Guest: Nancy Duffy – College of Nursing
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Nancy Duffy, who is Assistant Professor in the College of Nursing here at MUSC. Nancy, tell us about the work you have done with the Simulation Lab. First of all, just what is the Sim Lab?
Nancy Duffy: To me, the Simulation Lab is a perfect place to educate students. The focus in healthcare right now is safety, communication, delegation, leadership, and I can combine all of those important issues into one patient care scenario where that student has to think on their feet. They’ve got to problem solve. They have to pick up the phone and call somebody and let them know something has gone wrong. To me, it is the most perfect environment to practice healthcare.
Dr. Linda Austin: Now, describe, physically, the Simulation Lab. Most people, of course, have never even it, nor have they even seen a simulation lab. What does it look like?
Nancy Duffy: Well, I will tell you, MUSC has the top dog in simulation centers, at least in the state of South Carolina. It is approximately 10,000 square feet of the most high tech, expensive equipment donated from Hill-Rom. So, we have the best in beds, the best in stretchers, the best in simulated equipment. Some of this was in kind donation, which we have to give kudos to those folks. But it is, basically, rooms. There is an operating room which can be converted to a living room. There are two labor and delivery rooms where the manikins actually give birth, and you actually have an infant that moves and breathes, and cries, and turns blue if things aren’t going well. We have an emergency department room that we can use for mass disasters, mass casualty incidents. It’s an actual, live room where we can go in and decontaminate people that have been exposed to whatever agents out there. It looks real. It is real. Everything works. And then, I’m going to say off the top of my head, six patient care rooms that are top notch in equipment. It’s equipment that you would see across the street, at the hospital, in the ICU rooms, in kind donations, again. And then I can mimic whatever case scenario I want the students to be challenged with in those rooms.
Dr. Linda Austin: Using the manikins?
Nancy Duffy: Using manikins.
Dr. Linda Austin: Now, describe the manikins because they’re, obviously, a key part to this.
Nancy Duffy: Actually, I will tell you, healthcare and nursing have used simulation since day one. I mean, if you stick a needle syringe into an orange, that’s basically simulation. Well, now, we’ve come to the point where we have this manikin that can talk to you, that if you give it medication, it’s going to increase their pulse, so, their heart rate. The program can initiate that very response. If you violate a safety principle, you give a narcotic before you check the blood pressure, that patient’s blood pressure is going to bottom out, and then you’re going to have to figure out what’s wrong. So, I have a manikin that can do nothing but lay there. I have a manikin that can give birth. And then I have a manikin that will actually respond to the drugs that the students are administering. It’s phenomenal.
Dr. Linda Austin: Does the manikin have a name?
Nancy Duffy: Actually, the patient scenario has a name. So, it’s Vernon Watkins. They’re made up names.
Dr. Linda Austin: I see. So, you program in, we’ve given Vernon, let’s say, Lasix, or Tylenol, and then what happens?
Nancy Duffy: My job is to write the scenario. The simulation specialist, it is their job to program the computer. So, I just write that the student is going to give Lasix, 20 milligrams IV. Then, what I can do, in response, is to program a physiologic response. I can add urine in the urinary catheter bag. I can make them lose too much water, and program their heart rate to increase. So, it is physiologic, but I can program, and anticipate, the questions I think the students will initiate, and then the computer will give what I anticipate in terms of an answer. There are canned verbal responses in the manikins, and then I can always do a voice-over. If they’ve asked some question, out of thin air, that I didn’t anticipate, there’s a microphone inside the manikin’s head, so I just have to tap the microphone and say whatever the response happens to be.
So, while it is plastic, and they tend to kind of look alike, if it’s a female, then I try to put on something pink to make it look more real. I want the environment to be as live and real as I can make it so that student can take what they’ve learned in a simulation lab into the hospital.
Dr. Linda Austin: I’ve been in a simulation lab. It’s really quite remarkable.
Nancy Duffy: It’s phenomenal.
Dr. Linda Austin: Do the students love it?
Nancy Duffy: Love it.
Dr. Linda Austin: You’re in the College of Nursing, but the use of the lab is certainly not confined to the College of Nursing.
