Devices & Technology

Virtual Patients, Real-Life Scenarios

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By Suzi Birz, Principal, HiQ Analytics

In the beginning, there was Resusci-Annie, the “lifelike” mannequin used in CPR training. Now, virtual patients are being used to train health care providers around the country on steps to take in a variety of emergency situations. Today’s virtual patients even allow nurses to practice with virtual needles in a computer-based environment with simulated patients. These simulations are used in nursing and medical schools as well as continuing education and refresher training at hospitals and other facilities.

Computer-based simulation allows for the development or practice of vascular procedures such as IV insertion or blood drawing. One such simulation product, Immersion Medical’s CathSim® AccuTouch® System, requires the user to determine the site for the insertion, the sequence of steps and the size of the catheter before rewarding the user with the feel of tissue resistance, the pop of the needle entering, the return of blood flow and audio feedback from the virtual patient.

CathSim includes teaching aids of video, transparent anatomy, cross-sections, playback and evaluation, which allow the user to understand anatomically where the veins reside. Views are customized to the selected patient scenario. The virtual patients or scenarios represent varying ages, including pediatric, adult and geriatric, and clinical conditions, such as dehydration or drug addiction. The evaluation/report card includes several ratings, including a “pain factor.” Realistic training in a risk-free environment improves patient safety and reduces risk of error.

CathSim in Nursing School

In 2002, in an effort to “enhance dummy arms,” Madisonville Community College (MCC), in Madisonville, Kentucky, implemented the CathSim to provide a hands-on experience to its nursing students.

“The more experiences we could provide the nursing students, the more capable our graduates would be,” explained Linda Thomas, RN, MSN, division chair of nursing at Madisonville Community College.

The MCC faculty has not had difficulty learning and adapting the curriculum to include the CathSim, Thomas said.

“The simulation works so well, and its use is expanding in so many areas, that accreditation bodies are expressing the desire to see it included,” she added.

MCC is using the simulators in the respiratory and radiology programs as well as the nursing program. Thomas said she is looking forward to a time when she can include more needlestick scenarios as well as simulations for other procedures.

Additionally, Thomas noted that while the primary motivators for using simulators were to increase nursing students’ confidence and self-directed learning, the benefits of the technology have had far greater reach. MCC has used simulators in meetings with community leadership groups, which have all reacted positively to the innovative use of technology. In addition to community awareness, the technology has gained notice among prospective students.

CathSim in the Hospital

Whether it’s with staff new to a hospital or a role or new to nursing, Dana Etzel-Hardman, RN, BSN, CPN, training and education specialist at Children’s Hospital of Pittsburgh (CHP), in Pittsburgh, Pennsylvania, has found the scenario-based CathSim to increase confidence and provide an effective practice environment for all nurses.

When first taking on her position, Etzel-Hardman found that IV skills were taught via self-learning with a packet and a video. She also discovered a carton with the CathSim inside, which she decided to put to use in a new training program. Now, nurses at CHP attend a four-hour class that includes lectures, dummy arms and the CathSim. The program has been well-received and the nurses have become familiar and comfortable with computers and the simulator.

Etzel-Hardman stated that the scenarios are especially important in a pediatric environment, where “you will not always find a 17-year-old that has been pumping iron.” Acknowledging that veins will not always be easy to find, the CathSim provides vein sizes for infants, toddlers, pre-school and older children.

CHP also takes advantage of the portability of the CathSim. The simulator is brought to the floors to allow nurses an opportunity to practice as they enter a new clinical care area or as a refresher. At CHP, the patient care technicians draw blood; the CathSim is available to them as well.

The Overall Benefit

“Medical simulation exposes nurses to potential real-life situations. It prepares them with the basic understanding and proper steps while transferring the skills and techniques from classroom learning to clinical experience,” said Kevin Kunkler, M.D., medical director for Immersion Medical. "Medical simulators are an affordable way for nursing schools to improve training programs, reduce costs and allow nurses to learn in a comfortable and lower stress environment without risk to patients.”

Take-Away Messages

“Students of today are comfortable with computer-based tools,” Thomas said. “I encourage students: The more you work with a simulator, the better you will be. You have the opportunity to have more access to realistic scenarios from which to learn.”

Etzel-Hardman also urged nursing schools to look at simulation.

“Nursing school curricula are full of so many things and may have limited hands-on,” she said. “Use simulation as hands-on practice, to enhance critical thinking and decision making, and to take away anxiety.”


Immersion Medical

Madisonville Community College

Children's Hospital of Pittsburgh

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