WE ALL REMEMBER our first day as nursing students in the hospital: hands shaking, hearts racing, minds full of countless bits of disconnected knowledge. Our instructors tell us these feelings will fade with time and experience—but how do we get that experience at this stage of our education?
At Sinclair School of Nursing at the University of Missouri, students can learn and hone skills in a safe environment: the Clinical Simulation Center. As part of our nursing curriculum, we have the opportunity to practice clinical and interpersonal skills in a controlled setting. Our job is to then transfer those skills into an ever-changing environment where deadlines are emergencies, homework can save a life, and examinations have a heartbeat.
Practice makes “perfect?”
As nursing students, we pride ourselves on our ability to insert an I.V. catheter in veins that are perfectly visible, working in a quiet environment with all our supplies within reach. The hospital is a whole new world. The supplies we didn't have enough of to start with have gone missing, the patient knocks what's left onto the floor, and, unlike that perfect arm in the lab, this patient's veins are barely palpable, never mind visible.
So what's the solution? Students need to start practicing in an imperfect environment. No matter how lifelike the manikin may seem, it's still not a real patient and presents restrictions to learning such as a narrowed scope of interactions, a limited set of skills to practice, and more ambiguous symptoms.1 In our Simulation Center, we encounter real-world situations that mimic conditions we'll encounter in the hospital. Besides practicing clinical skills, we learn what to do when we encounter unexpected problems or experience an uncomfortable interaction with a patient or colleague.
Fresh approach to nursing education
The Joint Commission (TJC) recommends a team approach to nursing to improve communication and patient-care outcomes by reducing adverse events.1 In the Clinical Simulation Center, students put the TJC's recommendations into practice by participating in “simulation circuits.” Groups of students move from one station in the lab to another. At each station, an adverse event or problem is waiting. We don't know if we'll encounter an accidental sharps injury or a frantic child crying for her mother. We may enter a room with a catheter bag dragging on the floor or greet a patient whose armband doesn't match the medical record. We may even face an uncomfortable situation with another healthcare professional.
In each simulation circuit and clinical course, we're taught to learn from our mistakes during less-than-ideal scenarios.
In the Simulation Center, an uncomfortable situation with another healthcare professional is usually the result of poor communication and not fully understanding each other's role in a patient's care. Often, the “best” time for miscommunication is during a patient hand-off when another health professional assumes care of a patient. If mistakes are made and adverse events occur, the environment becomes negative and patient safety is compromised.2
To help improve communication and patient safety, students are enrolled in a course where we spend time working with students pursuing degrees in different healthcare professions. Nursing students, together with medical, pharmacy, respiratory therapy, and health management students, solve problems that would occur in a hospital using case studies and simulations. We work together both in the classroom and the Simulation Center so that we're better equipped to work as a team in a hospital. As we learn the various roles of other healthcare providers, we can better understand how to communicate effectively with students and professionals outside our fields, organize the best possible care for patients, and improve care in a hospital setting.
Our school of nursing is also home to a newly renovated safe practice room. Circuits in this area of our Clinical Simulation Center are meant to teach us how to enhance nurse and patient safety. This room is equipped with patient lifts, a bariatric manikin, and a simulated medication dispensing system.
The Simulation Center is home to 10 manikins, including 3 high-fidelity models that respond to medication, exhibit cyanosis, and generate heart, breath, and bowel sounds. Using manikins, we practice various clinical skills, including transferring patients while preventing back injuries. We also learn how to perform an environmental safety assessment so that students can see the effects of both “perfect” and “imperfect” work environments.
Prepping for success
When students walk through the sliding doors and enter the Clinical Simulation Center, we're wearing invisible armor over our scrubs: Nothing can touch us. Fifteen minutes later, we need to perform a skill that none of us has ever done before. Twenty minutes later, three less-than-ideal situations are already standing in the way of patient care. After 30 minutes, we remove our dented armor and are grateful that we could practice skills we'll need in the hospital, where mistakes can have serious consequences. Our hearts still race and our hands may tremble, but now we know what to do if our supplies fall on the floor. At Sinclair School of Nursing, students leave well prepared with the knowledge and resources we'll need to provide optimal patient care in an imperfect world.