The patient blinked his eyes and stared at the ceiling, mouth open. An unsettling moan erupted as his chest began to rise and fall. The stone-faced figure in a hospital bed looked like the high-fidelity mannequin that he was – yet the touch of his skin and the beat of his heart were lifelike.
Instructors at the University of New Mexico College of Nursing simulation lab know their new computerized mannequins can be intimidating at first.
“Our nursing students may start out a bit ambivalent about the experience," said lab director Joseph Poole Jr., RN, MSN. "They aren’t sure what to expect from the mannequins, and they are having to perform an exam on one in front of their peers. But their hesitancy doesn’t last long. It really does begin to mimic the clinical setting as they move through the session moment by moment."
Simulators have been in classrooms since the 1980s, but a new generation of high-fidelity simulators has brought about something of a revolution in the way nursing classes are taught. These Wi-Fi mannequins groan, wheeze and blink. Stomachs rumble. Pulses race and then drop dangerously low. They might vomit. With the help of moulage, bodily fluids flow, and smells waft across the exam table, mimicking the clinical setting.
Regulators love them. They want to see students learning without placing patients at any unnecessary risk or discomfort. They also know that when students can participate in complex and rare scenarios, they are better prepared to enter the workforce after graduation.
Every undergraduate student at the UNM College of Nursing is now required to spend time in the simulation lab. Beginning students practice inserting IVs and performing basic skills on low-tech mannequins. The more complex models are used for more complex scenarios, from cardiac arrest to multiple trauma injuries. Midwifery students can monitor the fetal heartbeat as Sim Mom labors. They can later practice using pediatric exam tools on Sim NewB, a newborn simulator.
“In the lab you can tie many nursing concepts and skills together that are needed by a student and increase the holistic way in which they care for their patients,” said Herica Torres, RN, MSN, a clinical instructor and simulation coordinator.
The evolution has been quick. Five years ago, most UNM nursing students encountered a small number of mannequins during their training. By 2013 there were a total of 856 student encounters in the lab. That number increased to 1,250 in the Spring of 2014.
“I love the sim,” said nursing student Darlene Lucille Baca, who is beginning her last semester of training. “It was creepy for a minute, but It really forces you to focus.”
“You can hear the wheezing in the chest. It helps even in little things, like remembering that you must first listen to the bowel before you palpate it or you will change what you are hearing. It really cements how to do your head-to-toe assessment, which is one of a nurse’s primary duties,” she said.
Undergraduate students usually begin a simulation lab day with a briefing session that orients them to the simulation, and they prepare for the patients they will be taking care of that day. Once the simulated experience is over, the students gather for debriefing, Poole said.
“Being able to follow up with a “hands-on” clinical time really can enhance the learning process,” he said.
Sessions typically last about 20 minutes. While one group will assemble to take care of their patients, the other will sit in the debrief room with their instructor and watch their peers perform in the scenario.
Lab supervisor Arthur Sedore then begins to put the mannequins through their paces from his post in the lab's control room, where he operates a computer linked to the mannequins. Students may hear low, anguished moans as Sedore changes vital signs and makes other adjustments to the patient's condition. Students administer medications and perform nursing interventions to see how the patient responds. Students have access to a nearby phone that they can use to consult with other members of the care team on better ways to care for their patient.
“If they are focused and achieving the simulation learning objectives, we might expand the scenario to allow them to complete all the objectives," Poole said. "If everyone is having difficulty and getting frustrated, then we stop and go to the debriefing room. Often that is the important part of the process, when they are learning from their peers."
Research is showing simulators to be good teachers. A recent National Council of State Board of Nursing study, “The Effect of High-Fidelity Simulation on Nursing Students’ Knowledge and Performance,” showed that students benefitted from combining simulation with clinical activities.
“The study showed what we had been hearing from employers – students who had been through simulations begin with a higher skill level during their first months on the job," Poole said. "With the simulations, they are able to see and treat a wide range of patients, and it shows up in their confidence and competency."