get from the patients they will care for in a hospital. Simulation gives our students valuable experience before they care for real patients.”
The home-visit simulations are especially valuable, Shirley says.
“When you have high-tech manikins and then also standardized patients, you’ve got the best of both worlds,” she says. “With the manikin, you cannot hurt anybody, and with the standardized patients, you have communication.
“People, after all, spend only a very little bit of their time in a hospital. They spend much more time in their workplace, their school place or their home. So, performing a simulated home visit in an on-site apartment is a very useful tool.”