Communications of the ACM
High-Tech Manikins Educate Nurses at Clinical Simulation Lab
SimMan Nursing students practices their nursing skills with the SimMan, an advanced patient simulator which allows students to practice realistic emergency treatment of patients in the classroom.
Credit: UTPA
"I feel like I could die."
This desperate-sounding utterance from a patient would grab the attention of nurses and caregivers on any hospital floor or in any ER. But in the Clinical Simulation Lab (CSL) at the University of South Carolina's College of Nursing, the plea is from a high-fidelity manikin, who is getting a great deal of attention from students and faculty.
The College of Nursing has opened the door to a group of manikins who are helping students learn routine procedures and special skills for patient care before their training moves to hospitals and clinic settings. They also are helping nursing students develop their abilities to prioritize care and make sound, rapid decisions.
The CSL manikins are malleable and can be programmed to have myriad health problems. The student interaction with these lifelike "patients" helps students develop critical-thinking skills and hone their adeptness handling routine procedures — shots, problem identification and intervention and taking blood pressure — that can intimidate new nurses. As students progress through the program, the clinical scenarios increase in complexity as well, serving students at all educational levels.
At Carolina, the lab itself is a realistic healthcare facility — complete with beds, medical equipment, examination rooms and a delivery room. A large, common area enables students to gather for a classroom-style presentation or to get feedback from the nursing faculty who are overseeing the day's lesson. Computer-generated illnesses and medical emergencies for the manikins challenge students to assess problems and provide care.
Erin McKinney, director of Carolina's CSL, says the high-tech facility and its patients reflect a growing trend in nursing, medical and healthcare education throughout the nation.
"Students say working with the manikins is an important first step in helping them move from the classroom to clinical settings," McKinney says. "In the beginning, they are uncertain about the experience. But it doesn't take long for them to see the experience as confidence-building and a wonderful way to gain in-depth clinical knowledge."
Crystal Gilmore-Hope of Rock Hill, a senior nursing major, has had classes in the lab since fall 2008 when the College of Nursing began developing the lab. However, the manikins have become increasingly more high-tech and challenging over the past year.
"It's very unsettling at first to work with a patient who already is sick or has health problems," says Gilmore-Hope. "But this bridges the gap between class and the real world."
When students train with the manikins, faculty often videotape the sessions and replay student responses. Students can see whether a particular response helped or harmed the patient — and learn from their experiences in a nonthreatening environment.
"This helps you gauge your bedside manner, your reaction time, how well you work with other people," Gilmore-Hope says. "It lets you see yourself in a real situation."
Low-Fi Trainers
The College of Nursing has four high-fidelity manikins, including the patient SimMan that believes he's dying, and a high-fidelity birthing pair, named Noelle and Hal, that can be programmed for problems associated with pregnancy and delivery. Other manikins, which are considered "low fidelity," provide valuable experience in training nurses for specific tasks, such as taking blood pressure, assessing heart and lung sounds, inserting intravenous needles and caring for wounds and ulcers.
Dr. Peggy Hewlett, dean of the College of Nursing, says the CSL experience is an important addition to nursing education.
"Having the Clinical Simulation Lab is part of the College of Nursing's efforts to provide our students with a quality education that will prepare them for the demands of their profession," says Hewlett. "This intense learning experience challenges our students at every level. And they love it!"
More than 12,500 student hours of lab time will be logged by the nursing students at Carolina this fall.
"The manikins are vital in an era of nationwide nurse shortages," says Hewlett, a leading expert on the nursing workforce. "They are being utilized to close the gap between the need for baccalaureate nursing graduates and the still-acute nursing faculty shortage."
In a traditional hospital setting, one faculty member oversees the training of eight to 10 nursing students for basic and advanced clinical skills. But in the simulation lab, dozens of students can learn from a faculty team.
"This helps our students to become better prepared and more confident during their first experiences in a hospital or clinic," Hewlett says. "Clearly, the simulation lab is vital for nursing education, and it also can be used by students in other health profession majors."
Life-Like Scenarios
McKinney says the CSL is invaluable for nursing faculty members who quickly adapt to this "student-centered" teaching style and become very creative in lending reality to the scenarios to make the experience as life-like as possible.
"We are able to collect and share data and share ideas among nursing institutions in our state and beyond. This data will be critical as we shape the CSL experience for other colleges, universities and healthcare facilities," she says.
Although simulation labs are developing around the country, the CSL experience in the Palmetto State is in a class all its own. Technology links the CSL at Carolina's College of Nursing with similar facilities at the Medical University of South Carolina, Clemson University, the Greenville Hospital System and Greenville Technical College.
This network puts faculty in touch with one another to develop courses and to address nursing students' educational needs. Ultimately, the data that are collected from CSL classes will form the basis for research programs on nursing education and healthcare, McKinney says.
"Our nursing faculty are proud to be among the leaders in changing the way that nursing education will be delivered — now and into the future," Hewlett says.
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