Dr. Brian Oxhorn, Director of the Skills & Simulation Lab for the College of Nursing at Roseman University, preps a health simulation mannequin at the Henderson, Nev. campus on Wednesday, April 16, 2014. Oxhorn is applying makeup to simulate an abused woman during childbirth scenario for students. (AP Photo/Las Vegas Review-Journal, Jeff Scheid)
HENDERSON — Dorothy is 17 years old and pregnant for the third time. She has come to the hospital with abdominal pains, accompanied by her physician father.
When the nurses ask Dorothy for her name and date of birth, her father answers for her. He does so again when the nurses uncover a large bruise on her belly.
“She fell down the stairs,” he says, standing close to her bedside.
Throughout the exam, Dorothy moans in pain. She doesn’t speak until her father leaves the room.
“If I tell you something, do you promise not to tell?” she asks the nurses.
The nurses agree.
“I didn’t fall,” she says. “My dad hit me.”
Though plausible, the scenario is staged. Dorothy is a high-tech mannequin, her “father” is adjunct professor Brian Oxhorn and the nurses are students at Roseman University of Health Sciences in Henderson.
Simulation labs are used in nursing schools to give students realistic experiences in controlled settings. The labs look like hospital rooms, and mannequins serve as patients. They can simulate speech, breathing, blood pressure, heart rate and other functions.
In the exercise, Oxhorn wants his students to recognize abuse and ensure patient safety while treating a life-threatening condition.
He performs this scenario in multiple roles — the mean boyfriend, the nice boyfriend, the father and the father who is a doctor. Interestingly, the nurses view the physician father as an authority figure and rarely ask him to leave as they do in other scenarios.
But it’s OK to make mistakes.
“There’s no right or wrong,” Oxhorn said in mid-April. “It’s just what you did and what you learn from it.”
Simulation labs have been an industry standard for 10 to 15 years.
Roseman University has four high-fidelity mannequins on its campus: infant, child, adult man and pregnant woman.
University of Nevada, Las Vegas and Nevada State College nursing students share 10 such mannequins at the Clinical Simulation Center of Las Vegas on Shadow Lane.
The 32,000-square-foot center has five simulation labs, standardized patient rooms, a hospital ward and a surgery skills hall. The facility is also used by University of Nevada School of Medicine doctors in training.
“The sim lab sets students up for success,” said Marcia Turner, vice chancellor of health sciences with the Nevada System of Higher Education, during a tour.
In the labs, students gain hands-on experience in as many as 50 scenarios, each with a specific objective.
Before simulation labs, “everything you would see was the first time you’d ever see it,” Oxhorn said.
He compares the nursing exercises to pilots using flight simulators or NFL teams reviewing their plays — improvement is the goal.
Interacting with the mannequins can be awkward for first-time students, but they acclimate with practice. Videos of UNLV students delivering CPR to a mannequin look like real hospital footage.
“Tactile learning, experiential learning is really valuable,” Oxhorn said. “It’s really important in nursing because that’s what our job is. It’s all doing stuff. It’s a doing position. Having (simulation) experience makes us a little more efficient when we get out there and do it for the first time on a real person.”
Scenarios run 15 to 30 minutes, and are streamed into the next room so classmates can watch. Afterward, the participants can review and critique the video.
A simulated episode can be programmed or controlled live by manipulating speech and vital stats from a one-way, mirrored control room.
“The first time it’s nerve-wracking because you know there’re cameras and you want to impress your classmates and your professors,” said Sydney Duke, a senior nursing student at UNLV.
Interacting with mannequins initially feels unnatural, she said last week, but after a while the mannequins begin to seem like real patients.
Duke said she likes simulation because it puts students in a nurse’s shoes. In hospital settings, students work as nurses’ aides.
For Duke, simulation has been especially helpful in learning to navigate death and dying scenarios, where nurses learn to comfort patients and their families and deliver bad news.
In school, “you can learn about how to do tasks, but communication is something you have to have experience with,” Duke said. “That scenario (with mannequins) really helps us out.”
The mannequins are also capable of bodily functions, such as crying, sweating and more.
“She can urinate, she can bleed, amniotic fluid can come out, meconium can come out,” Oxhorn said. “There’s an advanced SimMan that can do active bleeding. You can create those things (in nonadvanced models). It’s just a little more static.”
For example, Oxhorn might paint on cuts or bruises.
There are smells, too.
For infected wounds, Oxhorn mixes soup, kimchi and limburger cheese. To make fluids smell convincing, he adds ammonia to fake urine and lets nails soak in fake blood overnight.
UNLV and NSC students reported that they weren’t prepared for the odors when they began working in real hospitals, so the Nevada System of Higher Education lab created sprays that smell like feces and vomit.
Because the models can be injected with fluids, they must be flushed out occasionally. They also require software updates.
“It’s basically a big computer,” Rowena Saba, simulation program coordinator, said of the mannequins.
They are basically $30,000 to $60,000 computers that run Windows XP.
The Clinical Simulation Center was initially funded by $15.75 million from the state and $2 million from the federal government.
UNLV and NSC each pay 35 percent of the operating costs, while the University of Nevada School of Medicine pays 30 percent.
Although it’s uncommon, Oxhorn has experimented with using simulators for mental-health diagnosis. That is difficult because symptoms often manifest in nonverbal cues, which the mannequins can’t duplicate.
But that doesn’t stop him from trying.
In re-creating a homeless person found unconscious on the streets, Oxhorn pinned a mural showing an alleyway onto the wall, laid the simulator on the floor and dressed him in tattered clothing scented with deer urine.
To clue in students to a potential problem, he described the patient’s behavior and asked leading questions.
“When you walked into the room, you felt like you were in an alley,” Oxhorn said. “It’s really about creating a visual, auditory, tactile experience.”
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Information from: Las Vegas Review-Journal, http://www.lvrj.com