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Perfect Patient

Medical mannequins help nursing students learn

His heart rate is elevated, his breathing jagged, and moments ago he vomited. The nursing student attending this distressed patient appears nervous as she attempts to assess the symptoms. Secretly, she is afraid that if she does something wrong, the patient will get worse or even die.

Nursing students (from left) Natalia Klimenko, Wayne Strojie,
Ana Argueta, and Kim Murray under the watchful eye of Simlab
coordinator, Patti Nervino, RN.

Fortunately for all concerned, this patient is a medical mannequin in the high-tech simulation lab (Simlab) at the Maurine Church Coburn School of Nursing, which is operated in partnership between Monterey Peninsula College and Community Hospital of the Monterey Peninsula. Although the patient appears to breathe, blink her eyes, have a pulse, and even emit bowel sounds, an attending nurse can simply reset her if something goes wrong. Which means that students can learn from their mistakes and the patient is none the worse for wear.

Thanks to a 2007 grant and funds from the estate of Lillian Adams, the nursing school was able to purchase four mannequins — two adults, a child, and an infant. They cost $50,000 to $60,000 each, but they’re proving invaluable.

"These ‘patients' are computerized mannequin, high-fidelity human simulators. Depending on the objectives we are trying to teach, we give the patient a name, a written history and physical, doctor's orders, and specific symptoms. Then the students have to run through the scenario." - Patti Nervino, RN, Simlab coordinator

“These ‘patients’ are computerized mannequin, high-fidelity human simulators. Depending on the objectives we are trying to teach, we give the patient a name, a written history and physical, doctor’s orders, and specific symptoms. Then the students have to run through the scenario.” — Patti Nervino, RN, Simlab coordinator

"I have had three Simlab experiences," says Kim Murray, a second-year student. "After I got over the paralyzing fear that if I didn’t do everything right they’d make the dummy code (have its heart stop) on me, I realized I could just let the process happen. This is the only place where I can go risk-free into a clinical-like setting, apply what I’ve learned, and also have a follow-up discussion about what went well and what didn’t."

The learning opportunities, says Nervino, have been tremendous. The students run through clinical scenarios and their instructors videotape each one for a debriefing session that follows. Students can see what they did well, how they responded to the patient, and what they might do differently next time.

“What we find,” says Cheryl Jacobson, RN, assistant director of the nursing school, “is that we’re able to encapsulate, in one standard experience for all students, a scenario in which they are challenged to integrate freshly learned theoretic knowledge with a matching clinical experience. The timing and the pacing are structured so that the student is challenged to perform skillfully and quickly; and within that experience, students make that leap in understanding to the point of application. That is the magic of this type of experience; in a clinical situation, you would never encounter the exact experience for every student.”

In a clinical setting, says Jacobson, if a patient happens to be experiencing an emerging problem, the student is relegated to the role of observer while a registered nurse steps in and makes clinical decisions safely for the patient.

“In this experience,” says Murray, “we’re not just paying attention to a patient. We’re developing the nursing instinct, learning to walk into a room and assess if the rails are up and the bed is down and the fluids are correct and who those other people are in the room, all in a safe setting. It does have some limitations; we can’t exactly turn the patient over, and some sounds are artificial, but it’s the whole-room scenario. It’s a lot more than this dummy in the bed.”

The lab will also be used by experienced nurses at Community Hospital.

“The laboratory can also simulate high-risk, infrequent situations,” says Terril Lowe, RN, the hospital’s vice president for nursing. “These are things that don’t happen often, providing training that is useful to experienced nurses as well as students.”

In Appreciation

As a close friend and neighbor to Debra Schulte Hacker, RN, director of the Maurine Church Coburn School of Nursing at Monterey Peninsula College, Lillian Adams knew a lot about nurses. She understood the kind of care her neighbor gave her at a moment's notice and quite regularly toward the end of her long life. She appreciated the level of personalized service the nurses gave her on different occasions at Community Hospital. And as a past Auxiliary member, she recognized the long-standing shortage of nurses in the field. Adams died in 2003, two days before her 90th birthday, leaving a significant bequest to both the hospital and the nursing school. Among the efforts the bequest has helped fund is a simulation lab for aspiring and current nurses. "I know Lillian would be thrilled by what she helped us achieve on behalf of our nursing students and this community," Hacker says. 

For more information on the Maurine Church Coburn School of Nursing.