Interactive learning through a teaching/learning model puts nursing students in a virtual hospital

By Elizabeth Poster, PhD, RN, FAAN, Carolyn L. Cason, PhD, RN, & Mary E. (Beth) Mancini, PhD, RN, FAAN

Step onto the grounds of the University of Texas (UT) at Arlington and it looks like any other college campus. Walk through the doors of the Smart Hospital and you are immediately transported to the nearest level I trauma center or community hospital.

As part of UT Arlington's School of Nursing, the facility is home to state-of-the-science equipment, mannequins and technology. From a neonatal and adult ICU to labor and delivery, an emergency department and pediatrics, this is a site where nursing students, future NPs and even hospital-based transport teams can learn how to care for their patients in typical as well as critical situations.

It's a place where UT Arlington faculty members teach the art and science of nursing.

Flying Without Wings

In a recent column for Flying magazine, Dick Karl, MD, chairman of the Department of Surgery at the University of South Florida in Tampa, who appreciates the science involved in both surgery and flying, wrote of flight simulators and how the same teaching method could be used in medicine. He would appreciate the Smart Hospital.

While pilots have known for years the value of flight simulators, it's only recently that facilities like UT Arlington's Smart Hospital have played a part in nursing and medicine. In fact, the Smart Hospital, a designated Laerdal Center of Excellence in Simulation and Hill-Rom National Demonstration Showcase, has been in existence for just 2 years.

In that time, a new building was purchased, innovative technology installed, and countless patients in Texas and neighboring states have benefited from a program that teaches nurses to be, not only competent, but also confident.

Industry Partnerships

For our undergraduate and graduate students to achieve that level of expertise, our faculty and staff have forged a partnership with leaders in business and industry. Through this collaborative effort, we have received hundreds of thousands of dollars worth of equipment, hospital supplies, furniture, computers and mannequins who can tell you where they hurt. They're inanimate objects, but we still refer to them as "who" and not "that" because they're that real.

The partnership is real, too.

After classes are completed for the morning or afternoon, UT Arlington's School of Nursing faculty and staff are available when companies call to tour the facility, ask how the donated equipment is faring, or conduct research applicable to clinical practice and education. And while industry partners are gaining valuable insight for future business, a price cannot be placed on the knowledge gained by students and faculty alike.

Simulated Environments

To understand how this process works, let's take a walk through the hospital.

As the doors to the med/surg ward open, the first thing one sees is the nurses station, replete with an active call system. Computerized mannequins with varying symptoms, diseases and potential outcomes are being treated. The prognosis is good for some while others are in critical condition. Planning and action by their caregivers are essential.

All the while, cameras and microphones are recording what is happening at the bedside as a group of students in a nearby classroom watches and learns. This is important because within minutes it will be their turn to step out of the classroom and into the hospital where they will encounter a slightly different scene. It's here, too, that students take part in a clinical debriefing with instructors, evaluating what they encountered or viewed.

It's a real-life scenario in a simulated environment. Prompted by either a faculty member with a PDA who, with the touch of a stylus, can change a vital sign, or a hidden team member in the nearby control room, the patient takes a turn for the worse. Within seconds, the students respond appropriately and the patient is stabilized.

Next door in the ED, students are triaging a number of patients who have been injured in a car crash. A pregnant woman is in labor. A 5-year-old is screaming for his mother. A middle-aged man has a bruised and swollen eye — and a piece of metal stuck through his jowl. And then there's the 500-pound patient who's presented with chest pains.

For a new nursing student, the scene could be daunting. But working in the interactive learning environment of the Smart Hospital has taught UT Arlington's nursing students competence and confidence — competence in that they instinctively know what to do and confidence that their decisions are right.

In addition, we teach habits because, by their very nature, they are hard to break. For example, instructors and textbooks tell us why it's important to wash our hands before and after we care for a patient. We know the research. We've read the data. But by working in the Smart Hospital, students will begin to instinctively enter a ward or a unit and wash their hands. And, thus, a habit is forged.

Standardized Patients

In the next room, "Noelle" is pregnant. At 37 weeks, her baby is considered full-term and she is in active labor. For the next 25 minutes, nurses are assessing her condition as well as that of her unborn child. The nurses are also ensuring Noelle's "husband" doesn't faint at the sight of his child being born.

While the fully computerized mannequins challenge the students with ever-changing scenarios, a group of human "standardized patients" throw new challenges into the mix. These standardized patients are a group of individuals who have been trained to act in such roles as patients, family members or friends. While they are scripted on various scenarios, on occasion they will improvise. In other words, today, will the patients be nice to the staff or nasty? Do they understand what the caregivers are explaining, or do they speak little or no English?

As the students monitor Noelle's progress, soon a healthy baby is delivered and "dad" has not hit the floor. But while all looks good on initial assessment, the students quickly discover Noelle is hemorrhaging and the pace rapidly changes. The baby is placed in a warmer and dad is whisked to the nearby Family and Wellness Room. As students work to stabilize Noelle and take her to ICU where she will be closely monitored, others are comforting her husband. With a gentle touch and a kind word, they have learned the art of therapeutic communication.

Second Nature

While the ever-changing scenarios play an important part in our simulation center, it's what happens outside the Smart Hospital that benefits us all.

When the graduates of the UT Arlington's School of Nursing step foot in a hospital, health center or clinic, they are among the most highly educated. They know how to operate the equipment; but, more important, they think clinically and critically. They leave the school of nursing with a competence portfolio that will significantly decrease their employers' orientation cost.

In his book, Blink, Malcolm Gladwell writes about the concept of "just knowing." That is exactly what we want to take place with our graduates. In a high-risk crisis or emergency situation, when time is the difference between life and death, they may not immediately know why they know, they just do. Interventions will become second nature because of the hands-on, self-paced practice that is possible in the Smart Hospital.

Elizabeth Poster is dean and professor, Carolyn L. Cason is professor and associate dean for research, and Mary E. (Beth) Mancini is professor and associate dean for the undergraduate program, all at the University of Texas at Arlington School of Nursing.