Nancy Duffy: No. In fact, several of my colleagues and I, from the College of Nursing, College of Medicine, and the PA program, had a session for nursing students, med students, and PA students in the simulation lab, and we put them in teams so that they were working interprofessionally, learning from, with, and about each other, and they went through skill stations. Today, PA students were over there. Nursing students were over there. It is interproffessional. Anybody on the campus can use the Simulation Center. Nursing and Medicine, right now, are your heavy hitters.
Dr. Linda Austin: What are some of the comments your hear from students about the Sim Lab?
Nancy Duffy: Well, I guess it’s how well they feel they’ve performed. If they’ve been able to problem solve, if they’ve been able to think on their feet, if they like the way they look, if they like the way they sound on the camera, I think they’re pretty happy. I will tell you, I don’t think they leave there without having learned something significant.
Dr. Linda Austin: Now, you mention the camera. Tell us about that part of it.
Nancy Duffy: Well, everything down in the Simulation Lab is captured on an electronic checklist, as is the video recording of the event. And the proponents of simulation will tell you that while the simulated experience, certainly, has value, it’s the debriefing that follows that has a significant punch as well. Because if you see yourself addressing a patient in a condescending manner, and not intentionally, all of a sudden you see, oh, do I really sound like that when I talk to people? It can be a profound learning experience to hear how you’re dealing with your coworkers, or hear how you’re dealing with the nursing care techs, whomever. It can be a very eye-opening experience. And if you may a mistake, it’s not fun to make it live. It’s far less fun to have to relive the mistake again and see yourself on camera not picking up something that should have been picked up.
Dr. Linda Austin: But, I’m sure it’s an indelible experience.
Nancy Duffy: Yes. And, actually, the students will have the access, and the ability, to go back and view that video of themselves from their home, or remote location. It’s not up and ready for that yet. The simulation may take twenty minutes. Well, the debriefing is going to take at least another twelve, fifteen minutes. So, it can wallop a big message for students.
Dr. Linda Austin: Now, within the College of Nursing, at what point in the curriculum do the students use the Sim Lab?
Nancy Duffy: Day one. We actually have a plan for simulation throughout the undergraduate curriculum. And they actually are down there the very first week. Not all of it is high tech computerized programs. Some of it is just a task trainer where you might actually just have an arm where you’re going to give an injection.
Dr. Linda Austin: Or a skeleton where you look at the bones.
Nancy Duffy: Correct. Not all of it, but starting in their second semester, their simulations tie directly to course content, so that if the discussion is the care of the patient with renal disorders, then you can bet I’m going to have a kidney stone scenario. I’m going to have a pyelonephritis scenario. So, the student has a much better ability, I think, and I hope, of connecting that book theory to the patient care setting. And that, to me, is the best thing that can happen with simulation.
Dr. Linda Austin: I would think, also, just thinking back to my own experience in medical school, when you have to rely on a true clinical experience, you may or may not be exposed to all of the important disease conditions, or even techniques, that you need to be exposed to. You’re kind of reliant on the luck of the draw as to who shows up.
Nancy Duffy: Correct. Not all mothers deliver their babies at 10:00 AM.
Dr. Linda Austin: Or, let’s say, breach.
Nancy Duffy: Correct. I can guarantee a patient assignment. You will have a patient with neutropenia. You will have a patient who is diabetic and having a hypoglycemic reaction. I can guarantee the assignment. That, to me, is the second best thing about simulation. That may not happen in the hospital. You can wait all day long for an event, or plan the night before, for several hour, to take care of a patient with whatever disease process, and then you get there that morning and they’re gone. So, all of that work is out the door, and now you’re stuck. I can guarantee you an assignment. And if there’s downtime in the Simulation Lab, you can bet that I have a case study that you’re going to be working on and presenting that day. We’re going to go over NCLEX state board exam questions. I really try to cement class and clinical together. That, to me, is what the Simulation Lab has great potential for.
Dr. Linda Austin: I’m reminded of a personal story. I went, when I was in medical school, into the emergency room. The first time I ever had to stitch up a human being, it was a little boy, his mother said to me, are those your first stitches? And, for the life of me, I can’t remember what I said. But, at least, had I had a simulation lab, I wouldn’t have had to say, yes, they are, because you get to stitch up on someone other than a living, breathing human being.
Nancy Duffy: Right. It might be a pig foot, but, yes, you’re going to have that opportunity.
Dr. Linda Austin: Nancy, thanks so much for talking with us. This is such an exciting project, and you, clearly, are just so passionate about the Sim Lab.
Nancy Duffy: I love it.