Human Patient Simulators

kaydensmom01 · Jul 11, 2013

We use stimulators for learning skills and for practicing skills. For 4 weeks in the second semester we are just in the lab in order to Learn and test on Ivs, catheters, ng tubes, dressing changes but as soon as we are done we go to clinicals. We have a few weeks at the beginning of each semester in the lab when learning new skills but the majority of time is in the hospital. I wouldn't like the idea of changing a normal clinical that you are not learning a new skill into a lab clinical because I feel actual clinical experience is more valuable. Learning in the lab is different than doing something in the clinical setting; the more actual clinical time the better in my opinion.

Sun0408, ASN, RN · Jul 11, 2013

I loved our sim's in school, they coded, talked, you can assess heart,lung and bowel sounds, they also bleed out,and gave birth.. They can do just about anything a live pt can. You can learn a great deal from them. However, we only used them several times a semester in addition to clinicals. Our clinical times were not cut short. My facility uses them in learning situations for new grads.

Editorial Team / Admin · Jul 11, 2013

I think simulation can be very beneficial. It provides a safe environment where no harm can come to any patient where students can practice skills when they are not plentiful in the clinical environment. However, there should be a limit as to how many clinical hours should be allowed to be simulation scenarios. Florida allows 10%, California allows 25%. Because not every aspect of patient care can be simulated, I think California's 25% is too generous. Florida's is more realistic. My personal opinion of course, so if anyone has any journal articles comparing nursing performance with various amount of hours permitted to be simulation, I'd love some resources.

green34 · Jul 11, 2013

Well, I'm not talking about the mannequins. We have those too. The mannequins you can do heart rate, breathing, foley insertion, iv insertion, dressing changes, traction, trach care, etc. we use those but they do not count for clinical hours. The patient simulators do a lot more like talk to you, have ECG, take IV fluid and have scenarios set up. Like if we do not give potassium, then the patient may start having pvcs. If we give the wrong med, the patient can code. The vital signs can display shock. The HPS mannequins are more in depth. Oh and some can sense oxygen.

Although sometimes they can be glitchy like the spo2 dropped for no reason and the patient coded.

nurseprnRN, BSN, RN · Jul 11, 2013

I loved our sim's in school, they coded, talked, you can assess heart,lung and bowel sounds, they also bleed out,and gave birth.. They can do just about anything a live pt can. You can learn a great deal from them. However, we only used them several times a semester in addition to clinicals. Our clinical times were not cut short. My facility uses them in learning situations for new grads.

Um, no they can't, not by an extremely long shot. They can't teach you squat about time management, delegation to and working with coworkers, communication skills with other nurses, physicians, and ancillary services.

They can't teach you how to see fear in someone's eyes and how to sit quietly and hold a hand while she tells you all about it.

They don't weigh what people really weigh, so you can't move them the way real people move-- and you'll never learn how to avoid injury (hit, bite, wrenched arm) by working with them. They don't vomit or poop, or lose control of their bladders while you are walking them to the commode.

They never give you a good opportunity to ask about home situation, who lives with them, who cooks for them, how many stairs they have to climb, and how they will get to their physician appts after discharge. You'll never pick up a critical surprise finding using a simulator, like, oh, she's only been taking her medication every other day because she can't afford to buy it more often and she has vet bills for her beloved cat.

Or that she was sexually abused in the bathroom as a child, and that's why she freaks out when she has to be showered. Or that his wife is at home with dementia, he's her only caregiver, and he wants to sign out AMA before he gets his workup done because he fears for her safety.

And you'll never see a preceptor pick those up and get a chance to discuss them with her at break.

See, like most students, you fall into the trap of thinking that clinical and lab are all about what you call "skills," a large number of which are not really skills but tasks. This is why I agree with Sweet_Wild_Rose about serious limits on sim time. Sure, they're great for practicing one time or the inevitable "lab check-offs," but never, ever confuse that stuff with what nurses are and do. And no, the more advanced sims that can have PVCs and drop their SpO2s don't make up for that. When real people on the med/surg floor have arrhythmias, they're not on a monitor, sometimes they say things, or rub their sternums, or get very quiet and withdrawn. How would you notice that on a sim?

I think your school is doing you--and the public-- a very great disservice. An enormous disservice. Is this a real school, or one of those for-profit "nontraditional" programs?

