Don’t Call It a Dummy: How CSU’s Nursing Students Train for Medical Emergencies

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Written by Ashton Johnson

 

 

   His name was Gregg Gantz—a man with an agitated wife, nine children, and Crohn’s disease. The instructor gave her nursing students a run-down of his condition. Then, they broke off into groups. Each junior had a role: recorder, family member, and nurse. Inside the lab room, Gantz waited for his assessment.

 

 

    “Hi,” said the primary nurse. “My name is Kayla and I’ll be your RN today.” For thirty minutes, Kayla Tew and four other students worked under pressure on Gantz, a mannequin that blinked, breathed, and talked.

   “It’s challenging,” said Tew, “just trying to figure out where to delegate roles.” With so many voices in the simulation, she said, “It definitely makes you more anxious and distracts you from what you’re supposed to be doing, which is taking care of the patient.” Tew explained what her experience was like prior to the simulations.

   “We haven’t been in the role where we are the nurse. We’ve always just been the student nurse. So if you don’t know something, you can just go ask your RN.” It isn’t until they’re faced with a mannequin that they understand—feel—the pressure. “Here we’re pretending to be the nurse,” said Tew. “We are supposed to have the answers.”

   Nursing instructor Dona-Lee Ferguson voiced Gantz in the simulation: “I just don’t want to move at all. Every time I do it feels like my guts are falling out.” That’s no exaggeration. The students comforted their patient with an explanation of the process.

   With the slip of an IV needle, Gantz repeatedly cried, “Ow!” His reactions and responses were a constant reminder of reality. This was a person with a family waiting at home. His wife—played by a student—was in the room, questioning everything the students did. “You know, I can just take him home and we can deal with him there,” the wife insisted frantically. “We’ll be fine.” Such input made students uncomfortable, as some didn’t know how to answer family members with stakes that high.

   On the other side of a glass wall, Ferguson watched her students work on Gantz. They’ve had that mannequin for four years. In his previous home—Illges Hall—he depended on unreliable wires. Now, he has a network connection in Frank D. Brown Hall.

   “Here, I’m gonna make his heart-rate go up a little more,” Ferguson said inside the booth, “because they’re not really paying attention to the fact that he’s having some trouble breathing.” Before her were two monitors, one recording the students and the other displaying the mannequin’s vitals. From the blink of an eye to the respiratory rate, she controlled every function, and the slightest shift meant something.  Ferguson later commented, “For the first semester, I usually don’t let them kill somebody. That’s one of their fears.”

   After the simulation, the students regrouped in the classroom to discuss their performance. They conduct up to three simulations per day, each one layered with a debriefing. “We explore in the debriefing sessions what we could do differently,” Ferguson said.

   It’s a lengthy and thorough discussion. They focus on teamwork, assessment, prioritization, communication, intervention, and connecting those elements with the patient. Every simulation is intended to improve upon those values while testing the students on their medical knowledge. Overall, it’s an essential learning experience.

   “The first thing we want to do as a nurse with our patients is assess the situation and what they have going on,” explained Nikki Kenyon, who served as the second nurse in Gantz’s simulation. When it comes to communication, her peers are her resources, but those resources might very well be a team of strangers. “It’s good real-life experience. You can get thrown into anything at any time when you’re in the hospital.” This gives them an edge over nurses without that experience. By participating in this program, students with a Bachelor of Science in nursing are more likely to be managing nurses on the floor.

   A great deal of role play goes into the simulation and Laney Wilson has played every role, including family. “Some of us were wives, some of us moms, some of us daughters,” she said. Acting as a family member pushes the students to ask emotionally-weighted questions from a different perspective. It encourages them to empathize with everyone involved. “Not only do you want to address the patient’s concerns but you want to address the family’s concerns too. Because they’re just as concerned, if not more than the patient is.”

   “If you can empathize with situation, that’s always good,” commented Kenyon. “But I think most of us by now have had a family member in the hospital in real life too, so you know how it feels to be on the other side. Hopefully it makes you a more compassionate nurse in the end.”

   Acting is not without its humor. The family role enables students to make the situation crazy. Wilson explained, “You can make it harder on the nurses, or you can make it easier.” Anything can happen. That day, the other simulation required an estranged wife to be escorted out of the room—no wonder Gantz (the mannequin) didn’t want to go home. While amusing in a simulation, removing a family member is concerning for everyone involved. Instructors know this, and they discuss such complications with their students.

   In the nursing program, there’s a great emphasis on respect. Even when operating on a mannequin, students are expected to maintain its dignity just as they would with a human being. The same is true for every aspect of the assessment. However, for some students, there’s no suspending their disbelief in the simulation.

      “We’re not allowed to say…” Wilson lowered her voice. “Dummy.”

   That is actually a rule—one of three.

   You can’t call them dummies. Never, ever, say “diapers.” And, most importantly, don’t tell your instructor, “I would have done that if…”

   According to Ferguson, those students say, “I would have done that if it had been a real person.” Her response to that is, “That’s all well and good, but, if you’re not doing it here, how can I be reassured that you actually will do it?”

   There is a huge difference before and after simulation, and other clinical instructors take notice. “When the student comes back into their rotation, they can usually tell that they’ve been to sim lab,” said Ferguson. “Because they’re  much better at assessing, at looking at the environment, and thinking about all those other things that maybe their colleagues haven’t been able to do yet.”