The military has long used simulation to help soldiers prepare for the stresses of battle. The same idea applies to Sheridan College nursing students getting ready for the stresses of patient care.
Simulation is a learning technique that gives nursing students the chance to act out a variety of scenarios in a controlled setting.
“It’s the best way to educate students,” Crissy Hunter, a Sheridan College nursing instructor and the director of the Wyoming Simulation Center, said.
First-semester students come to the center a couple of times, but nearly all of the work is done in the second, third and fourth semesters, when the students are there for 30 to 40 hours each semester.
At the center, students mainly perform different tasks on the different nursing manikins. They perform physical assessments, check pulse and blood pressure, take blood samples, administer medicine and help the manikins give birth.
Yes, manikins can have children, which is why some of them cost about $150,000 each.
In addition to vital signs, manikins can sweat, bleed and turn blue due to lack of oxygen. A manikin’s lifespan is only five or six years, however, because they are essentially large computers that wear down after several hundred births and assessments. The center also has several lower-tech manikins that cost between $8,000 and $12,000.
Students take care of the manikins in small groups, usually two or three people. Teachers give students an idea of the scenario beforehand, and then actors or teachers usually talk into a microphone that connects to the manikin, so students can conversate with their patient in real-time.
Beforehand, students have to decide or are told what role they will perform, such as medication administrator or patient assessor. The scenarios aren’t quite life or death, but one example has students administer Narcan due to a manikin’s drop in heart rate after an opioid overdose.
In a debriefing afterward, teachers talk with the small groups on how they did. Students have the option of redoing the simulation if necessary. One of the simulation rooms even has audio and video recordings. Like a football coach pointing out missed assignments to players, instructors and students can look over film of student interactions and discuss thought processes and how to improve.
Over time, the students gain more autonomy. Second-year nursing student Jennie Way compared the types of knowledge to different-sized swimming pools.
“The first year, you go into a pool that’s four feet deep,” Way said. “You go all over the pool but you’re only going about four feet deep. We learn a little bit about everything. Then the next year, you’re going into the eight-foot deep pool. It’s a lot of the same things, only we’re in charge of more.”
Medical simulation practices began a few decades ago, increased in popularity about 10 years ago and have gained steam in the last five years. Hunter said it is more of a standard practice around the country, as most hospitals in the country have a simulation requirement for nurses.
Empirical evidence about simulation’s effectiveness at improving patient outcomes remains difficult to prove.
Hunter has taught simulation for eight years, the last six at the simulation center. Before teaching simulation, she had to learn it. When Hunter was an undergraduate nursing student, she learned mostly in a clinical setting, where mistakes can result in actual harm.
Over time, she practiced simulation and read literature on the topic. Hunter received her doctorate of nursing practice last year with an emphasis in nursing education. Naturally, her doctoral dissertation focused on simulation and its effectiveness with students.
As part of Hunter’s dissertation, students anonymously filled out questionnaires throughout their time using the simulation center. Questions focused on students’ confidence performing various tasks. The results showed that the more students used simulation, the more comfortable they felt.
Second-year nursing student Saije Pollard echoed that sentiment. Dealing with manikins takes adjusting to, she said. Asking questions to the manikins seems odd at first, especially with instructors watching, but students eventually get used to it.
First-year nursing students Sarah Brownell and Rachel Burton are not quite used to the process, as most of their time thus far has been spent in the nursing lab at Sheridan College. Brownell said she has trouble differentiating lung sounds, which are all similar but mean different things. Burton struggled taking blood samples, but instead of sticking a needle into the wrong part of a grandmother’s arm, she errored on a manikin, where no real-life harm was done.
The simulation center was a pivotal factor in Burton’s decision to attend Sheridan College. So far, she likes seeing how administering correct medications actually makes a difference for a patient.
Brownell worked as a certified nursing assistant for many years before going back to school. She said a highlight was her initial patient diagnosis.
“When we got to do our first physical assessment on a patient, for me that was big,” Brownell said. “I went home with a big smile on my face. That was my ‘Aha’ moment.”
Like a military simulation building trust and camaraderie in a platoon, nursing simulation can help students gain confidence and work with one another. For students who will soon be on the front lines of health care, those traits should come in handy.