Nurses learn medicine through simulations

The hospital is more than just the place where your grandmother gets her annual heart checkup or where lung transplants are performed. Cases that go in and out are very multifaceted, from bad splinters to limbs falling off and medical professionals are expected to be able to react to all situations. This includes talking to family members whose child was struck by lightning or helping a mass of patients in the emergency room who were victimized by a roof collapse in their building. At the Simulation Center at the School of Nursing, students experience real-life situations as part of their curriculum, so that future nurses will be equipped with not only the medical knowledge for their job, but also appropriate mentality and responsiveness as well.

At the School of Nursing, the 729-square foot Simulation Center is the stage where students apply their knowledge to the real-life situations that could happen in their future career. These simulations explore a variety of situations of differing incidences and risks.

Some examples are as common as managing the care of a patient with diabetes to as rigorous as saving people after a tornado disaster. To make these simulations as real as possible, actors and mannequins are brought into the center and dressed as “victims” with varying degrees of injuries while props such as furniture, trash and broken tree branches add to the chaos.

“It was dark. We turned the lights off and said the power had gone out,” Diane Aschenbrenner, RN and instructor at the School of Nursing, said. “They had to go in with flashlights and clear a path to get the patient out of there.”

Even in a frantic situation, students must learn to think calmly and carefully as they set up triage sites. But with such detailed scenes, the preparation for disaster simulations took a lot of time and help.

“It took quite a bit of work and many people to plan. We needed staff and faculty throughout the whole school to volunteer and help with this.” At times, actors act as relatives of the patient or as news reporters reporting on the disaster. This not only tests the students’ ability to interact with emotional family members but also their abidance to patient confidentiality, in accordance with the Health Insurance Portability and Accountability Act.

“We watch the students through a one-way mirror or else we videotape it … where we can actually see the students providing care,” Pamela Jeffries, Associate Dean for Academic Affairs at the School of Nursing, said. “And as an instructor, we’re looking to see if they’re appropriately interacting with the patient and with the family. Are they assessing the patient appropriately, intervening or providing the medication the patient needs for pain?” After the simulation, students are debriefed and reflect on their experience with their instructors.

“They come in and debrief, and at an instructor-led debriefing we ask the student ‘What do you feel went well? What would you have done differently?’ A good debriefing is when the students talk more than the instructor.” Here, students provide their own feedback and evaluate their thinking in order to improve their practical skills. At the same time, instructors can realize whether there are any gaps in the curriculum to improve the students’ learning.

“The [simulations] are a little intimidating when the students first start doing them because they are very closely observed in small groups,” Aschenbrenner says. “But students have said that they really do appreciate having an opportunity to learn without practicing on a real patient.” Some of the situations that nurses have experienced in their simulations have happened in practice, so they were able to perform more efficiently. In the simulations, students are allowed to do everything that the nurses do in a safe environment even before they are certified; here, they are tested on critical thinking, teamwork and communication.

“It is an opportunity for students to practice the role that they are learning to become,” Aschenbrenner said.

“Simulations provide a new clinical redesign where it’s very student-centered and experiential for students in a safe, non-threatening environment. And we look at new models of clinical education which are needed because we hear many times from nursing leaders and surveys that this is national and not just for Hopkins,” Jeffries said.

According to the National Council of State Boards of Nursing, Hopkins’s Nursing Program is one of ten participants in the National Simulation Study, which began in 2009. Nursing students attended training sessions that reviewed medical procedures, instruments and debriefing. After graduation, the study continued to monitor how these training simulations affected the graduates’ preparedness in the hospital. The data collection is currently continuing and will be completed by the end of next year. These results will hopefully show how the simulations affect daily medical practice.