What's New Spring 2013

This is an example of a recent simulation scenario that nursing students in the College of Health Professions are taking part in. 

Professors Elizabeth Berro MA, RN, PNP and Joanne Knoesel MSN, RN are leading simulation scenarios like this in the Clinical Education Labs on the New York City and Pleasantville campuses for RN4 and CDP students.

College of Health Professions students are also using human patient simulators (high tech manikins) that can be programmed to mimic various conditions -- they speak, breath, cough and groan! The students assess heart, lung and bowel sounds, and measure blood pressure and other hemodynamic measurements.  These highly realistic “patient encounters” in the safe environment of the Clinical Education Labs allow students to practice skills; thanks to simulation, students build confidence, having the benefit of the continual presence of the simulated patient, and they have the opportunity to safely learn from mistakes all while under the watchful guidance of an experienced faculty member.

According to Dean and Professor Harriet R. Feldman, PhD, RN, FAAN, “Our students get evidence-based learning experiences that are deeply meaningful while at the same time realistic and safe.”

According to Joanne Knoesel, “Our simulations include high and low fidelity simulators, role playing, and the use of standardized patients -- actors -- to add the realism of the scenario.  We have had two casting calls and trainings for our standardized patients, where we instruct them on the use of simulation in nursing education, and review scripts with them to ensure accuracy of information and consistency of the simulation sessions.”

Professor Berro adds, “Our software system affords us the opportunity to watch the scenarios in real time to ensure a consistent experience for each student, or to view sessions at another time.  Videos of scenarios are available for all faculty to view their students’ experiences.  We have logged over 150 hours of simulation sessions in the fall semester for RN4 and CDP students on both campuses.  Video review also offers the student the opportunity for self-reflection.”

A particular simulation scenario may be best suited for standardized patients because the learning objective relates to communication, while another scenario flows well with human patient simulators because of the invasive nature of the health care, and still others are deemed hybrids.  In an example of a hybrid scenario, the “patient” is a pediatric human patient simulator with asthma, and the standardized patient (actor) is his mother.  The child is in the emergency department, and it is up to the nurse to assess his condition, administer basic medications, and educate the mother on what to do for her child once he is discharged from the hospital.  Nursing student Carson Tippit, class of 2014, said of this scenario, “When the mom came in, that made it feel a lot more real.”

Another simulation using human patient simulators is called “Little Room of Errors” and it teaches aspiring health care professionals about patient safety.  It was developed in response to the Institute of Medicine (IOM) report on national patient safety goals entitled To Err Is Human: Building a Safer Health System; the goal of this scenario is to reduce errors to ensure patient safety.  The student identifies errors that have been set up in a simulated patient’s room.  For example, there is garbage on the floor; the oxygen mask is not connected properly; the bed railings are not in the right place. 

A final example of a simulation involves multiple human patient simulators and teaches students how to incorporate various skills and make decisions around priority setting and delegation.  Students are assigned roles - RN, LPN, or unlicensed assistant personnel.  They make decisions about which patient(s) to care for first; they also delegate tasks and set goals.

According to Professor Knoesel, “After the students finish the scenario and before the evaluation, we debrief.  This is where the students express how they felt about the scenario and self identify what they did correctly, and what they could have done better.  We sometimes use the video recording to give examples, and it usually leads to a discussion of current best practices for nursing.  Since the students identify the issues, they learn and retain the knowledge from the simulation experience.”

Simulations were extremely important in the fall semester in the wake of Hurricane Sandy, which caused the cancellation of students’ clinicals.  Professors Berro and Knoesel stepped in to make up clinical hours using simulation.  According to the professors, “We were able to accomplish that as well as provide simulations make ups for students who were absent from their other clinical days.”

According to Professor Berro, another benefit of simulation is that students are integrated between programs and campuses.  Recently a new CDP student working with upper classmen in a simulation expressed concern about upcoming exams.  She got support from fellow students who had already completed much of the program and felt reassured after speaking with them.  In addition, Professor Berro says simulation make-ups span programs, clinical areas, and years resulting in a positive learning experience for everyone. “It’s a bonding experience, and an eye-opening experience that shows students ‘we’re all in this together’ and lessens feelings of competition or rivalry that can be felt by different groups.” 

Students have very positive feedback when asked about their simulation experiences.  According to Mary Kate McShea, class of 2014, the simulation experience helped students think on their own.  “We can afford to make mistakes on the manikins.”  In addition, the small group experience helped because “you have to take the role of a leader instead of hiding behind a classmate.”  Camille Bailey, class of 2014, agreed, “The small groups made me participate more.”  Nicole Muccio, also a member of the class of 2014, appreciated the safe environment she found in the Clinical Education Labs.  “I get so nervous in a hospital setting. [This setting] lowered your nerves.”

In the spring, simulation will continue to be incorporated in clinical and non-clinical courses for undergraduate students and FNP students.  In addition, the College of Health Professions is developing an interdisciplinary simulation between the FNP program and the PA program.