Practice makes perfect

UNIVERSITY PARK, Pa. — All is calm in the hospital room. The heart rate monitor beeps steadily and rhythmically as the nearby patient’s chest rises and falls with each passing breath.

Without warning, the patient’s heart rate spikes in speed and pitch, and suddenly, the room is abuzz with urgency. A nurse rushes to the patient’s bedside and places two fingers on the veins in his wrist — there’s no pulse. It’s a code blue: cardiac arrest.

Nurses swarm around the patient with a crash cart equipped with a defibrillator. As each shock is administered, the team anxiously awaits an improvement in condition. 

“I’ve got a pulse!” shouts one of the nurses as the beeps from the monitor return to a rhythmic pace once again.

The team breathes a collective sigh of relief as they congratulate each other on a job well done. But the celebration is short-lived — it’s time to reset the scene and start the scenario all over again.
     
Such is the norm in the Nursing Simulation Laboratory in Penn State’s College of Nursing. Established in 2009, the lab gives students the chance to experience a variety of medical scenarios and emergencies in a controlled environment.

Spanning multiple rooms in the Nursing Sciences Building — including labor and delivery, pediatric, and intensive care units — the lab mirrors what would be found in a real hospital setting. Drawers are stocked with supplies like syringes and IV equipment and computers next to each bedside offer the same medical record software used at nearby Mount Nittany Medical Center.
      
“We really try to make everything as real as possible,” said Christopher Garrison, an instructor in nursing and coordinator of the lab. “So the more it mimics reality, the more the students are immersed in the experience.”

Through the use of simulation mannequins, students gain firsthand experience in the many aspects of caring for a patient. Mannequins range from a torso (affectionately referred to as Harvey) that uses radio waves to mimic heart sounds, to full-body mannequins with the ability to breathe, blink, speak and even bleed.

In addition to simulation mannequins, the lab also houses such tools as a virtual IV system that lets students practice inserting IVs while real-time feedback is displayed on a computer screen.

According to Garrison, giving students this kind of feedback is an essential mission of the lab.
     
“The technology is really great because the mannequin will give me feedback on how the students’ CPR performance is,” Garrison said. “The computer will record if they're compressing to the correct depth at the right rate and if their hands are in the right location. So I can show them on the computer whether they’re too slow or their hands are in the wrong place.”

As for how much can be simulated in the lab, instructors and students are only limited by their imagination.
     
“The simulators enable us to mimic clinical conditions. So if the students are managing somebody with asthma, I can make the simulator have wheezing, low oxygen levels, things the students will have to assess and then respond to,” Garrison said. “What we're trying to accomplish is have them use their analytical skills to put the pieces together and then make sound clinical judgments.”

One of the newest additions to the lab is a realistic maternity simulator, which will actually give birth to a newborn mannequin (either through traditional or cesarean birth). Students can view fetal heart patterns and maternal contractions on the nearby monitor, using the information to assess possible medical emergencies affecting both mother and child before, during and after labor.

Aiding students during these maternity scenarios is Kristal Hockenberry, a simulation lab assistant who works primarily with students in the labor and delivery and pediatric simulation units. Hockenberry, a registered nurse, strives to make pediatric simulations as real as possible for nursing students.

“One of the scenarios I'm doing this semester with the juniors is where the little boy mannequin will have seizures and the students will have to administer the correct medication,” Hockenberry said. “Until they administer the medicine, he will continue to seize, but once they do, all his vital signs will change and he'll stop seizing.”
    
According to Garrison, letting students work through these situations in a controlled environment allows for consistent experiences that might not be possible in a real-life setting.
     
“Some of the advantages of having this kind of experience are that we can give them a very unstable patient that may be deteriorating,” Garrison said. “In the real setting, if the patient is unstable, the experienced nurse is going to have to take over and run the situation and the students will help. But it's not the same as the student having to make the judgments and decide what to do.”

For Natalie Sullivan, a sophomore in the College of Nursing, working with the simulations is valuable preparation for future clinical work.

“Being able to work with the simulation mannequins is a really valuable opportunity. As students, we don’t want to go out into the health care setting and have to perform skills for the first time,” Sullivan said. “These mannequins can simulate pretty close to real-life scenarios, which allows us to experience something as simple as feeling for a pulse or as complex as labor and delivery. So it’s really valuable technology that we get to use.”

Although working through medical emergencies in the moment is valuable, the real benefit for students happens once the simulation is over.

“One of the things in simulation that's really important is the debriefing process. So managing the patient is only half of what we do,” Garrison said. “Afterward, we all sit down and talk about what happened, why it happened, what was done really well and how that impacted the patient or what could be done better. That's where the students really reflect on how they performed and can incorporate things into their practice to improve.”

As for the end result of each scenario, what’s most important isn’t necessarily whether or not the students can resuscitate a mannequin after a cardiac arrest on the first try; what matters most is the knowledge they take away from the experience.

“We don't expect them to be perfect at this stage in their careers,” Garrison said. “That’s why we give them scenarios that really challenge their thinking. It's all part of the learning process.”

For more IT stories at Penn State, visit http://news.it.psu.edu

Contacts: 
Last Updated April 22, 2016