Fake Patients, Real Learning
by Anita Cirulis

DAN ROSS

Dwight’s chest rises and falls as he breathes. His heart beats in a stethoscope, and his pulse throbs in his wrists, neck, feet and thighs. Insert a needle into his pliable skin, and his veins take the contents of an IV bag.

Dwight is as close to a real patient as modern technology can get. He’s a human patient simulator, a complex computerized machine that allows Northwestern nursing students to practice what they’re learning in the classroom.

“We use the simulators to prepare students for their clinicals in the hospital, where they’ll be dealing with real patients,” says Michelle Van Wyhe, who teaches in the college’s nursing department.

Working with the simulators, students have the opportunity to develop their nursing techniques and bedside manner in a safe environment, without the fear of injuring someone if they make a mistake. Van Wyhe has seen the difference that makes in their confidence levels.

“They did a great job at their first clinical,” she says of her students in this semester’s childbearing class. “You never would have known it was their first night, because they definitely had that confidence and knowledge. They were able to walk into the patient’s room and do what they were supposed to do without hesitating.”

Northwestern has three high-tech simulators—an adult, a child, and a childbirth version—each of which cost between $80,000 and $100,000. A private donor paid for Dwight, while a federal appropriate grant in 2009 purchased the other two.

The simulators are connected to computers that run pre-programmed illness and injury scenarios, control their physiological functions, and produce vital signs displayed on a monitor. A computerized medical records program enables the students to do electronic charting of their simulated patient’s health status and health history.

Prior to a lab, students are given a case study covering the gender, age, condition and medical history of that day’s patient. Each student is assigned a role during the scenario. Some act as nurses, another plays a doctor, several function as lab and pharmacy personnel, and still others provide dialogue for the patient or patient’s family using a prepared script.

DAN ROSS

Nursing instructor Deb Bomgaars work with students Michael Grossmann and Karina Smit using one of Northwestern’s human patient simulators.

As the students interact with the simulator, their professor enters into the computer the actions they take, and the computer adjusts the simulator’s responses accordingly.

“If they need to give some type of medication to the patient in order to save him and they don’t give that medicine, then the vitals will decrease and the patient will slowly deteriorate,” Van Wyhe explains. Conversely, proper interventions result in improved vital signs.

The realistic experiences provided by the simulators extend beyond their ability to breathe and have a heart rate. The company that manufacturers the machines also sells artificial blood and provides a recipe book for making products to represent different bodily fluids and functions. Coffee grounds look like dried blood in “vomit.” Yellow dye in sterile water makes urine. Cotton balls soaked in fake blood take on the appearance of blood clots.

“You try to simulate it as much as possible so they get the visual, tactile experience of what it’s going to be like,” Van Wyhe says.

The ability to mimic a patient’s appearance and responses is part of what makes the high-tech simulators effective as a teaching tool.

“They’re very, very realistic. They do everything a normal human being would do as far as vitals,” says Michael Grossmann, a sophomore from Mantorville, Minn. “As I’m working on the simulator, if things start to go bad, my heart rate will actually start to rise and my adrenaline will increase.”

That’s one of the advantages of the simulators, says Van Wyhe. “You can make a lot go wrong in a short amount of time, and that gives students practice they may not get during clinicals in the hospitals.”

Van Wyhe and her colleagues can also change the simulators’ heart and bowel sounds. “If we just practice on each other,” she says about her classes, “unless somebody has something abnormal, you wouldn’t know what abnormal is. With the simulator, we’re able to make it have a heart murmur so the students can hear what that sounds like.”

As the students take turns working with the simulators, they also learn by watching each other, making note of what their classmates do right and wrong. Labs can be videotaped, and the professors hold debriefing sessions at the completion of each scenario.

As realistic as the simulators are, there’s one important difference between artificial and real patients.

“You get a do-over with a simulator,” says nursing instructor Deb Bomgaars.

It’s because of those do-overs that Northwestern’s nursing students graduate prepared to provide the best possible care to those they serve.