Monday, November 20, 2017 - by Misty Wheeler, Dalton State College
A nurse’s worst nightmare is going into a room and not knowing how to care for a patient, said nursing student Chris Mendoza.
With the completion of the new simulation lab at Dalton State, nursing students, and others in the health professions, don’t have to worry about facing that fear. The simulation lab is designed to prepare health professions students for just about any situation they may face in clinical practice, and later, in the workplace.
“The sim lab increases my confidence 100-fold,” said Mr. Mendoza, a second-year student in the associate of science in nursing program. “You’re afraid to touch the patients the first year in the program, but that nervousness slows down so much because the sim lab brings you to where you can just do it without hesitation. The lab provides a safe space to learn. Health professions programs are intense. We learn a lot in a short amount of time, so a safe learning environment before working with real patients is even more important.”
Nursing students at Dalton State have had experience working with a simulation mannequin in the past. With the opening of the simulation lab this semester, students from the other disciplines – respiratory therapy, radiological technology, social work, and licensed practical nursing – have regular access to the lab as well.
The lab also opens the opportunity for students in the different disciplines to work together, as they would in a real hospital setting, said Melanie McCarley, simulation coordinator for the School of Health Professions.
“This is a safe learning, practicing place where students can make mistakes,” Ms. McCarley said. “If they make mistakes, there’s a gap somewhere, in communication or understanding. And we need to close that gap. We keep the lab nonjudgmental so when they care for real patients, we’ve closed any gaps. A lot of time errors occur in communication so one skill we practice is how to communicate, especially across disciplines.”
In hospitals, nurses, respiratory therapists, radiologic technologists, LPNs, and social workers all work together for the good of the patient. But traditionally in school, working together hasn’t been practiced on a regular basis.
Dalton State is changing that.
“A lot of schools have just a nursing sim lab, but ours is for all disciplines,” said Dr. Gina Kertulis-Tartar, dean of the School of Health Professions. “It certainly makes us unique to have an inter-disciplinary lab. We can create as many scenarios as possible for inter-professional education. We want all our disciplines to work together. Inter-professional education is growing in the health professions because when they graduate, they don’t work in silos. They work together.”
The lab includes three adult simulation mannequins, one of which can mimic pregnancy for birthing simulations, and one pediatric mannequin. There is also an infant simulation mannequin that can be used in the sim lab or the nursing skills lab.
The mannequins respond in real time. They can talk, breathe, bleed, and respond to what students are doing. Ms. McCarley runs the simulations from a control room.
“These mannequins can bleed out and die even,” Ms. McCarley said. “Sometimes students say ‘Why did you let our patient die?’ But I didn’t. All I do is enter into the computer what the students do.”
In one scenario a simulated patient had had knee replacement surgery. Nursing students were told they needed to care for him post-operatively.
“We have a pre-briefing where students are giving information about the patient and what they’ll need to do,” Ms. McCarley said. “But I always throw in a twist. So with our orthopedic simulation, he developed a pulmonary embolism, a blood clot in his lung. So he starts fine, like a normal post-op patient. But then he gets worse. We see if the students have the knowledge they need to pick up on a sudden change in the patient. You see the patient’s respiratory rate increase as the patient tries to breathe, and we see how fast the students can identify the problem and stabilize him.”
The scenarios become more complicated as students learn more. A blood sugar problem simulation for first-year students becomes a diabetic patient with chronic breathing problems for second-year students, Ms. McCarley said.
The rooms also have equipment similar to what students will see in a hospital setting, including digital medical records, a crash cart, and IV pumps. They practice routine hygiene to prevent the transmission of infectious disease.
The radiologic technology program has a lead-lined room so students can practice taking x-rays. They will have specialized equipment since the mannequins’ robotics cannot be subjected to x-rays. Social work students will have their own space to practice home visits and speak to patients in an office setting.
“The sim lab looks like a hospital,” said nursing student Stephanie Watson. “The lab is set up just like our patients’ rooms. It’s very important to know how to operate the equipment. We need to know how to turn up the oxygen, for example. So it’s important to have that exposure. I love the sim lab. It’s such a safe place to learn.”
A simulation might take about 30 minutes to complete, and afterward students watch themselves on video and talk about what they did right and where they need to improve. Then students repeat the scenario.
“Debriefing is the essence of the simulation lab,” Ms. McCarley said. “We talk about what needs to be improved, but also what went well. They build confidence as we progress. The simulations align with what students are learning in lectures and in their skills lab. We put the knowledge into context and we build on it as we go.”
Mr. Mendoza feared he had skipped a step in trying to get a patient to respond during a scenario.
“We had an emergency situation with a hypoglycemic patient,” he said. “I went through the motions of trying to get him to respond. First we try verbally, then we stimulate patients arm, and then apply pressure to the sternum. I didn’t remember stimulating his arm. I didn’t know until I watched the video of myself that I had done everything right. It helped boost my confidence. I know in an emergency my muscle memory takes over, and I know how to respond.”
Mr. Mendoza, who is completing a clinical rotation on the cardiology unit at Hamilton Medical Center, has seen how his learning and confidence have progressed as he’s experienced more in the simulation lab. He said he was able to detect an irregular heart rhythm in a patient and make a doctor aware of it because he had experienced a simulated arrhythmia already.
During an externship at Erlanger Medical Center in Chattanooga recently, Mr. Mendoza saw how his experience at Dalton State set him apart from other nursing students in other programs.
“We had so much more hands-on experience than they had,” he said. “Dalton State students were already comfortable with many skills the other students weren’t yet. The doctors and nurses there gave me opportunities to be more independent. I was even told one reason I was so trusted was because I was from Dalton State. They know how intense our program is and how all our time in the simulation lab and with clinicals prepares us.”
The same is true for respiratory therapy students at Dalton State.
“I believe this lab is helping us maintain a good rapport as Dalton State students with the clinical sites because they know we will be well prepared for whatever we encounter in the hospital,” said student Carrie Lovett. “I’m so glad health profession students have access to this lab to help us increase our confidence in patient interaction and in emergency situations. Being in the sim lab is astonishing because it is a stressful environment and the way the patient reacts to interventions is like a real patient. You’re in there trying to save the mannequin’s life as you would a real patient, and you begin to care for their well-being the same as you would if it were a living, breathing person.”
Through the lab, Lovett has learned how to rely on other team members to help during times of high stress. And she’s learned the importance of communicating so they can work as a team more efficiently.
The simulation lab was made possible by grants from the John Willis Mashburn Trust and the Dalton State Foundation.