University at Buffalo - The State University of New York

Published: April 3, 2003

By DONNA LONGENECKER
Reporter Assistant Editor

The School of Nursing has instituted new technological innovations—among them 10 fully functional clinical exam rooms complete with video and voice interaction capability, and the addition of a second human patient simulator—that are designed to enhance nurse training.

SimSon, a full-body mannequin with lifelike heartbeats and pulses, and realistic breath and body sounds, joins the more complex SimMan (Sam) in the school's arsenal of teaching tools. SimMan is used in the nurse anesthetist program.

Students visiting UB from Aichi-Prefectural College of Nursing & Health in Japan practice on SimSon.
PHOTO: School of Nursing

The purpose of the simulators, says Penny Cataldi, instructional support technician, is to give nursing students more realistic training and help them practice life-saving clinical, technical and decision-making skills without risk to patients or health-care providers. SimSon will be used primarily by undergraduate students to develop assessment-training, critical-thinking skills, Cataldi says.

SimSon has a unique, patented airway that allows for intubations and teaching of multiple advanced life-support skills. Students learn to perform CPR, or they can even shock him with a defibrillator. And if necessary, the simulator can "die."

SimSon's vital signs can be programmed to display a variety of health conditions, such as a failing heart, tongue edema, involuntary mouth tremors, fluid-filled lungs and a variety of bowel sounds related to age or condition or illness. This, says Cataldi, allows student to make assessments based on realistic, corresponding bodily sounds and physical changes in the body and helps them to learn to differentiate between what is normal and what is abnormal.

"It helps the student—if you're don't often hear these things or see these things before you go out to work, then you're picking them up as you go along. This way, they're more prepared and feel more secure and confident when they actually do get out and begin to work with patients," she says.

The simulator, a basic model, cost about $33,000; more advanced models easily can top $100,000.

One of those more advanced models is SimSon's "colleague," SimMan (Sam), which is used in the nurse anesthetist program. Sam's eyes open and his pupils dilate; he can receive real anesthetics and medications, and can be programmed for a wide variety of operating scenarios—including childbirth.

"Sam is perfect for the nurse anesthetist program, but we wanted to purchase one (for the undergraduate program) that wasn't as elaborate as that," Cataldi says. "We need tools that will teach them basic skills that we would want them to know once they get out into the field, rather than just learning those skills on the job."

The school is one of only a handful of nursing schools in the world using patient simulators, nursing school personnel say. Tom Obst, clinical professor, and Scott Erdley, clinical assistant professor, recently showed the Reporter a video of a training scenario in which Sam was programmed to give birth. The "patient's" fetus was experiencing fetal distress and the entire student surgical crew was notified, Obst explains. Sam was brought into the simulated operating room and students flew into action—it's hard to tell the difference between a training exercise and the real thing.

"It's a very stressful type of case," Obst says of emergency childbirth. It took some time to get the baby to cry in order to resuscitate it. "It's very fast moving and some people who have viewed the video were 'tricked' into thinking the scenario was real," he says.

Such simulations also provide students with the opportunity to experience critical events that they might see once in 20 years of practice, says Erdley. "Those kind of experiences are crucial when you get out in the real world," he says.

"What we've done over the past five or six years is to embed a lot of advanced simulation into the curriculum," Obst says. "In exit interviews, students uniformly report that working with Sam was the highlight of their education," he says, adding that the simulations are not meant to replace the actual operating-room experience.

It's easy to see how nursing students can suspend belief that the simulator isn't real—Sam responds to voice commands and touch, making comments like, "Your hands are warm," and "I don't feel so well," all while hooked up to a monitor recording vital signs and the blip of his heart rhythm.

"Basically, he demonstrates vital signs as a real patient," says Obst. Perhaps even more dramatic is the fact that real drugs and medication can be injected directly into his veins, and like a real patient, Sam responds differently each time, even though he may be receiving the same medication over a period of time.

"The unique thing about the simulator is that it behaves in a realistic fashion in response to stimuli. Sam doesn't have to be programmed to respond to a drug a certain way—he presents, almost intuitively, to each drug like a human would, which is different every time a drug is administered. He may give you a completely different presentation (of the drug) than the first time he received it. You don't have to tell him how to respond to that drug," says Erdley.

"It's not the technology, but the vision that surrounds it," adds Obst. "We're particularly proud of what it does to build upon their (students') clinical skills."

Those skills include effective communication, problem-solving, team-building, proper work habits and an appreciation for organizational influences and management skills, according to Obst.

Less flashy, but just as cutting-edge was the completion within the past six months of 10 fully functional clinical evaluation (exam) rooms featuring video and voice interaction capability that allows an instructor to guide students during patient evaluations. The school also has added videoconferencing/distance-learning technology that has greatly enhanced its outreach and ability to record and play class sessions for remote clinical evaluations at Erie County Medical Center and preceptors of the nursing program, says John Blyth, education specialist and Web developer.

The School of Nursing has partnered with Jamestown Community College, hosting interactive distance-learning classes for the college on a weekly basis, with plans to add more, says Blyth. The school also soon may train nursing students overseas via distance learning.

The clinical rooms, located on the seventh floor of Kimball Tower on the South Campus, are fully equipped as if they were in a clinical or hospital environment. Each room has two-way voice communication and video cameras to better guide the student as he/she interacts with patient volunteers.

"It's just as if you were in a doctor's office," says Cataldi. "We can assess adults, pediatrics and geriatrics. Students can make videotapes to review for improvements, and we will be able to make a videotape of what they're doing to learn from the experience," she explains. "This is really going to be state-of-the-art in nurse training."