Research Magazine 2006
students with patient manikin
Some manikins in the School of Nursing's Smart Hospital have pulses and can simulate breathing. Others can speak, and one gives birth.
Simulation allows students to apply their knowledge to make accurate assessments.... The goal is to create a clinically competent, confident and safe practitioner who can do his or her job in a hospital setting from day one.

Nouveau nursing

Futuristic hospital's lifelike manikins help students treat simulated illnesses

Lub-dub whoosh. Lub-dub whoosh. Lub-dub whoosh.

That’s the sound UT Arlington nursing student Jaclyn McTaggart heard when listening to a patient’s heart. It indicated a murmur caused by blood flowing through a heart valve possibly made leaky by disease. The student recognized the murmur even though the supervising nurse—and even the cardiologist—had missed it.

She knew what she was hearing because of SimMan®, an anatomical model of the human body used in the School of Nursing to teach students in trauma, emergency, intensive and primary care.

SimMan®, weighing 75 pounds and costing about $35,000, lets clinical nursing instructors control vital signs, alter heart rhythms and create scenarios that present an array of health care problems, including congestive heart failure, pediatric asthma, skin lesions, insulin shock and hemorrhaging following surgery.

The School of Nursing has 27 full-body patient simulators—infant, child and adult models, male and female. Twelve of them can simulate the act of breathing and have pulses. Some even speak. One gives birth.

One hundred task trainers of varying types allow students to draw blood, give an injection or insert an IV or chest tube. The school also has 15 static manikins that do not provide feedback but are used by students practicing basic skills such as dressing wounds, bathing patients, giving injections and practicing catheterizations.

The simulators are “patients” in UT Arlington’s Smart Hospital™, a multidisciplinary teaching facility that integrates simulation and patient role-playing into clinical nursing courses. It is one of only six sites in the world to be recognized as a Center of Excellence by Laerdal Medical for its simulation-based education, training and research.

Laerdal, the creator of SimMan® and SimBaby®, is the world’s premier manufacturer of simulation technology. The company serves more than 95 percent of the simulation market and was the first developer of CPR simulation technology.

“The manikins are a fully integrated part of the school’s curriculum,” said Mindi Anderson, simulation coordinator. “They help prepare students to assess patients, make decisions and implement care in real-life settings prior to graduation—all without jeopardizing the health and safety of real patients.”

Alvin Ibana, a nursing student who graduated in May and now works in the emergency department at John Peter Smith Hospital, recalled treating a SimBaby® 20 minutes after it was “born” in the school’s labor and delivery setting.

“I started to watch, feel and hear the baby breathing faster and harder,” he said. “Then we started to see a light blue discoloration on the baby’s lips, indicating a lack of oxygen. My heart started racing, and my ER instincts kicked in. I grabbed an Ambu-bag, and we assessed the airway and started bagging.”

SimBaby® provided almost immediate feedback as oxygen began to flow through the body and the blue around the lips subsided.

“The patient responds for better or worse based on what the students do,” said Kristine Nelson, lead teacher for the baccalaureate pediatric nursing course. “The idea is to give accurate feedback so students know what to do at the right time.”

SimMan® and the other manikins are controlled by the clinical instructor observing the students in practice. The instructors can alter simulations midstream to add variables that challenge critical thinking and decision-making.

“Nursing is more than doing what you see others do,” said Jackie Michael, RN to BSN instructor. “Nursing involves a higher level of thinking. It has been my experience that simulation allows students to apply their knowledge to make accurate assessments and carry out their plans of action in ways that parallel real-life situations in hospital settings—and do so more effectively and faster than a student who hasn’t used simulation.

“The goal is to create a clinically competent, confident and safe practitioner who can do his or her job in a hospital setting from day one.”

And students understand the benefits of the training.

“We have many opportunities to stop, call timeout and discuss the problems and possibilities of the simulation,” Ibana said. “Plus, we get to simulate situations that are complex and not so common in order to build confidence and the essential skills needed to be prepared at the bedside. I know that when I see a sick patient, I can say with confidence, ‘My name is Alvin Ibana, and I will be your nurse today.’ ”

Simulation technology may one day change health care education by allowing students to progress at their own rates outside traditional semester constraints, ultimately increasing enrollment and graduation rates.

A shortage of more than 800,000 nurses is predicted by 2020, but each year nursing schools turn away qualified applicants. In 2004, approximately 4,200 applicants could not be accommodated in Texas schools of nursing. A major limiting factor is the shortage of faculty.

“Through the Smart Hospital™, we are able to retain current and new faculty whose interests and scholarship are based on using simulation in nursing and multidisciplinary education, research and development of new products,” said School of Nursing Dean Elizabeth Poster. “The Smart Hospital™ uses technology to structure clinical learning experiences in ways that ensure our students will be more competent, confident and better prepared upon graduation to care for patients with highly complex needs.”

The Smart Hospital™ will have a new home beginning in the spring when a 13,000-square-foot facility opens. The building will provide space for UT Arlington’s more than 650 nursing students to evaluate and treat simulated patients.

With the new space, the school will also be able to develop new methods for increasing nursing work force capacity, reducing health care costs, enhancing safety for health care consumers and conducting research

— Becky Purvis