Simulators: Torrance hospital offers training in a different vein

 

style="WIDTH: 441px" cellSpacing=0 cellPadding=0> Wednesday, April 27, 2005 Torrance hospital offers training in a different vein That "person" may act and look like a real patient, but it's really a state-of-the-art medical mannequin used to provide hands-on learning for South Bay nurses. By Lee Peterson Daily Breeze On her first attempt to put the needle into the vein, the nurse missed. When she went in again, the patient expressed his dissatisfaction. "Go away," he said clearly. But as the red stuff finally started to flow into the needle, the patient relaxed. This is one patient who will let you know when he's not feeling well. In fact, he's programmed like that. The patient is a state-of-the-art medical mannequin. With simulated blood flowing through his veins, self-sealing skin that can take thousands of needle punctures, a chest that rises with each breath and a large repertoire of moans, groans and expressions of misery, this is about as real as a robot-patient could be. The "SimMan" is one of a family of six mannequin patients, including an infant, whose persistent diseases, heart attacks, wounds and even pregnancies are putting nurses and nursing students through their paces at the George W. and Virginia Schneider Institute for Nursing at Little Company of Mary Hospital in Torrance. "This is the new generation of health-care education," said Jane Kleinman, Little Company of Mary project specialist for the Schneider Institute. The interactive, high-tech mannequins are among the training resources at the nursing skills center, which recently opened up shop in a simulated ward on the Torrance hospital's first floor. In addition to the Little Company nurses who will receive training at the center, both new grads and veterans, the facility was also built to accommodate student nurses from El Camino College. The agreement with Little Company will allow El Camino to graduate an additional 24 students per year at a time when hospitals are coping with a long-term nursing shortage as they try to meet new minimum staffing laws in California. There's no guarantee that when those students graduate they will sign up to work for Little Company, but they might. And, either way, it provides more nurses for the work force in general. With the robotic patients and other tools, the nursing lab aims to provide students and nurses with simulations so real that nurses increase their confidence and competence as they learn to handle a variety of medical crises. The nursing skills center's star patients range in cost from $6,500 for a basic model to $35,000 for the most sophisticated SimMan, and are among only 50 currently in use in the state. The goal with the mannequins, or "smarties" as the staff calls them, is to create a simulation environment akin to how a pilot is trained by using a flight simulator, Kleinman said. "They throw everything at him so he's prepared for anything," Kleinman said. With interchangeable torsos and other body parts, the mannequins can be changed from male to female, they can give birth, they can vomit, and they can be outfitted with wounds, gangrene and amputations. They will tell a nurse who is having trouble hitting a vein to "go away." The mannequins can do everything but get up and leave. The trainees use real equipment kept in real equipment cabinets, so they learn how to find and use exactly what they need when dressing a wound, starting an IV or inserting a catheter. An instructor can use a laptop computer or a remote control, and change the patient's condition on the fly. The trainee must then determine how to respond. The leader can change the patient's oxygen stats, reflecting that he's not getting enough oxygen in his blood, and the monitor's healthy beep will slow. Nurses must assess how to restore proper breathing quickly. If they fail to adequately respond, by putting in a tube or using a bag and mask, the oxygen saturation situation will only get worse. That interactivity motivates trainees. "It makes you try your best," said clinical educator Claudette Dorsey. If the student responds properly to the oxygen problem, the instructor will make the stats go back up. The crisis scenarios can run off the instructor's commands or from a programmed scenario. At the end of the exercise, there is a computer printout on the robot's symptoms and the nurse's actions, as well as videotape to review. The SimMan mannequin is as big and heavy as a man, and will verbalize discomfort. "The big goal is to suspend disbelief and make it as realistic as possible," Kleinman said. Belief is suspended so well that although it's possible to make the robot-patient die, that's an option that's only rarely used. It can take too much of an emotional toll on the trainee. Little Company received the smarties in February, and began using them right away at a facility that was being phased out. This month, the smarties were transferred to the new nursing skills center at the main hospital. Little Company is using them to train the students, and new nursing graduates. Veteran nurses are using them to learn new skills, for example if a labor-delivery nurse wants to transfer to the emergency department. The units can be used to train doctors, medics and nurses. Around the country, the military is the biggest customer so far for Laerdal Medical Corp., the company that makes the SimMan. Nurse training centers are second.

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The New Yorker: A MODEL PATIENT

The New Yorker: PRINTABLESFour students in their third year at Harvard Medical School recently met a patient named Mr. Martin. The students’ mentors, two physicians, told them that Martin had come to the emergency room complaining of abdominal pain that had grown steadily worse over several days.

Martin was lying on a stretcher, moaning. A monitor next to the stretcher indicated that his blood pressure was dangerously low—eighty over fifty-four—and his heart was racing at a hundred and eighteen beats per minute. An X-ray mounted on a light box on the wall showed loops of distended bowel, called an ileus. The intestine can swell like this when it is obstructed or inflamed.

“It hurts!” Martin cried as the students reviewed his chart. “They told me you’d give me something for the pain.”

A Human Simulator mimics a patient physiologically

Monday, April 25, 2005

After the ether By Maryann Gogniat Eidemiller FOR THE TRIBUNE-REVIEW Monday, April 25, 2005 Anesthesiologists are medical doctors who specialize in anesthesia, he explained. They oversee teams of nurse anesthetists -- many of them men -- who are increasingly well trained. "Anesthesia was the first specialized area of nursing," said Daniel Stairs, a nurse anesthetist and assistant director of the Westmoreland-Latrobe school. Nowadays, La Roche College, near Pittsburgh, offers the academic portion of a master's degree in anesthetics, with students earning clinical credits for the program through several schools of anesthesia in Pennsylvania and elsewhere. One is the Westmoreland-Latrobe school, on Route 136, near Greensburg, PA and another is affiliated with Allegheny Valley Hospital in Natrona Heights. "As our knowledge base continues, we are constantly having to add more and more classes," said Howard Armour, a nurse anesthetist for 30 years and program director of the Westmoreland-Latrobe school since 1980. "We have to keep up with the new anesthetics that are being used, and with the new monitoring equipment." Students practice the latest techniques on mannequins, learning to insert breathing tubes and introduce drugs into the spinal column. The most sophisticated simulators are computer programmed to mimic human responses. Students at the Westmoreland-Latrobe school practice on a mannequin that's used in the trauma program at Conemaugh Hospital, in Johnstown, one of the school's clinical sites. "The human simulator mimics a patient physiologically," Armour said. "It responds the same way that a patient would. The chest rises, and there are vital signs, and it's so realistic that sometimes it's scary, especially when the simulator opens its eyes." The University of Pittsburgh School of Nursing, which has its own training program, utilizes an entire learning center equipped with mannequins that simulate heartbeats, blood pressure and breathing. They even have computerized voices that can complain about pain and won't let up until the student does something about it. "They have pulses on the wrists, carotid artery and the groin," said John O'Donnell, a nurse anesthetist and director of the university's Nurse Anesthesia Program. "They are set up in a high-intensity audiovisual lab that has the ability to record digitally and to overlay the vital signs of the mannequin. "They are also used in crisis training," he said, so students learn to respond to rare but life-threatening events, such as uncontrolled bleeding, drug reactions and heart attacks. The center has recently acquired a simulator the size of a 9-month-old infant. "The biggest error is in thinking that children are small adults, but their organs and their physiology are not mature," O'Donnell said. "Anesthetic agents that work a certain predictable way in adults are not at all predictable in children, who require almost an entirely different subset of skills in anesthetic management."