Peds OR L&D? And it's OK because you'd "cover the content"? So...you take your kid to the ER one night and you get the nurse that got that coveted job in the ER...but has never really cared for a child in clinical. Are you happy that she "covered the content"-- it's just fine by you that she's your child's nurse? Or you get an OR trainee job and you rotate through preop and see a woman who's there for a C-section. Got it covered, right? Even though you never set foot in an L&D unit? Stunning. Let me know where you all get jobs. I ain't going there.

armygirl2013 · Jul 11, 2013

Totally agree with GrnTea. I am in an accel program, right now in our second "session." We are giving up a clinical day to have a sim lab "experience." I asked my clinical instructor why the school feels this is beneficial, when we are already doing clinical in the hospitals with actual patients. She actually got quite irritated with me and snapped off that it's "statistically proven" that students who spend a lot of time in the sim lab do "better" and that "most schools are going to cut down on actual clinical time in favor of sim lab." Thank God I'll be graduated before that happens. It's just not the same, no matter how high speed the mannequins are.

allnurses Guide · Jul 11, 2013

While most of the time I don't need to post anything because GrnTea already said it better.....

this time I am going to disagree just a little. Sims do a good job of teaching skills, which are needed. No, it can't and won't teach the true art of nursing; but skill sets do have their place. What I have seen students do, is get so totally into the scenario that it becomes real, they feel stress and pressure and have to perform anyway. The sim person behind the glass does answer questions and give history. The students get practice in teamwork and delegation, and are forced to put thing together (critical thinking) and come up with interventions or solutions.

I totally agree with limiting how much clinical hours sim should count for, but with so many schools competing for clinical space at least the students are getting some exposure, especially to situations they might never see otherwise. Also, being competent at skills allows for more time for the arts of nursing in actual clinicals, because the instructor doesn't have to stop to reteach a skill and can lead the student through refining listening and assessing at the bedside.

Star RN · Jul 12, 2013

Wow, wish they had this when I was in nursing school. I can understand how this could be very useful. I don't believe it should replace clinical time at all. The sim class would be a great supplement to the program and should be a requirement.

green34 · Jul 12, 2013

Um, no they can't, not by an extremely long shot. They can't teach you squat about time management, delegation to and working with coworkers, communication skills with other nurses, physicians, and ancillary services.
They can't teach you how to see fear in someone's eyes and how to sit quietly and hold a hand while she tells you all about it.
They don't weigh what people really weigh, so you can't move them the way real people move-- and you'll never learn how to avoid injury (hit, bite, wrenched arm) by working with them. They don't vomit or poop, or lose control of their bladders while you are walking them to the commode.
They never give you a good opportunity to ask about home situation, who lives with them, who cooks for them, how many stairs they have to climb, and how they will get to their physician appts after discharge. You'll never pick up a critical surprise finding using a simulator, like, oh, she's only been taking her medication every other day because she can't afford to buy it more often and she has vet bills for her beloved cat.
Or that she was sexually abused in the bathroom as a child, and that's why she freaks out when she has to be showered. Or that his wife is at home with dementia, he's her only caregiver, and he wants to sign out AMA before he gets his workup done because he fears for her safety.
And you'll never see a preceptor pick those up and get a chance to discuss them with her at break.

See, like most students, you fall into the trap of thinking that clinical and lab are all about what you call "skills," a large number of which are not really skills but tasks. This is why I agree with Sweet_Wild_Rose about serious limits on sim time. Sure, they're great for practicing one time or the inevitable "lab check-offs," but never, ever confuse that stuff with what nurses are and do. And no, the more advanced sims that can have PVCs and drop their SpO2s don't make up for that. When real people on the med/surg floor have arrhythmias, they're not on a monitor, sometimes they say things, or rub their sternums, or get very quiet and withdrawn. How would you notice that on a sim?

I think your school is doing you--and the public-- a very great disservice. An enormous disservice. Is this a real school, or one of those for-profit "nontraditional" programs?

Peds OR L&D? And it's OK because you'd "cover the content"? So...you take your kid to the ER one night and you get the nurse that got that coveted job in the ER...but has never really cared for a child in clinical. Are you happy that she "covered the content"-- it's just fine by you that she's your child's nurse? Or you get an OR trainee job and you rotate through preop and see a woman who's there for a C-section. Got it covered, right? Even though you never set foot in an L&D unit? Stunning. Let me know where you all get jobs. I ain't going there.

Some of it can be simulated. We had to work with delegating. In clinical, we only delegated in team nursing. Other wise we were the patient care tech, LPN, and RN. In the sim labs, we all played different parts. I was the obxnious wife who kept on hitting the PCA pump, yelling at the nurses to get pain meds, demanding to know what was going on, in general I was a pain in the ass. We have had patient family members who were coached to be obxnious. We were able to talk to nurses pretending to be doctors and they are not nice. They will hang up on you, yell at you, and in general make a stressful situation more stressful. The patients in general do have pretty good backgrounds. We did have a man who was refusing to be admitted because he was the caretaker to his wife and they were sharing pills. We had another one who had altered mental status and okaying blood products but his wife insisted he would not take any blood products.

