Allison Lewin, a University of Michigan nursing student, is working hard to talk her patient—an expectant mother with preeclampsia—out of a full-blown panic attack.
“Is this going to hurt?” the patient asks. Lewin knows it will. “Generally yes, contractions do hurt,” Lewin says sympathetically, and promises to bring in someone to discuss pain control.
But this is no ordinary patient. It’s Victoria, a high-fidelity, life-sized mannequin used to teach nursing students how to respond to real-life medical situations, especially emergency situations like this one.
Victoria and the mannequins like her are the undisputed stars of the Clinical Learning Center Simulation Lab in the new U-M School of Nursing building. The six simulation rooms that comprise the SIM lab recreate real-life patient situations—especially trauma—that the majority of nursing students won’t ever see during clinical rotations.
Depending on the mannequin and the SIM room, students can practice suctioning secretions from the trachea and administer oxygen, electrically shock the heart into starting again, administer intravenous drugs, insert catheters and nasogastric tubes, and practice tracheostomy care and other skills. The mannequins can bleed, vomit, yell in pain and ask questions just like real patients.
“The chances of a student being the nurse delivering that kind of care is slim to none,” said Michelle Aebersold, director of the Clinical Learning Center.
Studies show that undergraduate student nurses can replace up to half of their clinical hours by simulations without impacting their ability to pass their nursing certification exam, she said.
Clinical instructor Maureen Westfall is overseeing three nursing students tending to Victoria from behind a one-way mirror that overlooks the birthing room. From her control bank of screens, wireless controls and a microphone, Westfall acts as Victoria’s mind and body. She programs Victoria’s physiological responses wirelessly, and when she speaks for Victoria her words are piped into the birthing room. Westfall can change Victoria’s physiology and cause conditions like septic shock, kidney failure, heart attack and seizure.
“I can present just about any complication,” Westfall said.
Suddenly Victoria starts to shake, and the student nurses roll her on her side. She’s seizing, and the students are taking too long to administer the necessary drugs, Westfall says.
“I need that Ativan in,” Westfall orders.
Despite the fact that Victoria is a mannequin, it’s impossible not to get caught up in the stress of watching her convulse. Eventually, Victoria gives birth to a 9-pound infant that’s slippery with mineral oil, followed by the placenta.
Grace Moore, 20, a junior, says she’ll remember the mistakes she makes in SIM lab for the rest of her life. Westfall agrees, and says there’s a physiological basis for this.
“It sears it into the memory because the body has an actual chemical response to stress,” Westfall said. “Here we can create a safe space for trial and error. You’d never get that in the hospital. It’s important to create a safe space, because when you feel safe, you remember.”
After the birth, the students head into a debriefing room and talk with each other and Westfall and about what went right and what didn’t.
The need for state-of-the-art nursing training is more critical than ever in light of a looming physician scarcity. The American Medical Association predicts a shortfall of 45,000 primary care physicians and 46,000 specialists by 2025, and one way to alleviate the shortage is through Advanced Practice Registered Nurses.
An APRN is a nurse with a master’s, post-master’s or doctoral degree in a nursing specialty, and in many states APRNs can practice in clinics without the supervision of a physician.
The 13,000-square-foot Clinical Learning Center also hosts standardized patient rooms set up as primary care offices, and a skills training room where primarily graduate students practice lumbar punctures, central line placement, intubation, casting and suturing. In the anatomy lab, students can use the Anatomage Table to view the human body in 3-D.