The male figure in the intensive-care setting seems comfortable. His pulse is strong. A stethoscope detects normal breath sounds. His electronic monitor displays normal blood pressure and electrocardiogram.
“My chest hurts!” With that utterance his blood pressure abruptly falls. His heart accelerates and his electrocardiogram shows evidence of insufficient blood flow to his heart muscle. His pulse at the wrist is no longer detectable. Breath sounds suggest heart failure.
The male figure is a remarkably lifelike mannequin in the simulation lab at the Vanderbilt School of Nursing. An instructor at a computer alters symptoms and clinical findings to present examiners with a variety of clinical situations. I was part of a small group participating in a behind-the-scenes look at the process of education for students in the Master of Science in Nursing program.
When students work with a mannequin, they have all the resources at hand to address each simulated emergency. Medications can be selected and given via veins in the arms of the mannequin. A respirator can assist in breathing. The medical crises seem quite real.
Another mannequin on our tour resembles a seated boy in some distress as he complains of a painful left wrist. Unless the wrist is examined gently, he cries out. Until an X-ray can be obtained to determine if his wrist is fractured, the joint needs to be carefully splinted and wrapped with an elastic bandage. A member of our group performs this task.
We move to a birthing setting. The female mannequin complains of intensifying labor pains that occur more closely together. My fellow visitors nominate me to deliver the baby. Relying on skills last used almost 50 years ago, I guide the baby into a new world amid the continuing reports of the mother. The instructor reminds me to check the airway of the infant mannequin as I place it (a girl) into a warmed bassinet. I am completely caught up in the moment.
The instructor can create different scenarios of maternal or newborn distress from her station at the computer. I would like to think that, had the situation been real, I could have safely managed a delivery.
The varied mannequins in the simulation lab allow standardized instruction in the diagnosis and proper management of diverse acute and chronic conditions. After students have been guided through a scenario, they can later be evaluated singly or in teams by instructors located behind one-way mirrors. The instructors can alter the circumstances of each event to mimic the rapidly changing dynamics of real medical or surgical crises. Students respond as if real lives depend upon their actions.
Before the introduction of mannequins into clinical instruction, students had to depend upon events that occurred unpredictably among patients. A student might never have firsthand experience with a patient experiencing a particular calamitous event. Mannequins assure uniform experiences that can be critiqued immediately.
The computerized devices offer the further advantage of continuous availability. Once fortified with instruction on mannequins, a student can move confidently into inpatient or outpatient settings with real humans.
The simulation lab is one component in Vanderbilt’s post-graduate curriculum for nurses. Students also may work online with computer-generated patients. Students who live at a distance from Nashville can spend two-week segments of intensive clinical instruction on campus and work on other aspects of their training both online and under the supervision of mentors in their hometowns.
Most of the students in the Master of Science in Nursing program pursue specialty tracks that prepare them for clinical careers as nurse practitioners. Some will become midwives; others will direct their training toward adult, pediatric, emergency or psychiatric specialization.
A small number will work in the field of medical informatics — the application of computer-based technologies to patient care, while others develop a background in administration. Still others will pursue advanced research degrees upon completion of their masters-level studies.
Demand for graduates is high. Computer-assisted instruction blended with actual patients assures their readiness for evolving roles in health care.
Contact Clif Cleaveland at cleaveland1000@comcast.net.