However, I think part of their reasoning is that some of the clinical locations aren't necessarily the most exciting floors.

However, I don't think they should replace any clinical time with it. While it is useful, it is something I would rather give up some lecture time to have in place. Some lectures are pointless in my opinion. One semester I skipped most of the lectures and instead went online and did a self-taught.

You do have the option to do both OB and peds, but then there are some people who will not want to touch OB at all.

It's a real public school that has had a nurisng program since the 50s if not longer. They average one of the highest NCLEX passing rates in the area. Last time I checked it was about 97% pass for the entire year and the last quarter was 94%.

However, this is just the plan and they are working on refining it. It sounds like they are totally redoing the program.

Sun0408, ASN, RN · Jul 12, 2013

Um, no they can't, not by an extremely long shot. They can't teach you squat about time management, delegation to and working with coworkers, communication skills with other nurses, physicians, and ancillary services.
They can't teach you how to see fear in someone's eyes and how to sit quietly and hold a hand while she tells you all about it.
They don't weigh what people really weigh, so you can't move them the way real people move-- and you'll never learn how to avoid injury (hit, bite, wrenched arm) by working with them. They don't vomit or poop, or lose control of their bladders while you are walking them to the commode.
They never give you a good opportunity to ask about home situation, who lives with them, who cooks for them, how many stairs they have to climb, and how they will get to their physician appts after discharge. You'll never pick up a critical surprise finding using a simulator, like, oh, she's only been taking her medication every other day because she can't afford to buy it more often and she has vet bills for her beloved cat.
Or that she was sexually abused in the bathroom as a child, and that's why she freaks out when she has to be showered. Or that his wife is at home with dementia, he's her only caregiver, and he wants to sign out AMA before he gets his workup done because he fears for her safety.
And you'll never see a preceptor pick those up and get a chance to discuss them with her at break.

See, like most students, you fall into the trap of thinking that clinical and lab are all about what you call "skills," a large number of which are not really skills but tasks. This is why I agree with Sweet_Wild_Rose about serious limits on sim time. Sure, they're great for practicing one time or the inevitable "lab check-offs," but never, ever confuse that stuff with what nurses are and do. And no, the more advanced sims that can have PVCs and drop their SpO2s don't make up for that. When real people on the med/surg floor have arrhythmias, they're not on a monitor, sometimes they say things, or rub their sternums, or get very quiet and withdrawn. How would you notice that on a sim?

I think your school is doing you--and the public-- a very great disservice. An enormous disservice. Is this a real school, or one of those for-profit "nontraditional" programs?

Peds OR L&D? And it's OK because you'd "cover the content"? So...you take your kid to the ER one night and you get the nurse that got that coveted job in the ER...but has never really cared for a child in clinical. Are you happy that she "covered the content"-- it's just fine by you that she's your child's nurse? Or you get an OR trainee job and you rotate through preop and see a woman who's there for a C-section. Got it covered, right? Even though you never set foot in an L&D unit? Stunning. Let me know where you all get jobs. I ain't going there.

Wow, I think you took ,my statement a bit too far and out of content... The sims are great for the things I listed, simply used as learning tool in a safe environment.. .

What you did not pay attention too was the fact that I said they could be used in addition to clinical's and clinical time should not be cut short. I never stated they should replace face time etc..I understand fully how much face time, communication, time management etc is.

A&Ox6, MSN, RN · Jul 12, 2013

In my program, each semester we have one or two simulation experiences. For fundamentals of nursing, we had to focus on communication as well as getting a basic h&p. Med Surg 1, we had a clinical scenario related to the material we were responsible for. The same for Med Surg 2. For pediatric, we did a PICU scenario (which was really helpful because we aren't allowed to go to a real PICU). We also have a room set up like a home where we do a home health scenario and we do a delivery room scenario. My psych class participated in an NLN sample psych simulation. We each had different parts, patients with different dx, nurses with different responsibilities and in different settings, family...

All of our simulations have pretest/post test, debriefing, and assigned reading. Some of them are during clinical hours when the hospital can't accommodate us, but some we are required to schedule appointments on our own.

I find them very helpful for many reasons.

1. We get experiences that we wouldn't get otherwise. For example, being the primary nurse, or being responsible to make critical assessments.

2. We have a safe place to try out skills and critical thinking.

3. We can learn about team nursing

4. Since these experiences are videotaped, we can actually see ourselves. This helps you find patterns in your actions. For example, I've noticed that when I don't know what to do next, or when I feel like things are wrong, I tend to do things that don't make sense. Like I hold the oxygen mask on the patient. By seeing what I actually look like, I am able to take control if my actions and reactions to scenarios.