Before nurses begin working in real-world scenarios, they have to go through lots of training and preparation. At the University of Wyoming (UW) Faye W. Whitney School of Nursing, students have to complete a minimum of 1,125 hours of clinical practice, which includes around 100 hours of simulations.
They are also required to complete an additional 90 hours of laboratory skills training in the four years they complete their degree.
Krista Sullivan, a Doctor of Nursing Practice (DNP) student, helps run the simulations that give UW nursing students crucial experience caring for patients.
"So a large part of nursing is critical thinking. And we use the nursing process to formulate that critical thinking," Sullivan said. "And simulation is a really good place to cement that because we can take what would be four to five hours and simulate it as 30 minutes."
UW's School of Nursing has several highly advanced mannequins that play the part of "patient."
Clinical simulation coordinator Denise Gable said these mannequins do everything - from blinking and breathing to showing symptoms.
"She bleeds. She urinates. She cries, she sweats. She vomits. She doesn't projectile vomit but you can hear the vomit. You can push medications through her. She's got blood pressure. She's got pulses. She's got heart, lung, bowel sounds. She's got all of that. It truly is like it's a real patient," Gable said.
Gable added they even give birth to realistic mannequin babies.
Students in the simulations are split into two groups: the observers and the caregivers. The observers watch from a remote room and take note of things that are done well by the caregivers and those that need to be fixed.
The caregiving is done in mock hospital rooms with real, working equipment. First, they get a detailed medical history from Sullivan, the DNP student.
"It's currently Monday at sixteen-hundred. Your patient presented to the emergency department at oh-six hundred on Monday and was admitted to the floor at 7:30 on Monday, and then went to surgery and returned from surgery at 15:45 to the floor. Her name is Agnes Taylor."
And then the scenario begins when the student nurses introduce themselves and ask how the patient is doing.
Each scenario is different and completely customizable. Sullivan oversees the simulation through a one-way mirror. She has the ability to change any aspect of the scenario in real-time, and she’s also the voice of the patient and can add information or affect the simulation as needed.
After both groups act as caregiver, Sullivan and the students critique their performances, which she said is the most important part of the process.
Clinical Simulation Coordinator Denise Gable said this program allows students to train in a variety of real-world situations without the risk that comes with real patients.
"It's as real as it can be when they come in here, so that they know that even though they do their best, they can make mistakes," Gable said. "And that's the whole point of simulation to make mistakes and not have to do it on a real patient. They can learn from this part here."
This is especially important now. School of Nursing Dean Sherrill Smith said student’s access to in-person clinical practice was cut short thanks to COVID-19.
"When the campus closed, the other thing that happened was our hospital partners also asked that we not bring students into their settings," Smith said.
Luckily, seniors had enough in-person hours before the pandemic hit to graduate. But Smith worries about their current students.
"We have told our students to graduate they will have to have some face to face time. The rest of our students, they're in the middle of their program - I need to make sure they get the direct patient care hours," Smith said. "And I'm hoping that we are able to continue that and not have to hold people back from graduating, but it will be hard to graduate students if they don't have the competencies they need."
And while they await final word from the hospitals, the lab is looking into new opportunities. For instance, clinical students will get the opportunity to study COVID-19 and work with simulated patients.
"Because even if we are saying we're going to keep them out of those rooms now, we want them to be able to understand the care of those patients so when they graduate, they're prepared and at least have an understanding of the things that are required for those types of patients," Smith said.
She said they're looking into building a virtual 3D lab on campus and creating similar technology that students can use at home. As always, the staff is focused on giving their students the best training possible, with or without a pandemic.
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