Provides Students Next Generation Training
By Selena Larson
Mr. Jones moans in pain.
A nurse says, “Hang in there, Mr. Jones. Just relax for now and take some deep easy breaths for us, please.”
Mr. Jones went into respiratory arrest and is now being monitored by a team of experienced nurses. They are checking his heart rate, blood pressure, and breathing.
But Mr. Jones will never feel better; he can’t feel anything at all. In fact, in a few minutes he won’t even be Mr. Jones, he will be Mr. Adams, a 61-year-old male who was admitted to the hospital after he blacked out.
Mr. Jones is a highly sophisticated medical mannequin at the Banner Health Simulation Medical Center, programmed to breathe, speak and act like a live patient.
The Banner Simulation Medical Center in East Mesa is the largest such center in the United States and the third largest in the world. The 55,000 square foot facility is home to 74 computerized mannequins and 12 Registered Nurse Simulation Specialists. The “virtual hospital” was developed to provide training for nurses, physicians, allied health providers and emergency responders.
The first group of students was welcomed to the next generation of learning in October 2009. Since its opening, more than 6,700 people from Banner facilities in Arizona have received training.
“The bottom line is we want quality, safe patient care,” said Terry Chavez, center manager. “Everything we’re doing is so that we make our patients safe.” Both new graduates and experienced nurses from Banner Health participate in the training, but the new graduates spend more time at the facility.
“We did needs assessments and asked educators at the facilities what the new grads need when they come on board,” Chavez said. “We kept hearing patterns. They need to know time management, decision making, and critical thinking. When we develop the curriculum, we ask ourselves, ‘How can we help these new grads’?”
Virtual hospital units in the center include Intensive Care and Progressive Care, Emergency Department, Labor and Delivery, Neonatal Intensive Care, Pediatrics, and two operating rooms. There are also several skills stations including IV, chest tube, Foley catheter and wounds.
“Can you tell me what’s happening?” Mr. Adams asks his nurses as he is treated in the Emergency Department. Beeping machines continuously monitor the mannequin’s vitals, and a laptop controlled by a simulation specialist can change them at any time. With a few clicks, Mr. Adams begins vomiting, so the nurses roll him on his side. The mannequins are controlled by simulation specialists, or “drivers,” and each mannequin has a corresponding computer.
In the ICU and Pediatric Unit, video monitoring allows drivers to control multiple mannequins at once. There are seven monitors in two rooms and each has a 24 inch computer screen with a corresponding laptop. The drivers can change heart beat, oxygen saturation, respiration and other vitals. Phrases like “I’m hungry,” or “That hurts,” are programmed into the computer, but different scenarios and phrases can be programmed to add different situations.
Back in the “Emergency Department,” the nursing team gives Mr. Adams a medication to maintain proper heart function. The vitals return to a normal level. Mr. Adams says, “I’m hungry,” to let the instructor and nurses know the scenario is complete. The team stands back to debrief with their instructor, and await the next patient.
The three experienced nurses running the different scenarios are impressed by the sophistication of the mannequins. Chris Dennis, licensed in 1974, experienced his first simulation training at a Banner hospital. “This is just different, this is incredible,” Dennis said. “It’s going to better prepare new nurses to go into the work force.”
The new graduates are working in the virtual Intensive Care and Progressive Care Units. In the ICU, a patient has respiratory failure, and the new grads bag and intubate the patient.
Samantha Hasso, a 22-year-old nursing school graduate, enjoys training in the facility. “I had clinical in the hospital (while) in nursing school, and I can compare it a little bit, and it is a lot like real life,” she said. “The feel of the hospital is the same.”
The students monitor three patients daily, and call for the same physicians and tests they would request for a live patient. The instructors answer the phones and respond to the requests as if they were doctors.
“You will have different doctors, and they will have different personalities,” Hasso said. “Not everything is just happy around here.” The instructors enjoy playing the different people that come and go in a hospital. In fact, many think it’s the best part of the instructor’s job. They get to simulate doctors, family members and therapists, and take a majority of the scenarios from real life situations.
Along with patient care, the clinical educators assess team dynamics. The groups aren’t always familiar with each other, and usually come from different facilities. Although they may not know each other, the teams always seem to click.
Hasso sees it as an opportunity to open new doors and work with a lot of other people. “It’s good because you get to know that each Banner facility is doing the same thing and it’s beneficial just in case you travel to other facilities,” Hasso said. “We can rely on each other and work as a team.”
The nursing team in the “Emergency Department” is now working with Mr. Smith, a patient who had a heart attack. They are working together to prevent an irreversible situation. “So what do you do?” the instructor calls out to her team. “How’s his heart rate? What’s going on over there?” The experienced team of nurses responds with ease. The patient is in good hands.
Experienced nurses spend their first week getting acquainted at the Banner facility where they will be working, then spend two days at the training facility, including a full days focused on skills and scenarios.
The new grads spend their first week at the hospital where they will work and then spend two weeks at the training facility. They practice two days of skills training and three eight-hour days of four-hour scenarios. When they start their jobs they will spend six to eight weeks in a preceptorship in which they are mentored by an experienced registered nurse.
So far, the students have found the training beneficial and the center has received a lot of positive feedback, Chavez said. The employees have recognized the innovation and investment Banner is providing..
The training facility is benefiting the medical community as well as the surrounding neighborhood. The site was previously Banner Mesa Medical Center, and closed in 2007. “The community that surrounds the hospital was disappointed when the hospital closed,” said Vickie Hawkins, an instructor at the center. “I think the community is very glad to see it revitalized, and not just as offices, but also what it’s become as an education center for the nurses for Banner.” The facility will continue to grow in the future incorporating physician training and other health services.
“It will definitely grow,” Chavez said. “And we are definitely open to schools. We are looking at some emergency departments, and code training with the University of Arizona Medical School Phoenix.”
The team in the “Emergency Department” is almost finished. Mr. Smith went into cardiac arrest and required emergency resuscitation. He was the third scenario of the day, and now the team’s work is done. As for Mr. Jones, he will rest until he is programmed to wake up as someone else.