A recently diagnosed diabetic was playing basketball when his blood sugar dropped. By the time his friend got him to the hospital, he was unresponsive. In another room, a young woman was told she had HIV, and her head dropped. The nurse asked how her partner would react. “Supportive,” she said quietly.
Although the scenarios were real, the patients were not. They were standardized patients, or “labbies” as they are affectionately referred to in the Nursing Simulation Lab. Illinois State nursing students audition and are hired to play the role of patients and family members. Scenarios detail emotions, behaviors, and symptoms, but there’s no script. Written cues may suggest they act excited, angry, depressed, pace, or make excuses for their bruises.
It’s all about making it more real for nursing students, said Marcia Buchs, coordinator of Mennonite College of Nursing’s Simulation Lab. She hires and trains the actors who pull on hospital gowns and wristbands.
Senior nursing student Morgan Bangert played a diabetic patient, which taught her more about being a nurse.
“By being the patient, I know how scary it is when nurses don’t communicate with you,” she said.
Nursing senior Elise Austin has played several roles, from the mother of a pediatric patient, to a domestic violence victim being treated after a possible suicide attempt.
“The nurse asked if it was OK if she sat next to me. The way she handled the communication—a hand on my shoulder, a comforting voice—I was actually comforted by her,” she said.
Buchs and other nursing faculty watch what’s going on from another room. They’re evaluating how students assess the patient and whether they initiate the proper interventions, but also want to see if they used hand sanitizer, identified themselves, and checked the patient’s wristband. Debriefing sessions follow.
The labbies have to be able to think on their feet because they never know what the nursing students are going to say or do, Buchs said. “In order to keep it real, they need to be paying attention.”
Scenarios can get intense. An incarcerated woman shackled to her bed pleaded with a social services worker not to take her newborn. A veteran with post-traumatic stress syndrome pushed his way into the exam room and insisted on taking his battered wife home. Dealing with such real-life situations is the next step for junior and senior nursing students.
“There’s a reality to it that you can never create with a mannequin,” Buchs said.
For the first time, simulations are including community members in a health care setting off campus. Assistant Professor Valerie Wright is able to provide the additional practice through the CAUSE grant (Change Agents for the Underserved: Service Education). She hired students and community members to act as patients at the Community Health Care Clinic and Chestnut Health Systems, two of Mennonite’s health care partners.
Nursing students have 30 seconds to read a patient’s chart before walking into an exam room, where they do an initial assessment. The patient may have heart failure, depression, or not be taking their medications.
“Our goal is to suspend reality so this seems like a very real encounter, not a simulation,” Wright said.
During a mental health scenario, the nursing student screens for depression by asking a series of questions.
“Asking these questions of a friend is a lot different than with a human being you don’t know,” Wright said. “Typically, when you ask someone if they have had suicidal thoughts, you don’t expect the answer to be “Yes,” so when it is, what do you do with that?”
The community members give students feedback in a debriefing.
“They can say, ‘You sat really far away from me and your arms were crossed and it made me feel like you really didn’t want to be in the room,’” Wright said. “How many times do providers get real-time feedback from their patients? This is a safe space for that to occur.”
Retirees Cyndee and Dean Brown acted in two of the simulations. Although acting experience is not required, the two are active in community theater. Cyndee was an associate professor in theater education at Illinois State and sees this “as a wonderful way of giving back.”
She played “Sam,” a diabetic diagnosed with depression during the health screening. Her evaluation included a lot of positive feedback.
“These young women were so empathetic, so kind, there was just a bottom line there of concern and empathy that I was really impressed with,” she said.