Real practice without grade pressure

The simulation lab program at UCLA recreates clinical events to give students an opportunity to role-play and make decisions as nurses. Students make clinical assessments and administer treatments on lifelike manikins according to the scenario given.

Unlike the actual clinical setting, where students are directed to complete tasks, the simulation lab allows students to make their own decisions, said Dr. Mary Ann Shinnick, Director of the Skills and Simulation Lab. 

“When in a clinical setting, students don't get the opportunity to think on their feet. They predominantly follow the directions of a nurse” she said, “and then they graduate and all of a sudden, they are the nurse.”

The current simulation program started at UCLA in 2010, and is based on National Standards and Guidelines. Students enthusiastically attend three to four hours of simulation sessions for most every clinical course. In each session, students work with a team and rotate through four or five different simulation scenarios. In addition, students complete a leadership course, which includes a large multi-patient simulation.

The scenarios in the Simulation lab program are devised to enable all students to have the same experiences, something that cannot occur in the clinical setting. They are designed to complement course objectives and fill in the knowledge gaps beyond what they learn in the clinical setting. For example, when a patient has chest pain in the clinical setting, the student is relegated to only observe, usually from the back of the room, as the nurse takes over to administer care. In simulation, the student is the nurse not only making the decisions but implementing care.

“Therefore, in simulation, it makes sense to practice those kind of situations. We try to be creative, but realistic at the same time so that it's a valuable learning experience for students.” Shinnick said.

Students are not assessed for their performance in the simulation program. Each simulation session is followed by a non-judgmental debriefing, where faculty and students discuss what happened, where the gaps are and goals for improvement. Students are not penalized for making mistakes in the lab but rather encouraged to learn from them.

Students have responded positively to the program since it was initiated. Not only has it helped students gain confidence, but it consolidates the knowledge students learned in classroom setting and allows them a realistic opportunity to apply it in a safe setting in which a patient cannot be harmed..

The overarching goal of simulation is to have the experiences transfer to the clinical setting. Three students told their stories of how they applied what they learned in simulations in actual situations.

Tanisha (March 15):

“I was on the way back to the car. Approximately 10 feet in front of me, I noticed a person on the ground. A young woman was about to pour water into a man’s mouth. One of the things that I immediately remembered from the beginning of the nursing program was, when someone is lying on the ground, possibly unconscious, don’t pour water in their mouth. I calmly walked up and interjected.

“I started remembering things that I learned in class and in the simulation lab about assessing and controlling the environment. A lot of the times, when there’s an urgent situation, you just want to respond. I used skills I learned in a Sim lab, like a focused assessment, instead of trying to look at the entire body. I talked to the young man on the ground to see if he’s coherent. I was checking the circulation, checking if he’s breathing, checking his level of consciousness. I was asking him questions, about his history, so I know what to tell the ambulance or EMT when it arrives. One of the things we learn is how to do an SBAR, it’s a shortcut way to give a report to another healthcare professional. I was able to use those skills to relay information to the EMT when they arrived. It became a more controlled environment, less chaotic. And keeping myself calm. It was amazing. I didn’t feel scared. There was a calmness that came over me.

“At the time during the simulation, you don’t really think you’re absorbing anything. The simulation shocks your systems. They put you in a scenario, and you don’t know what they’re going to do. You don’t know how you’re going to react. Some of the skills you haven’t even learned yet. So in that moment, I felt prepared. I was able to retrieve those things I learned. It was an eye-opening experience to me. It built my confidence.”

Shelby (April 22):

“I was at the newborn intensive care unit (NICU).  . My patient that I was taking care of needed a PICC line placement. Her PICC had gone bad, so they needed to put a new one in, and she was breathing on a ventilator. It was more difficult to take her elsewhere to do the procedure, so they decided they wanted to do it in the room. They needed to give her Vecuronium, which is a paralytic agent, to increase her tolerance of the procedure and make her not feel anything. In simulation, we had to give that medication, like you have to push really hard and fast and flush really quickly. And that was the first time I’d seen that medication given in a clinical setting. So I had just done it in simulation like a week before, and I was able to tell the nurse in the NICU. She asked me if I’d ever seen the medication or if I knew what it was, and I was able to tell her I did it in the simulation. That was the one time in clinical setting I thought about something that had happened in SIM because it happened less than a week before.

“In SIM in general, it prepares you. It’s a high stress environment, and it puts you in roles that you wouldn’t be in as a student. You’re in roles you’ve never played before. They make these scenarios realistic obviously, to elicit this response in us and get us thinking on our feet. They will be the voice of the patient. Like all of a sudden, “I can’t breathe, oh my god, what’s going on. I can’t breathe, help me!” and there’s a family member that’s supposed to also freak out on you. As the nurse, you’re trying to manage that and know what to do. I wish we did more of them. It’s the most hands on learning you can get!”

Heather: (April 12)

In the NICU, we were admitting a baby. My preceptor nurse wanted me to observe. As I watched the team work, I looked to the side and saw a very scared dad sitting alone and watching. It was overwhelming and alien for him to be in an environment with all these beeping machines. I immediately thought of last year’s simulation lab and heard Professor Demman in my head saying “none of you talked to the patient’s family!” I was a little uncomfortable because I didn’t know all of the procedures that the team was performing, but I knew I could at least explain the monitor readings, and reassure the new father. Even a year later, my experience in that sim made a difference today and helped me support a patient’s family member.

There’s such a disconnect between sitting in class to learning something, versus skills based learning in simulation. It really connects well to the clinical setting.

I would love to do more SIMS. We get to do simulation several times, and I was really sad for our last simulation. I learn by doing things. One of the biggest parts of nursing school that benefited my personal education were the simulations.

 

By Wendy Li