Gordon McKeown, RN, told ADVANCE about his own advanced cardiac life support (ACLS) training as if he was recalling a moment in distant history.
"There I was in nursing school in 1997 at an ACLS class," he recalled. "We used the sort of old-style, pulseless, breathless mannequin - there was a torso and a rhythm generator on a table top."
There's nothing "old style" about the equipment McKeown, a simulation specialist, now uses to teach nurses, nursing students and residents at the Palmetto Health/University of South Carolina (USC) Simulation Center in Columbia, SC.
A joint venture between Palmetto Health and the USC School of Medicine, the center's mission is to provide a dedicated environment where healthcare providers can learn to provide safe, quality patient care.
The center's equipment ranges from full-sized mannequins that mimic the effects of trauma and labor and delivery, to smaller task trainers consisting of a simulated body part, such as an arm on which to practice IV insertion.
True to Life
For the most part, the center uses full-sized tethered simulators, in which the mannequins are connected to a computer via cables. "We do our best to try to hide the cords, but after people have been in the room for a while they stop noticing them," McKeown said.
The center also has some wireless simulation equipment, and all the simulators are operated from a control booth by McKeown or one of the other simulation specialists at the center: Joshua Nuelken, RN, or Tim Wojcik, NREMT-P, who has a background in emergency medical services.
"We are fortunate in that we have three clinicians in the booth," McKeown said. "Our expertise makes it easy for us to adapt on the fly so we are able to change parameters like blood pressure, pulse and pulse ox. We can either pre-program a mannequin, or we can change these things depending on what the learners do. We make the experience as true to life as much as we can."
McKeown thinks simulation training puts today's learners at a great advantage.
"Having worked as a critical care nurse and been in real codes, I can say with confidence this is very realistic when compared to a code situation," he explained. "I feel strongly that simulation is the future of nursing and healthcare education in general."
The Simulation Center provides continuing education for practicing RNs from the Palmetto Health hospitals on topics such as ACLS and pediatric advanced life support. Student nurses have mainly visited the center for task training rather high-tech simulation. For example, students may work on their proficiency with tasks on low-tech simulators such as IV arms or airway trainer models. In addition, the center teaches a course on the fundamentals of critical care support.
"We have been primarily geared toward residents and doctors, but we have a lot nurses coming through [the center] and benefitting from that course," McKeown said. In fact, the center recently implemented rapid response training for med/surg nurses.
"A lot of the focus had been on training the critical care part of the rapid response team, but med/surg nurses need to know what to do for the first few minutes of the code until the team gets there. We are trying to do as much for nurses as we can."
Try, Try Again
McKeown thinks simulation exercises enable learners to achieve a more consistent level of experience.
"I know from my own training it was very much 'see one, do one, teach one,' and you didn't always know what you were going to get," he recalled. "One student nurse might get five opportunities to put in a Foley catheter and the next student maybe wouldn't get any.
"Simulation provides learners with the opportunity to do a procedure as many times as they want to, in a relatively lifelike manner," he continued. "If nothing else, it gives the learner the opportunity to go through the mechanics of a procedure, whereas before, they have been fumbling around with a real person." No nurse wants their patient to ask, "Have you done this before?"
The simulation mannequin enables an individual to get used to the mechanics of a procedure. "Simulation training may be a little overwhelming when someone first comes in, perhaps for an ACLS class, but it is beneficial," McKeown said.
More so, he views it as essential. "Nursing is really one of the only high-risk professions that don't regularly drill for emergencies and urgent situations, and I really believe that simulation is going to change that."