Clinical education bring ‘real world’ into the classroom

Joanne McDonald spends her days being cared for by students at Western’s Arthur Labatt Family School of Nursing. They check her vital signs, administer her medication, bathe and feed her, and even change her mastectomy dressings.

But although she has a measurable pulse and is often surrounded by flowers and photographs of family and friends, McDonald isn’t a real patient; she’s one of eight high-tech mannequins being used to train future nurses in the school’s Clinical Education Suite.

With its nursing station, medical cart and functioning bedside equipment, the simulated suite looks just like a nine-bed hospital unit. “Sometimes it’s an emergency room, or an examining room in an outpatient clinic,” said Barbara Sinclair, simulated education coordinator.

Whatever the set-up, Sinclair and her team make the scenario as close to real life as possible, including giving each mannequin a name. “The more real you can make it, the more buy-in you get from students,” she said.

Recognizing a need to improve clinical nursing education, Western was one of several Ontario universities to receive government funding for the development of simulated education suites in the early 2000s.

“With all the changes in health care, students need to be better prepared,” Sinclair said. “Patients are acutely ill, there’s a lot more technology and nurses have to be able to make great clinical judgements and think fast on their feet.”

Western’s Clinical Education Suite opened in 2005, and has revolutionized how students learn and develop the skills necessary to become successful RNs.

While many nursing programs use simulation to teach specific skills, Western’s simulation suite is thoroughly integrated into the entire nursing curriculum.

All undergraduate students complete six-week placements in the Clinical Education Suite in addition to their traditional community placements. “It’s considered on-campus clinical,” said Mary-Anne Andrusyszyn, School of Nursing director.

The extended time frame allows Western to standardize learning opportunities, something that can’t be guaranteed in a community setting. “There are certain things we want everybody to experience,” Sinclair said.

During the on-campus clinical placement, the education suite is run just like a hospital setting with students working collaboratively as a health-care team. “But we are able to slow things down, or stop and call a time-out and look at the rationale behind the approach,” she said.

And when even the most sophisticated computerized mannequin won’t do the trick, actors trained by the Schulich School of Medicine & Dentistry are brought in to play standardized patients.

“When we create a simulation we always focus on three things – the actual skills and critical thinking involved in that patient care scenario, teamwork, and communication,” Sinclair said. “It gives students a very well-rounded experience.”

Laura Crich, Faculty of Health Sciences Students’ Council president and second-year nursing student, called the Clinical Education Suite “a wonderful place to make mistakes.”

The opportunity to become familiar with standard hospital equipment and procedures boosted her confidence during a clinical placement at University Hospital’s cardiac unit. “I had never been in a hospital setting before, so the simulated lab was extremely helpful,” she said.

In 2012, Western was the first university in Ontario to use its simulated education suite for a six-week, on-campus mental health placement. Using standardized patients, the placement exposed students to a whole range of mental health issues including homelessness, substance abuse, schizophrenia, anxiety disorders and depression.

“Many clients with mental health issues are now living in the community,” Andrusyszyn said. This makes it more important than ever for nurses to be able to recognize signs of mental illness and offer appropriate intervention, even if they don’t work in a mental health facility.

The innovative approach to mental health-related services was launched as part of the school’s Compressed Time Frame Program (CTF) but will soon be offered to all undergraduate nursing students.

Although simulation has long been part of health-care education, Western is a leader in using the high-tech Clinical Education Suite to train nursing students to provide the compassionate complex care patients require.

“Barb Sinclair really understands pedagogy,” Andrusyszyn said. “She makes sure that students get the most out of the experience in the richest way possible.”

By all accounts, student response to the Clinical Education Suite has been overwhelmingly positive, with many shedding real tears when McDonald passes away at the end of their rotation.