One after another, the student nurses pump the hand sanitizer dispenser and approach the bedside. They turn the patient's name band to check his birth date and full name and say, in that singsong manner typical of young adults, "Good morning, Mr. Johnson, I'm your nurse today. How are you feeling?" The patient is a manikin called SimMan, short for simulation man, and I'm his voice. Hidden behind a one-way mirror, I also control SimMan's physiological responses to the students' interventions. My goal is to replicate the essential aspects of a clinical situation in order to prepare the students to encounter them in a living patient.
After asking the patient several basic clinical questions, each student performs a quick physical assessment guided by the information on the change-of-shift worksheet, followed by a more thorough head-to-toe assessment, all the while keeping up a conversation with the patient.
The manikins used today are increasingly evolved (they can bleed, develop a pneumothorax, and "die"), but their speech is not. So I improvise conversation to add more realism to each scenario. I've coughed and wheezed like a 40-pack-a-year COPDer, panted like a person in diabetic ketoacidosis, and vented my fears as a physically abused woman. When I'm not playing an unresponsive patient, I can thank the nurses for their skills or bark at them for not giving me water when my mouth is dry.
When I voice the patients, I don't just articulate their pain-I also react as they might. Sometimes I'm moved and awed by a student nurse's empathy. Take "Lora," for example. Her voice was soothing as I enacted the role of a patient with a COPD exacerbation, and when she told me, "you'll be fine, and I'm doing everything I can to make you feel better," I trusted her just as a three-year-old child trusts a reassuring adult.
In a scenario in which the patient went into respiratory distress, student nurse "Erica" kept an eye on the pulse oximetry monitor and reached for SimMan's hand as she called for help. Though I was watching from behind the mirror, I somehow knew how comforting it would be to be held like that if my oxygen saturation level sat at 85%. Then there was the male student with the voice of a drill sergeant. When "Carlos" ordered me to do my incentive spirometry exercises, I took the deepest breath I could muster-simply out of fear he might make me do 40 sit-ups if I didn't comply.
In such simulation exercises, not only do students get to audition for lifesaving clinical roles, they become well rehearsed in the profound art of human empathy through therapeutic communication. In voicing the patient, I too find myself gaining a deeper understanding of what makes good nursing care. It's both enchanting and liberating to become another person, if only in voice, and to experience their frailties and suffering.
This is a privilege not found in the faculty handbook. Simulation has given me not only a creative way to teach, but a recurring chance to consider the precariousness of life. When a student nurse looks at SimMan, I can "feel" her comforting gaze. And my new emotional perspective as the patient influences my role when I'm the nurse at the bedside-as if I could serve as a kind of channel for a comforting, guiding force looking out for us all.
In one scenario, I played the physician who was called to attend a patient in respiratory distress. As the event unfolded, I frantically tried to intubate SimMan, but I failed. Beads of sweat lined my forehead. The students stood in silence, glancing nervously at each other. The student playing the primary nurse held SimMan's hand as if afraid to lose him. My heart was racing-and so was SimMan's.
Before a full-blown cardiac arrest could ensue, I stopped the scenario. In the debriefing that followed, someone asked, "Do you think he would have died?" Hoping to say something clever enough to distract attention from my poor intubation skills, I said, "I don't know, but one thing's for sure, the learning experience will live." And it was true. At least momentarily, both the faculty member and his students had been transformed.