National curriculum survey, ‘a game changer,’ validates value in simulation

The patient, a middle-aged male, complains of severe chest pain. His mouth is drawn into a grimace; his skin is pale and clammy. A quick check of his vital signs reveals an elevated pulse, and the medical team strongly suspects a heart attack.

The student nurse:

a) Is asked to leave the room

b) Observes the action from the corner

c) Helps under the direction of her clinical advisor

d) Takes control of the situation

The correct answer? D, at least it is in the Johns Hopkins School of Nursing (JHSON) simulation lab. There’s no penalty, though, for answering A, B, or C; after all, those answers reflect the clinical experience of most nurses currently in practice. If a patient develops an acute complication during a clinical rotation–and that’s a pretty big if, as complications are by definition unpredictable–students are likely asked to leave the room, limited to the role of a bystander, or allowed to help in a very small, very supervised way.

In the JHSON sims lab, though, students guide a patient’s care. They obtain an EKG, get a “pulse ox” (a noninvasive reading of blood oxygen level), assess the patient’s pain, and notify the doctor. They keep an eye on the patient’s condition and respond appropriately when, say, atrial fibrillation occurs. They then stabilize and prepare the patient for transfer to a higher acuity setting.

They get to do those things because the “patient” is actually a high-fidelity manikin, capable of sweating, speaking, and responding to student interventions. The use of manikins (and, occasionally, actors) allows student nurses to safely perfect their skills in low-risk simulations before being called upon to respond in high-intensity, high-risk, real-life situations.