Nursing Simulation Center Opens
From left, Carol Luppi, Dorothy Bradley, Miriam Greenspan and Diane Campbell have developed orientation pilot programs in the safe, judgment-free environment of the new Nursing Simulation Center.
Inpatient David Von Trapp, 62, was complaining of chest pain. Michelle Madan, BSN, RN, checked his blood pressure, listened to his lungs and started an EKG. Erin Foley, BA, RN, AD, checked eMAR to find an order for nitroglycerin to ease the pain. Dyanna Sun, BSN, RN, paged the attending physician.
“This tastes gross,” Von Trapp complained of the nitrogylcerin, as this team of new-to-BWH nurses worked together to bring his blood pressure back to normal and relieve his pain.
This scenario was part of a pilot program designed to orient experienced, newly-hired nurses in the Center of Nursing Excellence’s new simulation center. Von Trapp, a computerized mannequin, served as the patient in a room that can be set up to match those in the Tower, Connors Center or the soon-to-open Shapiro Cardiovascular Center.
“We believe clinical simulation is instrumental in educating and integrating staff into our highly technical care environment.,” said Miriam Greenspan, MSN, RN, program manager of the Nursing Simulation Center. “Staff are able to practice skills they need and learn BWH technology in a safe, risk-free and non-judgmental environment.”
At the Simulation Center, Erin Foley, RN, right, scans “patient” David Von Trapp’s ID bracelet, while Michelle Madan, RN, asks about his chest pain.
Background of the Simulation Center
In planning and developing the Nursing Simulation Center in recent years, educators learned a lot from BWH’s Department of Emergency Medicine, which opened its STRATUS Center for Medical Simulation in 2004. A year later, the nursing effort received a significant boost when Diane Campbell, BSN, RN, central nurse educator, and Carol Luppi, BSN, RN, nurse educator for technology, received a Mary Fay Enrichment award. That grant enabled Campbell and Luppi to travel to Oregon Health Sciences University to meet with the directors and observe the simulation and clinical learning center.
“We saw firsthand how effective simulation experiences are for nurses, and we learned a great deal about how we could apply it here in the BWH Department of Nursing,” Campbell said. Campbell and Luppi also sought information, guidance and feedback from other health care facilities with simulation training programs, including MGH, Children’s Hospital Boston and Beth Israel Deaconess Medical Center.
Planning turned to construction more than a year ago, and BWH’s Biomedical Engineering was instrumental. Plans are in place for open houses and grand opening celebrations this month.
Offering the Best Equipment and Technology
The Nursing Simulation Center boasts adult and neonate patient mannequins in an inpatient room completely equipped with BWH’s bedside technology, including eMAR, monitors, a code cart, Alaris Smart Pumps and other technology. Clinical simulations are designed so nurses can learn how to use new equipment and practice techniques on patients who are as unique and distinct as actual patients.
Von Trapp, for example, was sensitive. “Your hands are cold,” he chirped, or rather Campbell, central nurse educator, had him say from the control room behind a two-way mirror. Simulation center staff also control the patient’s symptoms and vital signs, and the patient mannequins have their own medical histories and templates in eMAR.
“We can increase the mannequin’s heart rate, lower blood pressure, create a physiologic crisis such as a code and basically craft any scenario that staff nurses at BWH face,” Dorothy Bradley, MSN, RN, program coordinator in the Center for Nursing Excellence, said. Mannequins can make wheezing sounds, hiccup, and, in the case of the mannequin baby, cry like a real infant.
In one scenario, Sadie, an 86-year-old woman who had undergone total right hip replacement, didn’t stop talking to nurses. “She complained of pain, and as nurses checked her PCA pump and eMAR to find out what else they could do for her pain, she started complaining she was hungry,” Greenspan said.
Nursing Simulation Center Ground Rules:
Take responsibility for this experience
Allow each person the time they need
Simulation as Part of Education
The Nursing Simulation Center is home to a pilot program through January. The pilot is designed to enhance BWH’s training and orienting of new nurses to determine how simulation best fits into the educational programming of the Center for Nursing Excellence.
So far, two groups of nurses new to the Brigham, have completed the pilot program in the simulation center. The pilot simulation includes a debriefing session after each simulated exercise. Facilitated by simulation faculty, discussion offers participants an opportunity to reflect on their own practice, review skills needed to work together as a team and review relevant clinical knowledge.
The pilot program for experienced nurses who are new to BWH adheres to BWH’s faculty model philosophy.
“These new nurses spend two days in the simulation lab and then go directly to their unit of hire where they are matched with their preceptor or clinical colleague,” Greenspan said. Bradley, who leads the training in the faculty model, then offers direct support to both the new nurse and preceptor.
The simulation center pilot ensures new BWH nurses are exposed to consistent, predictable clinical scenarios before they are assigned to their units. “This way, we ensure that everyone gets the same information and practice,” Bradley said. “Otherwise, on 14AB you may not care for a patient who has a patient-controlled analgesia pump (PCA), and you wouldn’t get to practice on that equipment or engage in clinical decision-making around pain assessment and treatment.”
“When you’re on the floor and a patient is saying ‘Please help me,’ familiarity with the technology is necessary for the nurse to care for the patient’s needs,” Bradley said.
The early feedback from all participants has been overwhelmingly positive, according to Greenspan. “Nurses feel confident in their skills when they go to their floors,” she said.
Bradley added, “They said they had a comprehensive introduction to our systems, like BICS and Web-based eMAR, and they remembered what they practiced in the simulation center.”
Plans for the Future
Simulation center staff plan to analyze data collected from preceptors and new nurses prior to the opening of the center, as well as data from surveys of nurses who trained in the simulation center and their preceptors to evaluate the effectiveness of training at the simulation center. In addition to reviewing anecdotal information following initial pilot programs, the Center for Nursing Excellence will form a simulation center advisory council.
“We expect to have a wide range of clinical nurses who represent the many practice areas and nursing specialties here at BWH,” said Greenspan.
Future uses of the center will go beyond orientation programs and may include training sessions that include multi-disciplinary clinical scenarios. Training and refresher sessions on code response, competencies and other nursing programs likely will be offered as well.
“This is not an evaluation tool, but a teaching/learning method that helps us to advance our practice in a safe, judgment-free environment as opposed to on-the-job training at the bedside,” Greenspan said.
Diane Campbell, front left, and Miriam Greenspan, right, control the mannequin and watch from behind a two-way mirror as Erin Foley, Michelle Madan and Dyanna Sun work to care for the patient during a scenario in the Simulation Center.
Simulation Center Open House
Dec. 19, 9 a.m. to 5 p.m.
At 2 p.m., Chief Nursing Officer and Senior Vice President of Patient Care Services Mairead Hickey, PhD, RN, will mark the official opening of the center with remarks on what simulation means to nursing education at BWH. A second open house is planned for an evening in January.
Photos from the Simulation Center: