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Real-world scenarios challenge healthcare students

CVTC Nursing student Kasie Tervelt of Chippewa Falls checks for a pulse while fellow student Emily Nelson of Jim Falls applied chest compressions and Respiratory Therapy student Kayla Bowe of Bloomer maintains and air flow during a “code blue” situation in which the Human Patient Simulator went into cardiac arrest, at CVTC Tuesday. All week, healthcare students from multiple disciplines worked together in realistic, real-time scenarios much like the situations they will face in the real world.

Eau Claire, WI – An alarm sounded and the blue light flashed. Paramedics, nurses and a respiratory therapist sprang into action. Each member of the team had a role to play, and they worked together, communicating constantly through each step of the life-saving procedures.

The scene recently in one of the labs at the Health Education Center at Chippewa Valley Technical College (CVTC) was only a simulation, and the students had worked frequently in the past with the Human Patient Simulators within their respective healthcare disciplines. But there was something vastly different about this exercise.

This time, the students from Nursing, Respiratory Therapy and Paramedic Technician programs were working together with resident physicians from the UW-Health Clinic, all under the observation of professionals and faculty members from multiple disciplines. And this time simulator patients actually spoke to the students with complaints, questions and realistic reactions through instructors wired to microphones in another room.

Adding a little more flavor to the mix were volunteers playing the parts of family members who provided comfort to their loved ones, but also sometimes got in the way.

The hours-long scene was as close to a real, live critical patient care situation as the students would see prior to their upcoming graduations. In planning the training session, organizers could not find anything similar being done elsewhere.

“This is fairly groundbreaking,” said CVTC Respiratory Therapist Instructor Don Raymond, who helped put together the scenarios. “Multidisciplinary education is becoming more important. It teaches collaborative teamwork, communication, respect across disciplines and professionalism.”

“This is to help all the disciplines understand the roles of team members and the importance of collaboration and communication, with the ultimate goal of improving patient care,” CVTC Associate Dean of Health Linda Krueger said.

Four patient simulators were used, simulating a pediatric patient, a pulmonary embolism, a heart attack, and severe COPD symptoms. Students were used to working with the simulators, but typically they learned to do specific procedures involved in their disciplines, one at a time. The multidisciplinary training involved more than one patient in the unit to care for, with more than one problem, with other healthcare workers helping, and sometimes with unexpected results.

“Sometimes we operate in separate silos,” Kim Ernstmeyer, CVTC Nursing instructor said. “We do our nursing thing, respiratory does its thing. . . in scenarios like this, we all work together.”

“In true hospital settings, everyone works as a team,” Raymond said.

“This gives them a chance to work together as a team like they will be doing when they graduate,” Krueger said.

Part of the purpose was to get students out of their comfort zones. One of the scenarios involved a “code blue” – a patient going into cardiac arrest. In a fast-paced simulation, respiratory therapist worked to maintain air flow while a paramedic did chest compressions, and nurses monitored signs and operated the defibrillator. A nurse eventually took over chest compressions for the fatigued paramedic.

The “patient” ultimately died.

“We were really hesitant to have that patient die. We did not want the students to feel they did something wrong or had failed. But sometimes you do everything perfectly and a patient still dies,” Krueger said.

That point was emphasized in a post-exercise debriefing with the students. Ernstmeyer told them that death was decided no matter what they did.  Mike Miller, a critical care paramedic with the Eau Claire Fire Department and a CVTC adjunct faculty member, told the students dealing with death is part of the job.

“Don’t get down on yourself if someone dies. It happens,” Miller said.

“We want you walking away thinking you did everything you could,” Ernstmeyer added.

Nursing student Sarah Crotty of Alma found herself out of her comfort zone when a person playing a family member tried to wake the deceased person. She had to deliver the news.

“I said, ‘well, he passed away,’ ” Crotty related. “I’ve never been faced with that before.”

Raymond explained that the exercise was not graded; instructors did not want students to worry about passing or failing. “It’s not about evaluation; it’s a learning experience,” he said.

Feedback from the students has been overwhelmingly positive, organizers said.

“Acting it out instead of just looking at it in a textbook really puts things into your mind,” said Emily Nelson, a Nursing student from Jim Falls. “And not knowing what you are coming into is what is going to happen in the real world.”

Crotty said she learned about the collaboration between the disciplines. “You stick to your nursing role, but here I got to see a lot more about what the paramedic is for and what the respiratory therapist is for,” she said.

The pace of the exercise was new to the students. Respiratory Therapy student Kayla Bowe of Bloomer said she learned to “Keep calm, and keep doing what you’re doing.”

CVTC faculty praised the cooperation of the UW-Health Clinic with the participation of their resident physicians. Residents have completed medical school and are in final stages of training before becoming fully practicing MDs. They, too, gained from the experience. People involved naturally looked to them for guidance during the exercise.

“I’m still learning how to be a leader,” said Dr. Jessie Lindemann.

Each session was four hours long, with sessions both morning and afternoon all week. The same scenario was conducted at each, with different students taking part.

Krueger said Raymond originally developed a multi-disciplinary course plan that became part of a grant application for purchase of a new Human Patient Simulator. Conducting the multidisciplinary training is part of the grant, with more sessions planned through next year. All student participants were in their last semester of their CVTC programs.

Chippewa Valley Technical College delivers superior, progressive technical education which improves the lives of students, meets the workforce needs of the region, and strengthens the larger community. Campuses are located in Chippewa Falls, Eau Claire, Menomonie, Neillsville and River Falls. CVTC serves an 11-county area in west central Wisconsin. CVTC is part of the Wisconsin Technical College System (WTCS) and is one of 16 WTCS colleges located throughout the state.