Joint medical simulation bigger and better this year

By Sandra Snyder / For The Scranton Journal, Winter 2016

If you want to rattle some future nurses, put them in a small room with some future doctors and a social worker or two they’ve never met.

Send in a teenage patient in severe asthmatic distress and unafraid to talk back.

Then add the patient’s mother and the students’ teachers. The mother is frantic, and the teachers are hidden behind a wall, but the students know they are there – and observing carefully.

Simply put, “It’s nerve-racking,” Danae Snyder, a senior nursing student from Clarks Summit, said of the cross-disciplinary exercise designed to teach teamwork and communication to nursing students at the University of Scranton, social-work students at Marywood University and medical students at The Commonwealth Medical College.

Fortunately, the stressful exercise, in which the patient went into respiratory failure and required intubation, was only a dramatization, once again starring SimMan, an advanced patient simulator, and an actor hired by TCMC to play the worried mother.

Margarete Zalon, Ph.D., a university nursing professor, was among the organizers of the exercise involving more than 200 people. “This year, we went bigger and better, which was no small feat,” she said.

Last year, half of the junior and half of the senior nursing class were involved. “This year we decided we would take everybody,” she said.

The high-fidelity simulation, which permits an escalating situation, was broken down into 48 sessions. Two took place at the University and two at the medical college, and faculty from each institution were represented at both.

“We wanted to cross-pollinate,” Zalon explained. “They came here; we went there.”

“It’s really like a huge orchestrated event, in which everybody has their little part,” Zalon said.

The scenario, which had to be programmed into the simulator, was written by Deborah Zielinski, the University’s laboratory director, and Colleen Heckman, assistant laboratory director. The laboratory staff, including University alumna and instructor Laura Skoronski, was charged with running the simulators. The lab staff also programs the mannequin to respond to student interventions.

The circumstances were the same ones presented to students last year in the cooperative project with TCMC.

The staff considered the fact that some of this year’s students also would have participated last year, Zalon said. “But a year changes things.”

Even repeat students, she said, would be working with new people whom they had not previously met, and that is always a challenge, especially in an emergency.

Cooperation across fields also was a key point of the simulation, Zalon said.

Cross-disciplinary opportunities are “very limited in the course of students’ regular experiences,” she said, explaining the value of having nursing and social-work majors problem-solve together.

One of those problems was the patient’s mother, who was “a little annoying,” Dana Addesa, a junior nursing student from Old Forge, said with a laugh.

The actor was well-trained to panic and so accomplished her job of throwing some students off their game.

“It was hard to focus while she was freaking out,” Addesa said, quickly noting the actor’s important role in teaching the importance of on-the-spot problem solving.

Her team decided a social worker should calm her, but “we all agreed a nurse should have gone over to her as well,” Addesa said. “Somebody should have stayed with her to help calm her down.”

Snyder said her team also found the mother challenging.

During the intubation, she said. “We had to ask her to step out.”

Snyder’s team elected to have the social worker make this request as well.

“You have to be able to look at each other and give each other cues,” she said, explaining how nonverbal communication was an important lesson here as well.

Zalon confirmed the mother’s panic and outbursts were all part of the plan. “They get into the role quite a bit,” she said of the actors, whom TCMC regularly employs to play such roles.

SIM-Man, though not real, also gets into his role, Snyder said. “He even started to sweat.”

In other situations, she said, he’ll challenge you. For example, he has said, “I have a headache. You’re not helping.”

Students had to take SIM-Man’s blood-pressure reading and check his heart rate and respiration, and “the whole time the patient was talking to us,” she said.

In turn, they had to talk to each other and eventually take the case to the top.

“We had to communicate with the doctor, and this was good to practice doing that,” Snyder said. “In our situation, the patient wasn’t getting any better. It’s about learning when to call the doctor.”

Watching the decision-making unfold was important for the faculty observers, who would then take the students into a conference room for a debriefing.

“That’s where the learning takes place,” Zalon said.

Six faculty members ­­– Marian Farrell, Linda Lewis, Bernard Gilligan, Susan Elczyna, Cristen Walker and Wendy Manetti, an undergraduate and graduate alumna who was on the team that planned the pilot for this simulation two years ago – served as debriefers.

Addesa and Snyder agreed the exercise, as intended, drove home the importance of communication.

Snyder, who has been through about eight other simulations in her four years at Scranton, said she feels better prepared to work in critical care before reaching her ultimate goal of becoming a nurse anesthetist.

“They’re great,” she said. “They are exactly what we need. They really pull all of our education and training together.”