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Nursing school's computerized patient ain't no dummy: $36 million mannequin capable of simulating array of emergencies

April 9, 2007

Mr. Jackson is admitted to the hospital, complaining of shortness of breath and loss of appetite.

The 71-year-old is experiencing tightness in his chest, although not enough to be considered painful.

The nurses scurry to administer oxygen and draw blood while recommending an electrocardiogram to measure heart activity. Several minutes later, a diagnosis of heart failure is returned.

The events unfolding at the Indiana University School of Nursing on the IUPUI campus mirror actual situations that could occur at any hospital. The only difference is that Mr. Jackson is not human; he's what's known as a high-fidelity mannequin used to simulate several medical emergencies.

The computerized patient can be programmed to breathe, speak and respond to treatment in a futuristic way that makes the dummies many of us learned CPR on in health class seem archaic.

The $36,000 mannequin marvel, which produces computer-generated scenarios such as changes in heartbeat and blood pressure as he suffers a heart attack, represents a dramatic change in the way nursing students are taught.

The school of nursing purchased the mannequin with grant money in February 2006 and began introducing simulated emergencies to seniors this semester.

Andrew Howe, who graduates in December, works as a student-nurse at a Saint Francis Hospital and Health Centers emergency room and gives the lifelike training high marks.

"I've been in code [blue] situations before," he said. "As far as the controlled chaos, it's pretty close. That's what actually happens in real life."

The simulations better prepare students for what they will encounter on the job and mark the first real transformation in the way they learn medical procedures in decades.

Students spend time in the classroom and learning laboratory before proceeding to their clinical practicum that involves caring for real patients. The simulations, however, bridge the gap between the academic and clinical learning, said Pamela Jeffries, the nursing school's associate dean of undergraduate programs.

"We're still teaching nursing students like I was taught in the 1970s, and that's probably not the best way to do it," Jeffries said. "Things are more complex now, so we've got to look at new models."

In those days, patients having their gallbladders removed required a hospital stay of up to 10 days. Those types of procedures now are considered outpatient surgery and hospital stays are reserved for the sickest patients.

Moreover, growing concerns over patient safety have caused hospitals to increasingly restrict access. They no longer allow students to take blood and test blood-sugar counts, for instance, because the caregiver must be certified, Jeffries said.

Real-life scenarios

School of nursing students practicing on the simulated patients team up into groups of up to five and rotate among three stations. Two stops contain highfidelity mannequins-one simulating a heart attack and the other sporting a knife in the chest to mimic a trauma case. That one was borrowed from the IU School of Medicine. The third houses a standard mannequin, used primarily to teach students how to insert IVs, catheters, and to perform intubations.

The simulator with the knife wound has no pulse but shows electroactivity, prompting the students to perform CPR while administering several drugs, to no avail.

The students spend about 20 minutes at each station, including a debriefing with a professor who queries them about their decisions and asks what they might have done differently.

Anne Martin, a visiting lecturer from Toronto, observed the nurses in training as they tended to the patient who ultimately succumbed from the stabbing.

"This is a huge step, because it's hit and miss in terms of getting them in the hospital," she said. "This way, you ensure that they've at least done it on a mannequin."

The next step is to use the two highfidelity mannequins to train medical and nursing students together. While they collaborate in the operating room, Jeffries said, it's rare that they get together in an educational setting. But that's about to change.

Clarian education center

Clarian Health Systems is building what is known as the IU/Fairbanks Hall-Clarian Education and Resource Center across from the hospital network's pathology lab near the downtown canal.

The six-story structure, to be finished next year, will devote an entire floor to simulated education that both the schools of nursing and medicine can share.

Features will include an acute care area with simulated operating and emergency rooms, vascular cardiac area, and flexible space that might be used for an intensive care unit.

A virtual hospital on one side of the floor will contain five patient-care rooms for medical, surgical or ICU patients. The multi-purpose rooms will enable nursing students to simulate patient care. One of the high-fidelity mannequins there even will simulate giving birth. A shell of a Lifeline helicopter will complete the training facilities.

The building is funded by grants and endowment funds, and represents a partnership between Clarian and the medical and nursing schools, said Jennifer Dwyer, education specialist for Clarian.

"Simulation technology can allow the student, and the employee coming on board, to practice a simulation in a safe environment," Dwyer said. "They can make mistakes, not at the risk of the patient, and be able to learn from the mistakes."

Students more confident

Getting the high-tech simulator at the school of nursing is a process that started in 2003, when Jeffries was appointed to be a project director for the National League for Nursing in New York City.

In that capacity, Jeffries helped conduct research at eight sites on simulated education and developed a framework for educators. One of the more important aspects of the research found that students who train on the simulators are more confident and caring.

As the technology has evolved and become more affordable, more schools are beginning to purchase the simulators, said Mary Anne Rizzolo, the National League for Nursing's senior director for professional development.

"It's a great interim step, because they learn from their classroom and textbooks, but then you have to apply it to a patient situation," Rizzolo said. "That's not as simple as going down a list of items."

Since beginning her research on hightech simulators, Jeffries has become an expert in the field. She wrote a book, "Simulation in Nursing Education," that came out within the past month.

In late March, she and her colleagues at the school of nursing presented a two-day seminar on the topic for educators.
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