By Joseph Gaccione (UNLV School of Nursing Associate Director of Communications)
A nursing student is talking to a patient when suddenly, that patient begins to complain of chest pains. The aches quickly worsen, and the student recognizes the signs of a heart attack. Now, the student is forced to make a critical decision in seconds that will positively or negatively impact a patient’s care, potentially their life.
This is just one kind of scenario students encounter when they take NURS313R, or 'Med Surg' as it’s more informally known. The class is a key component of a nursing student’s academic and professional trajectory. This is where the students get a truer taste of what it’s like in the real world.
UNLV nursing undergraduate students take this course in their second semester, building on their fundamentals. Dr. Rhigel “Jay” Tan, assistant professor, has taught the course at UNLV since 2005. He instructs the students in both theory and clinical simulation, utilizing space at the Clinical Simulation Center of Las Vegas for the hands-on skills assessments. As Dr. Tan describes, this is where skills, knowledge, and attitude are all formed.
Q: Can you explain what the Med Surg course involves?
A: Med Surg is basically taking care of individuals in a medical and surgical environment. The students in this course learn about a lot of disease processes you would see in the hospital, both medically and surgically. The focus is on adults in an acute care setting who are hospitalized for a particular medical problem. We study nursing care related to this. There are a variety of diseases and diagnoses in this field. In fact, when we say med surg, this is a core piece of nursing, because a lot of our patients have medical and surgical problems, [and] most are generally learned in this course. This is a basic course, in the sense that it captures a lot of patient types. This may be diagnosis-wise, symptom-wise, or even just management.
Q: How do you simulate this topic in a class?
A: Because of the variety of illnesses and diseases, a student may not be able to take care of every disease process during their student life. That's where the [Clinical Simulation Center] comes in, because in simulation, the teacher and other support groups can design a certain disease process [students] may not see in the hospital because of limitations of their time, cases, and so on. The Sim Center captures this experience by simulating different illnesses the student has to go through as an add-on to their experience. [A simulation] mannequin can be programmed to talk and exhibit different symptoms a patient with the same problem would undergo. Then the student nurse will be able to do their care based on the problem manifested by the mannequin, interrupt, and either progress or deteriorate. While the students are taking care of them in a simulation area, you take away the risk of harming somebody, yet you enhanced the experience. The Sim Center offers the students a chance to commit an error without harming anyone.
Q: What kind of symptoms can you program into a mannequin?
A: They have difficulty breathing. People having a heart attack will have pain. They will have bluish discoloration of their face. They will moan and groan. They cannot tell you exactly what's happening. They are restless. They're anxious. That can be simulated with bluish tint on the mannequin. The face turns blue because of the light. Then [the students] have to decide to do something, what they're trained to do in the classroom - bring it to actual hands-on [moments] and interrupt. When you do it right, that problem starts to improve, but if you do it wrong, the patient can deteriorate, even die, but it's a mannequin. All you need to do is reset for another student experience, and the student may learn from their mistake.
Q: How difficult does it get for students working with just a mannequin?
A: There are cases the student probably doesn't prioritize, or they don't have a good background on what they do. They just act on something that can harm the patient, and the patient could die. I don't see the beauty of death, but the beauty of it is this student learns from their mistakes. They are recorded, so we could go back and review events that led to something that created a potential problem with a patient. Then we debrief on things that can be improved. What are things we need to maintain and what can be done better? Then we can let the students express how they feel and what their thought process was in a certain scenario. We need to have debriefing because it has a psychological impact for our students. A lot of student cry, and we let them because that's human emotion; that's part of the experience. But it never killed anyone. The learning comes in because of the discussion about it.
Q: What would be something that might surprise non-nurses or non-health care workers about a course like this?
A: It probably would surprise them we simulate illnesses and patient care with robots. The robot is a contributing factor to our students' learning and training because they are very high-tech. We call it high fidelity that there are things that human body normally do that cannot be experienced by reading. These robot patients will manifest it under a controlled environment.
Q: How did you adapt simulations during COVID?
A: During the height of COVID, when COVID was not fully understood and what we're going to do, our exposure was limited over the concern of being exposed. Simulation offers an alternative way where we could practice taking care of a patient without being exposed to the virus. We have a lot of simulation activities. In fact, when I was president of the [Nevada State] Board of Nursing, I was also active nationally where we participated in the study of how does clinical simulation equate to clinical experience. We found out that it is very much equivalent. I had to evolve the course into what was actually needed, so I updated some of the discussion when you go into respiratory, decision-making, modalities of care that they have to do due to what’s been found out, created, and established during the pandemic.
Q: What are the challenges in keeping this course up with current trends?
A: As an assistant professor, you need to also take care of your own growth and that growth reflects on how you bring the course. So over time, you need to be innovative in your teaching strategy. [Recently], I introduced clinical judgment model in this course. 10 years ago, we taught nurses how to critically think, so we teach them in this course how to connect the dots. Why is this patient manifesting this? What's the connection [between] the swelling of the leg to the difficulty of breathing of a patient that has a heart problem? Now, it's not enough to say, ‘Oh, I understand the connection between the symptoms.’ The question is, ‘Now you understand, so what are you going to do?’ I think that's the beauty of an eclectic change of nursing education that stimulation can contribute. That's what I'm doing with this course.
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