High-tech ‘patients’ help nursing students learn

Colleen Callahan (left) and Carrie Bledsoe, freshman nursing students, practice taking blood pressures.

9:14 a.m., March 28, 2005--For nurse Elaine Burkett and the patients in the hospital ward she supervises, life is one medical crisis after another.

A child suddenly is stricken with an asthma attack, while, just one bed away, a woman’s blood pressure unexpectedly skyrockets. Not long after, an alarm sounds to warn that a newborn’s body temperature is dropping, and a nearby patient begins to experience such extreme breathing distress that he needs an emergency tracheotomy.

Fortunately for everyone concerned, this hospital ward really is a simulation lab for UD nursing students, and the patients occupying its beds are state-of-the-art, computerized mannequins that Burkett can program to mimic a variety of medical problems. It’s all part of a major initiative by the Department of Nursing to revamp the way students hone the clinical skills they will need as professionals.

“All our equipment is authentic hospital equipment, and the simulators are so lifelike and so advanced that we can program almost any kind of medical situation,” Burkett said. “I draw on my 20 years of nursing experience in a variety of settings to try to think of any kind of problem the students might encounter.”

The mannequins, manufactured by Laerdal Medical, have removable body parts to fit the scenarios Burkett devises. For example, after students learn how to dress a patient’s gaping abdominal wound, Burkett can replace the injured midsection with a normal one and instead program the chest to produce the sounds a nurse might hear through a stethoscope.

Funded by a Unidel grant, the high-tech lab is the wave of the future in nursing education, Burkett said, as well as a way to make the University’s undergraduate nursing curriculum more efficient in the midst of the current national shortage of health-care professionals. That shortage has meant not just a struggle for hospitals to hire adequate staff, but also a lack of professors and clinical supervisors to educate future nurses.

Previously, the University’s nursing students gained clinical experience off-campus throughout their four years as undergraduates. But, the number of nurses available to serve as preceptors has dropped, at the same time that the average hospital patient has become more acutely ill. That combination of factors has made it more difficult for beginning students to learn basic skills in an actual clinical setting.

The new curriculum at UD uses simulators to teach students both basic and more advanced skills during their first three undergraduate years. They still visit hospitals and other health-care settings during those years to observe medical practices, but their real-world, hands-on clinical work now is concentrated in their senior year.

“This system makes a lot of sense,” Burkett said. “It means the students are much more comfortable and proficient before they go into a clinical setting.”

Lab coordinator Elaine Burkett (left) works with junior Lauren Bieri on an infant mannequin.

Students first visit the simulation lab as freshmen, learning to take a patient’s pulse, blood pressure and other vital signs and to learn fundamental hospital practices. Burkett insists that they dress professionally and follow such procedures as pulling privacy curtains around the beds, donning gloves and washing their hands thoroughly. Each mannequin wears a hospital wristband, and the students learn to double-check the name on the band to make sure they are following the correct treatment orders for the correct patient.

“This is amazing. It’s so real that it makes you feel very well prepared for the time when you’ll be in an actual hospital,” Lauren Bieri, CHNS ’06, said of the lab, where she helps out as a teaching assistant. “There’s a patient with a mechanical ventilator, and his chest moves up and down. If the tube comes loose, he actually stops breathing, and he doesn’t start again until you’ve inserted it the right way.”

For Christina Wintrup, CHNS ’05, the new lab didn’t go into operation until she already was a senior, doing clinical work at a hospital. She now helps Burkett as a teaching assistant and said, “I wish we had had this earlier. It’s just awesome how realistic it is.”

Students come to the lab from a variety of nursing courses, signing up to learn and practice the particular skills their professors require. Burkett instructs and observes them and, after they have mastered a skill, she certifies their proficiency.

“I get input from the faculty in deciding what kinds of specialties we should add, such as pediatrics or women’s health,” Burkett said. One simulator expected soon will be an obstetric model, which can be programmed to deliver a baby after anywhere from 8 minutes to 18 hours of labor. The mannequin can be attached to a fetal monitor, and the simulated newborns can come into the world with a variety of medical conditions. One is a “blue baby,” Burkett said, which is programmed gradually to turn pink—but only if the student nurse administers oxygen correctly.

“The goal for everything in this lab is learning to trouble-shoot, to identify any possible medical problem and the proper intervention,” Burkett said. “I find that the students stay completely focused on what they’re doing, just as if they were caring for a real patient.”

To supplement the large simulation lab that Burkett set up when she was hired as the lab coordinator in August 2004, two smaller labs will be renovated. One will simulate cases of cardiac arrest and other critical-care situations, while another is planned for use by freshmen learning such basic skills as how to transfer a patient from a stretcher to a bed. A third lab, already set up like a patient examining room, is used by graduate students in the nurse practitioner program.

Article by Ann Manser
Photos by Kathy F. Atkinson

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