Mock scenarios featuring actors bring realism to URI’s nursing simulation classrooms

Students learn to deal with the unexpected in a safe teaching environment

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URI College of Nursing Professor Maureen Hillier, foreground, left, instructs students gathered around the bed of an “infant,” an interactive mannequin, during a class in the College’s simulation laboratory in White Hall on the Kingston Campus. Photo by Nora Lewis

KINGSTON, RI, November 3, 2016 — The young woman cradling the bundled-up baby at the back of the room appears anxious and standoffish. The two dozen University of Rhode Island freshman nursing students huddled around the bed of an infant with a racing heart across the way barely notice. After several minutes, student Jillian Bernier of Woonsocket, R.I., approaches her.

“Are you OK,” she asks. A classmate hands Bernier a stethoscope. “Let’s just take a look,” she says to the mom, who won’t budge. “Have you felt her temperature,” she asks, getting no answer.

“Help me,” Bernier mouths to classmates, who keep their distance. “I’m so scared right now.”

Two students wheel over a bassinet, but the mom won’t put the baby down. The entire class exchanges confused glances.

Then Maureen Hillier, simulation educator and assistant clinical professor at URI’s College of Nursing, enters the room. She ends the mock nursing scenario and asks students to join her for a debriefing. Hillier reveals that the “mom” is really junior nursing student Sara Kingsborough of Coventry, R.I., and the “baby” is a mannequin. The scenario was arranged to add a layer of realism to the college’s simulation laboratories, a critical component of nursing education.

“We try to mimic the situations they will find in real life, to make nursing tangible,” Hillier says. “You can’t plan a seizure in a clinical rotation. You can plan that in a sim lab.”

Todd Madison, instructional technology manager for URI’s College of Nursing, monitors students from the control room of the simulation laboratory in White Hall on the Kingston Campus. Photo by Nora Lewis
Todd Madison, instructional technology manager for URI’s College of Nursing, monitors students from the control room of the simulation laboratory in White Hall on the Kingston Campus. Photo by Nora Lewis

Nearly 100 freshmen got a first dose of the simulation labs this fall and will return several times as upperclassmen. The labs are set up to mirror hospital settings, with a range of “patients” — interactive mannequins that cough, breathe, speak, cry, vomit and exhibit vital sign changes. Although directed by an instructor, high-quality simulation also depends on Todd Madison, an instructional technology manager at the College. Madison drives the action from behind one-way glass in a darkened control room. The instructors monitor and assess students’ responses to scenarios.

“He has been the backbone of the simulation program,” Hillier says of Madison, who spearheaded recent upgrades: acquiring more sophisticated mannequins, building wall dividers to impart a busy health-care setting and streaming live simulation into the classroom.

Sometimes Madison voices a “patient” from the control room. “We want to crank the pressure up a bit. We can program in a medical error or have graduate assistants play the role of family members,” he says.

URI College of Nursing students listen to the heart of an interactive baby mannequin in the simulation laboratory at White Hall on the Kingston Campus. Photo by Nora Lewis
URI College of Nursing students listen to the heart of an interactive baby mannequin in the simulation laboratory at White Hall on the Kingston Campus. Photo by Nora Lewis

“It’s a very resource-intensive enterprise, and we want to do it well,” says Hillier, a Westboro, Mass., resident and a URI nursing alumna. She led simulation education at Boston Children’s Hospital, remains on that faculty part time and began teaching clinical rotations for URI nursing students at Children’s three years ago. Hillier returned to URI this fall to give something back, she says, introducing the actor component to simulation this semester.

During the class when Madison put the baby mannequin in cardiac distress, the students became anxious. Then Kingsborough walked in, adding confusion. “We push you to the edge of the cliff but we are never going to let you fall off. That’s where some of the best learning takes place,” Hillier tells the students later.

The students share their feelings (confusion and surprise), and Hillier reassures them that they have not failed their first test. “You can practice here in a safe environment,” she says. “You are never graded on what happens here.”

Hillier asks Bernier about the interaction with Kingsborough. “Help us to understand what drove you to take steps to ask what’s wrong.”

“It’s just my instinct; I kind of always have had that in me,” Bernier says. “I want to take care of the situation.”

“Congratulations, you completed the first stage of the nursing process: assessment,” Hillier concludes.

The learning that takes place in the student-centered debriefing is as important as the simulation, she notes. One by one, the freshmen share what the unscripted experience taught them: Work together, be confident, pay attention, address a problem as soon as you see it, be kind.

All are valuable lessons for nursing in the real world.