Simulation in the School

Sim Man was the first purchase of a high fidelity mannequin in the School of Nursing. He was later upgraded to Adult Hal. Able to communicate and react as most any sick patient, his “home” environment replicates a general patient hospital room, including electronic bed, functioning headwall equipment and a patient monitor displaying respirations, heart rate, heart rhythm and blood pressure. His physical surroundings can be altered to reflect any number of “scenes” to provide a wide variety of patient situations, such as a nursing home, private home for home health visits, school, etc. The Adult Simulation lab includes not only a patient room, but video cameras to record teaching sessions and allow instructors to view and control the student/patient interaction from the post conference lab next door. Other students and faculty members can watch the live scenario while the instructor also has the ability to modify the script unseen. Scenarios are purchased or created to replicate hundreds of real life health issues. These scenarios are programmed into the Sim Man system. He has a pulse, heart and lung sounds. He coughs, he complains, he goes into cardiac arrest. Students can take his blood pressure and temperature. The instructor has the option to immediately respond verbally through Adult Hal to comment on an action by the student or to modify the script unseen. This open communication enhances the reality of the experience. The high fidelity simulator gives students the opportunity to practice their skills and react to very human conditions that change with their input. Following each scenario, the students and instructor meet in the post conference lab to review and learn from the recorded simulation.

With the success of Adult Hal, an administrative decision was made to grow the simulation program at Graham. Two high fidelity infant simulators, Baby Hals, and Pediatric Hal, have been added to provide practice experiences for students in maternity, pediatric and community courses, along with a related teaching lab. Also, our adult female high fidelity mannequin, Noelle, allows students to simulate labor and delivery experiences, plus gynecological scenarios, in a lab of her own. Some examples of practice experiences are normal vaginal and c-section deliveries, breech and shoulder dystocia deliveries, hemorrhage, and infant seizures. There are two monitors that display Noelle’s vital signs, the fetal heart monitor tracing, and once Noelle’s baby is delivered, the fetal heart rate monitor tracing changes over to Baby Hal’s vital signs. Noelle actually births a smaller version of Baby Hal. Students can insert notes in a performance log as well as perform many assessment and care activities. Noelle has an extensive library of pre-recorded comments which can be played in English or Spanish. Baby Hal cries and has sounds emulating respiratory distress. All simulators are intubatable with breathing, pulses, ECGs, heart and lung sounds, skin color changes (cyanosis) and many more options. Currently, Sim Man is controlled by a laptop and other simulators are controlled with tablet computers. Both the OB and the pediatric labs have recording equipment so simulations can be recorded for later discussion and the option for the instructor and other students to view the simulation as it is taking place.

Students comment, that in the beginning, it seems awkward to speak to the mannequin, but once the scenario gets started, the interaction becomes life like and they often forget they are in a simulation. Two medium fidelity mannequins, round out this teaching family, a pediatric five year old, Michael/Michelle and adult, Nursing Annie. The success of these teaching tools has resulted in honing practice skills, preparation for the unexpected and building confidence in our nursing students in an environment safe for both patients and learners.