Virtual patients help train nursing students

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Simulation training might be best known as the technique of choice among military recruits and pilots, but it’s also playing an increasingly vital role in the education of tomorrow’s nurses. According to Suzanne Campbell, the new director of UBC’s school of nursing—who is an expert in the virtual teaching tool—the technology enables future health-care professionals to gain the skills and self-assurance they need to hit the workforce.

Equipped with high-tech human-patient simulators—computer-driven, anatomically correct mannequins that come complete with a pulse, breathing sounds, blinking eyes, and other human attributes—simulation labs in nursing programs allow for the creation of lifelike medical scenarios and for learning opportunities that even the most detailed textbook or vivid classroom discussion simply can’t offer.

“Two or three nursing students at a time enter a room that’s set up like a hospital room or an emergency room or a birthing centre and interact with the ‘patient’ while I can be behind mirrored glass answering all their questions—how’s my pain, when did my symptoms start—using headphones in real time,” Campbell explains on the line from her office. “Meanwhile, their 30 classmates are back in the classroom watching them on video, taking notes on their laptops and devising their own care plans.”

As an example of a situation students might encounter in this setting, Campbell points to a scenario involving an emergency delivery with postpartum hemorrhage. “In real life, in that kind of critical situation, a nursing student would probably be sent outside the room and not be able to actively participate. But in a simulated scenario, they can’t hurt anyone. The patient’s heart rate can drop and they can continue bleeding, but if the students give them oxygen or give the right medication, their vital signs improve and they start doing better. It’s really neat for them to have that kind of concrete, immediate feedback.

“This kind of innovative teaching will never make up for live-patient contact, at the bedside in a hospital or community setting with one-on-one instruction from faculty members, but what I’ve found is that you can make material come alive in the classroom and help students start connecting the dots. Then when they get into a clinical area, they’ve got increased confidence and they know what to do.”

Nursing programs throughout Metro Vancouver have simulation labs, including those at UBC, BCIT, Douglas College, Langara College, and Kwantlen Polytechnic University. And with Campbell having just started her five-year term at UBC, the province is poised to become a leader in virtual, computer-assisted education.

Campbell is co-editor of the 2008 book Simulation Scenarios for Nurse Educators: Making It Real, which is about to be released in its second edition. In it, Campbell and Karen Daley offer a range of medical situations and crises that nursing students can practise for in a controlled, nonrisky environment: bacterial meningitis in a pediatric patient; assessment of a patient with a mood disorder; resuscitation following trauma; differential diagnoses when a person presents with chest pain; and acute respiratory failure in an elderly patient, among others.

“Simulation is a tool, and I look at it as part of innovative education,” Campbell says. “Where the learning really occurs is after students have completed the simulation and are back in the classroom, being debriefed by expert faculty going over questions like ‘What could you have done differently? What else could you have asked?’

“I had a graduate write me saying, ‘I had a postpartum hemorrhage [case] and I knew just what to do,’ ” she says. “Not every scenario is going to play out like a textbook, but it’s very confirming to get out there and know exactly what to do. It makes learning exciting and very real. The rigorousness of the learning experience is very important.”

Besides providing an experiential learning environment for undergrads, simulation labs do the same for working nurses looking to upgrade their skills in specialty areas such as emergency and critical care.

Bill Dow, dean of BCIT’s school of health sciences, says the institute’s simulation lab is a hallmark of its nursing programs, helping students develop practical techniques along with critical-thinking and decision-making skills.

“Besides sending students out into hospital, community-care, or home-care settings, we do a lot of simulation,” Dow says in a phone interview. “We’re proud of how well we’ve incorporated that into our curriculum and the number of hours students get practising in a safe place over and over again so that their confidence is there when they go into the workplace. They’re really prepared. The simulation labs are unique in that they really give an understanding of what it takes to be a nurse.”

According to a 2010 review of research into simulation in nursing education published in the online research journal Qualitative Report, simulation labs act as a bridge for the transfer of classroom knowledge to practical use. “While participating in a clinical rotation as a student, they may never see a particular type of patient, whereas with simulation, many things become possible,” the review says. “Students stated they now realized the gravity of what could happen in a real clinical setting when a patient is not doing well, and they felt the simulation experience will make them more aware when checking allergies and administering medications.”

Simulated scenarios can also be used to teach health-sciences students solid communication skills, Campbell notes.

“When you look at health-care errors, many times they can be circled back to miscommunication,” she says. “If you can give students theoretical background and practise in a simulated environment, then when they get into a clinical situation, they have the foundation of skills they need to effectively communicate.”

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