Patient simulator use expanded at School of Nursing

Sunday, March 27, 2016 - 3:24pm

At the University of Michigan School of Nursing, along with students, you'll also find Donnie Philips — who appears to be a child with pneumonia. However, Philips is actually one of many robotic mannequins used to teach nursing students.

The current Nursing School building, opened last semester houses six simulation rooms — including two pediatrics rooms, two medical surgical rooms and two obstetrical rooms — in which mannequins like Philips are used for classroom exercises.

High-fidelity mannequins are operated through a sophisticated software program and have been in use at the University of Michigan since 2008, while low and mid-fidelity mannequins have been in use for much longer.

Low-fidelity mannequins are similar to those used for teaching CPR because they do not give any feedback to the students, simulation specialist Ben Oliver said. Mid-fidelity mannequins have a few more capabilities, but cannot react like a human would.

High-fidelity mannequins are the most sophisticated of the three and are able to emit fluids such as artificial blood, vomit and sweat. They can also react to medication distribution, have pupils adjustable to light like a human’s eyes would and can give birth.

Clinical Instructor Maureen Westfall said Nursing instructors are able to program the mannequins either before or during the students’ simulation experience. In obstetrics, for example, she can program how many contractions the mannequin has while giving birth and how often.

"The focus of simulation is really problem-based learning,” Westfall said. “You use problem-based learning in relation to objectives we create.”

Though the mannequin can react on its own in certain cases, the instructors often adjust the scenarios based on the students’ performance, Westfall said. She added that students should recognize signs and symptoms of medical issues the mannequins exhibit through clues provided by instructors. Each simulation session is recorded so students can look back and review their experience later.

“It’s safe space for us to help coach the students into managing these patient situations appropriately,” Westfall said.

During a planned simulation day, students come into the simulation room — usually in pairs — while other students watch the simulation via cameras. Michelle Aebersold, director of the Clinical Learning Center, said the students not participating can also play roles, such as a “frantic parent,” to make the simulation more challenging. Following the simulation, the students all gather for a debriefing to discuss how it went.

“If you don’t make these things challenging enough, then you don’t get the emotions involved and then it’s not a good experience and students don’t really get as involved in it and the learning doesn’t occur,” Aebersold said.

Nursing junior Sarah Brzezinski said she thinks it is beneficial to have hands-on experience that is safe for both the student and patient, while still difficult.

“You come into (simulations) and you never go unchallenged,” Brzezinski said. “If you do everything perfectly in sim, then you’re not learning and we’re not going our job. So I think it’s really good that they push us and they continue to challenge us and I think it’s very effective for the clinical setting.”

Aebersold said the overall benefit of simulations is that they can reduce the amount of time students need to spend in the clinical setting with real patients, with little effect on the students’ learning.

“We can effectively replace time in the actual clinical environment with simulation; up to 50 percent of those hours can be replaced by simulation, with no change in those pass rates on those state boards,” she said.

Nursing junior Jade Curl said working with the mannequins is a unique but effective experience.

“It feels real," Curl said. “You don’t feel like you’re pretending. You walk in and you hold their hand and when you talk to them, you look them in the eye. It’s really odd thinking about how you act in the sim, because you don’t think about it.  You just act like this is a real person. You give them respect. You’re excited when the baby comes out and the baby is fine.”

Because it can be difficult to get used to the robotic characteristics and mechanical sounds of the “patients,” students have to sign a fictional contract, agreeing they will treat them as if they were real.

“Sometimes it’s a learning curve for students to wrap their head around the fact that they should treat this robot as a real person,” Westfall said. “But what I’ve observed over time is that that is pretty short-lived because the learners we do have here are highly motivated and want to do well and want to understand … They really do act as if the patient is a real person.”

Aebersold said the mannequins also have the capability of dying, though this is usually part of a planned learning experience so as not to be traumatic for the students.

“It’s most important because it’s a great stepping stone to patient-care exposure for the students,” Westfall said. “It provides an excellent lead-in to the real clinical environment and it promotes more confidence once the student is in the real clinical environment.”

Nursing junior Rebecca Ford said simulations are something she will never forget.

“Nothing sticks in your head the way it does when you screw up in sim,” Ford said. “Being able to get an interactive experience makes you remember things way more than reading it or someone teaching it to you, especially if you messed up the first time. That’s the coolest thing about sim — we’re allowed to mess up and it’s OK; we talk about it and learn from it.”