Interprofessional Simulation Prepares Students for Real World Health Care

It’s 2:06 p.m. on a Thursday, and Noelle has just delivered a beautiful, full-term baby named Hal. A serious medical issue arises for Noelle. She is losing a lot of blood, and her team must get the situation under control to stop her hemorrhaging. The nurses need to focus. They need to prioritize. After all, there are human lives at stake … right?

Wrong.

Noelle is not a real, live new mom, and baby Hal is not a real, live newborn. Both are high fidelity manikins: full-sized human models that demonstrate realistic reactions through state-of-the art technology and programming.

Members of the delivery team are not licensed nurses and clinicians, but they aspire to be. They are students participating in a simulation, or sim, exercise at Howard Community College. Students refer to these simulations as safe places to learn, where it is acceptable to ask a lot of questions, make mistakes, and even acknowledge that they do not know what to do when the patient suddenly presents new symptoms. While the cases that unfold are serious and designed to mimic what happens in the real world of health care, they are just simulated scenarios. Here, students can apply theory, explore processes, and learn by trial and error, without compromising the safety and well-being of real, live human beings.

“As educators, we have a responsibility to challenge our students, and put them in situations where they have to apply critical reasoning,” said Cheryl Nitz, assistant professor of nursing and allied health laboratory manager at HCC.  “By practicing scenarios in simulation labs, it’s much more likely that students will be able to provide safe patient care when they get jobs and are out there working in the field.”

One such student is Anne Mannarelli, a recent graduate of HCC’s nursing program who completed her final semester clinical rotation at Howard County General Hospital. Fortunately, the first time she faced the intensity of taking care of patients was long before she actually set foot in the hospital.

“When I decided to go to nursing school, one of my biggest concerns was that I would do something that could harm a patient,” said Mannarelli. “In simulation, I felt pressure and anxiety, but there wasn’t a risk of hurting a real person if I did make a mistake. I was able to trust my gut, then look back at the decisions I made and evaluate what I would do differently the next time.”

HCC’s simulation suites and technologies are housed in the college’s Health Sciences Building. Noelle, Hal, and nearly 50 other high-fidelity manikins create career-specific simulations, as well as unique interprofessional simulations, which are experiences that provide exposure to multiple disciplines within the allied health field.

For paramedic student Jarad Modaber-Alvarado, who will graduate this December, the simulations have taught him how to respond to and treat emergency cardiac issues, respiratory distress, medication overdoses, and more.  Many of these scenarios have been practiced in HCC’s full-size, state-of-the-art ambulance simulator, complete with lights, sirens, and emergency response equipment.

“It’s very real,” said Modaber-Alvarado. “A dispatch call comes in, same as it would happen in the real world, and we have to figure out how to respond. Sometimes all we know is that the person we need to help is sick and we have to act as the situation unfolds. We are challenged to think critically about the process, how to prioritize our time and how to work efficiently as a team. As a student, you feel like you are being tossed into the deep end of the water, but because it is a simulation, you have a safety rope attached.”

Simulations that involve manikins in cardiac arrest also bring students from various allied health programs together to practice. A team of students is asked to assess the situation and consult with an acting cardiologist (a role that is played by one of HCC’s faculty members) to determine their patient’s treatment plan. Should he go to the cardiac catheterization lab for a stent? Does he need bypass surgery? They collaborate, prioritize, and work together as a team to make those critical decisions, with every step of the process captured on video. The students can then watch and discuss the video following the simulation.

“Sometimes students will express that they weren’t aware that this type of patient would experience certain symptoms. They can be honest in saying they were nervous or didn’t know exactly what to do,” said Jessica DiPalma, MS, RN, professor of nursing at HCC.  “And that’s okay. That’s why we do this.”

Read the full article in the Fall 2016 issue of Pathways Magazine.