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Nursing Simulation Labs

Mock situations,
real lessons

By Keely Grasser

College of Nursing

With cardiac monitors, divider curtains and hospital beds, these aren’t your typical classrooms. And your usual textbook doesn’t blink, cry and bleed.

But simulated hospital rooms and high-tech manikins are teaching tools used in the nursing simulations labs at University of Phoenix. And this innovative program has both faculty and nursing students raving about its powerful learning benefits.

The students feel that they’re in a hospital environment when they’re in here—and they get real life scenarios,” said Gerald Fox, a technician at the Phoenix Campus lab. Students also learn real life lessons from the atmosphere of the realistic simulations and the substantial teaching and discovery process that follows. And almost any medical situation can be simulated, Fox said.

Carefully crafted medical emergencies

The lab’s ‘patients’ are weight- and size-appropriate manikins. The highest-tech manikins blink, have chests that rise and fall and eyes that react to light. They can cry, vomit and urinate, among other things. The manikins lay in real hospital beds in rooms that mimic a hospital setting, right down to the texture of the walls. Here, students assess their patients with working medical equipment. Cardiac monitors and a mock wall unit depicting oxygen, air and suction, add to the clinical atmosphere.

Each simulation that occurs in the lab is a medical situation carefully constructed by faculty to teach students a particular lesson. “The manikin will go through a series of steps of changes in level of consciousness or vital signs or blood pressure, for example,” said Erich Widemark, Campus College Chair for the College of Nursing.

Students can speak with the manikin, and the manikin will respond via commands input by faculty in a control room, Widemark explained. Some simulations also include actors who portray family members or hospital staff. Two students participate in each simulation—one as a primary nurse and one as a backup. The rest of the class will watch the simulation via closed-circuit monitors. Each simulation lasts 20 to 30 minutes. “We basically watch the student nurses as they go through their activities, evaluate the room and the environment, and make decisions about what to do based on what they see,” Widemark said.

Hindsight is 20-20: debriefing

After the simulation, the class is brought into an adjacent room for debriefing, “which everyone will tell you is where the learning occurs,” Fox said. The debriefing is a welcoming and safe environment where students sit in a horseshoe, he explained. They review the video, which the facilitator has bookmarked, from the simulation.

The bookmarks are used as the basis of discussion about what went right, what went wrong and what could be done differently at those particular points, explained Widemark. “The concept behind the debriefing process is to facilitate discussion among the students so they arrive at realizations and real learning experiences as to what they saw as a third party, watching on the monitor, or what they felt, actually being in the room,” he said.

Open-ended questions are used to lead the debriefing discussion. “This is often the time when a student will say, ‘Yes, I was doing this, I didn’t realize this was going on.’ Or, ‘You know, I thought about doing this, but I didn’t because I wasn’t sure,’” explained Widemark. “These are chances for students to relive the experience from their own point of view or from the third-person. We want them to think, ‘Wow, I see myself on video doing that and I didn’t realize I did it that way.’”

He said the debriefing, at an hour to an hour and a half, lasts longer than the simulation itself. Students report that they like getting the reinforcement of their nursing skills, both positive and negative, said Fox. In fact, students enjoy the simulations so much that they often ask for more, added Widemark.

The simulations are strategically placed throughout the nursing program, usually before the students’ first clinical day in the hospital with live patients, Widemark explained. “It helps them prepare. Kind of like dipping your toe in the water without actually jumping in all the way.”

Simulations also give students experiences they may not get during clinical time, Fox pointed out. “The simulated environment takes out a lot of the factors that we have no control over so we can expose the students to disease processes as we want; expose them to the types of personalities we want, good and bad, and see how they react to it in a controlled, safe environment.”

Adrenalin levels and learning

And the realistic environment causes real physical responses in the students. “Many of the students going through the simulation have elevated levels of adrenalin because of the nerves related to the simulation,” said Widemark. “We just know they’re going to remember these experiences much more than if they learned it from a book.” It has been shown that students gain more from a learning experience when their adrenalin levels are raised, he added.

Practice is important, explained Kristy Chambers, a principal at Medical Simulation Design, which helped UOPX develop their simulation program. But she explained that it’s even better when students are emotionally attached to that practice. Chambers said there were manikins when she was at college, but she never felt like they were real patients. Students in the University simulation labs do. “That emotional investment is just so powerful,” explained Chambers, a University of Phoenix alumna herself.

Designed for long-term success

Medical Simulation Design was instrumental in helping UOPX design the labs, and also assisted with training faculty and creating a lab curriculum the school could standardize, said Charlotte Saylors, a vice president of product marketing at the University. Saylors is the project manager for the simulation labs, which the University started developing about three years ago.

Often, according to Chambers, simulation labs evolve from a grassroots movement within an organization. That wasn’t the case at University of Phoenix, she said. “The level of support from the top down has been pretty refreshing.”

The standardized program Medical Simulation Design developed is now in place at four UOPX campus labs: Arizona, Colorado, Hawaii and California. A standardized approach for faculty means outcomes are more valid, Chambers explained, adding that consistency is vitally important.

“No matter which University of Phoenix campus students in this program attend, they’re going to have a similar experience and will complete the program with the same level of knowledge and expertise,” explained Saylors. And that’s where she sees the program’s ultimate success. It’s not about the high-tech equipment or the facilities, but about putting together the system of learning that creates the faculty training and the scenario library for the program, she said.

Those sentiments ring true with Pam Fuller, Dean of the College of Nursing. “The development of the simulation labs is yet another example of the University’s commitment to providing the best student experience,” says Fuller. “While the labs are still in the early stages, we are very pleased with the faculty development, creation of a scenario library and the level of consistency we will attain for our students. I am very pleased with the positive response from both faculty and students.”


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