By Debra Wood, RN, contributor
Nursing students walking into the University of Texas Arlington’s Smart Hospital know they will care for “patients” with complicated and serious conditions, but the high-tech, simulated learning environment lets them hone their skills without risk of harming a living person.
“It increases my confidence,” said Hattie Jackson, a senior BSN student at UT Arlington (UTA). “I’m thankful to be at an institution where we have an opportunity to get ahead of the game—being prepared before we go to the hospital setting.”
Phase II of the Smart Hospital, a 13,000-square-foot facility, opened in 2007. Twenty-seven manikins simulate nearly any type of patient or disease process. There are preemies, laboring women, sick children and geriatric manikins that respond appropriately to the nursing students’ interventions.
“When students enter the Smart Hospital, they are entering a hospital atmosphere,” said Mindi Anderson, Ph.D., RN, CPNP-PC, simulation coordinator at UTA. “Students see what they would see in that particular unit.”
The hospital has seven emergency beds, four intensive-care beds, two labor-and-delivery suites, three pediatric beds, two neonatal intensive care beds and four medical/surgical beds. Units have a nursing station, med carts in the halls, waiting areas. They are outfitted with equipment and furnishings from founding partners Hill-Rom and Cardinal Health.
“Sounds of the hospital can also be heard with the high-fidelity simulators,” Anderson said. “For example, when the oxygen saturation decreases or the heart rate increases, monitors will alarm just like in the real hospital.”
Molds, wigs, clothing and makeup make the manikins look as realistic as possible, perhaps adding a wound or broken bone to simulate trauma. The faculty and staff also have recipes to make mock urine and vomit.
“You want it to look, feel and smell just like where they will be doing this stuff, so you suspend disbelief and recreate reality,” said Judy LeFlore, PhD, RNC, NNP, CPNP-ACNPC, director of the pediatric, acute-care pediatric and neonatal nurse practitioner program at the UTA School of Nursing.
Actors play supporting roles as concerned parents on the pediatric unit, perhaps screaming for someone to help their baby, or as patients to help a nurse gain history-taking skills.
“This allows students to practice communication skills that are harder to achieve with manikins,” Anderson said.
Instructors select pre-programmed scenarios, many written by the faculty, which complement what the students are learning in class. As the students work on the patients, the faculty member may switch the manikin to “on-the-fly” mode and control by computer or PDA how the manikin responds to an intervention.
“We never know what the instructor might throw at us,” Jackson said. “We might be prepared as possible. But they might change something to see how much we know about the subject or to give us something unexpected. You never know what will go on in a real-life situation. They try to make it as real as possible.”
Kristine Nelson, RN, MN, clinical instructor at the UTA School of Nursing, said the Smart Hospital presents a challenging role for faculty members as well, because they not only have to watch what the student is doing but also determine how the patient will react. For instance, if a student walks up to a patient and attempts to put a syringe full of medicine in his mouth, a real patient will automatically scream and rebuff the nurse. In the Smart Hospital, the instructor has to make sure that happens.
“There are opportunities to teach how to properly approach a patient,” Nelson said. “It’s not just physiological. There are a lot of other elements to it.”
After the 15-minute to 20-minute intervention, students and faculty debrief, talking about the scenario, how it went, and what could have been differently to produce a better outcome.
“Debriefing is considered one of the most important aspects of a simulation experience,” Anderson said. “Students are able to view portions of the video of themselves performing in the simulation in order to further help with self-reflection.”
LeFlore said 99 percent of her graduate students have identified what they should and should not have done before she says a word.
Undergraduate students typically spend from five to eight hours at the Smart Hospital, caring for one patient after another. In some courses, they may be responsible for multiple patients to allow them to prioritize needs, as they will after graduation.
Three or four instructors run multiple scenarios simultaneously, with small groups of students working with each manikin. One student will be responsible for medication, anther assessments and still another will act as charge nurse.
“It’s an added benefit to simulation education having students work as a team,” Nelson said. “They work together and combine their data and information to map out a plan of what to do for the patient, implement the plan and evaluate the effects of their actions.”
At the graduate-school level, nurse practitioner students also use the Smart Hospital to apply what they have learned in class. LeFlore creates scenarios that reinforce and build on students’ knowledge. Each semester, the situations become more difficult.
“I create what happens in an emergency,” LeFlore said. “They are nervous. Many of them shake. I’ve had students cry, but its better they do it with me in a controlled lab setting, where we can go through it over and over until it becomes part of their nature.”
The practice makes the nurse practitioners much more confident and skilled when they enter the clinical setting. In the last semester, nurse practitioner students must successfully manage a cardiac arrest and an airway obstruction, with a team that includes a nurse, a respiratory therapist and a social worker, since rarely does someone take care of a patient in isolation.
“The way we educate is going to have a direct, positive relationship on the outcomes of our patients,” LeFlore said.
UTA School of Nursing plans to build a 100,000-sqaure-foot, 60-bed Smart Hospital facility, which will operate as a regional and national demonstration center. Plans also call for it to serve as a community resource for disaster-response preparedness.
Currently, nurses from facilities in the Arlington area use the Smart Hospital to help experienced nurses maintain their skills. Repeatedly practicing emergencies allows correct responses to become a habit, so nurses will respond appropriately when a real emergency occurs, LeFlore said.
Many possibilities exist for expanding the Smart Hospital’s reach in teaching the next generation of nurses and nurse practitioners.
“The sky is the limit,” Nelson said. “We have just scratched the surface.”
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