Making Better Nurses

By Katie Kassler

TCU Nursing students in the HPLC

Tori Miller and Caroline Goode, junior nursing students, practice their skills on a mannequin at the HPLC. Technology in the facility allows students to gain experience in realistic settings ranging from hospital rooms to residential suites and learn from mistakes in a safe and forgiving environment.

Just two years ago, there wasn’t much elbow room in the Harris College Learning Center. The simulation lab had only four beds, a small isolation room, and a control center about the size of a closet. The inadequate space and outdated technology limited nursing students in their hands-on learning experiences.

“Some of the equipment was the same equipment I had when I was here, and I graduated in 1983,” recalled Dr. Suzy Lockwood, associate dean of nursing.

Needless to say, it was time for a renovation.

In 2015, funding was provided to build a simulation lab and expand its capacity. Now called the Health Professions Learning Center, or HPLC, the three-part facility reopened in the fall of 2016 and hosts skills and simulation labs for sophomores, juniors and seniors.

Ambulatory Care Center

With a space designed to emulate a doctor’s office, students practice assessing patients in separate exam rooms equipped with dressing areas, storage, and calling systems.

The ambulatory care center also features a residential suite — a fully-furnished micro-apartment where students can practice caring for patients in a home health setting. The apartment has a kitchen and is wheelchair accessible so that it feels just like a home.

But it’s not just nursing students who use the space; students studying social work, nutritional sciences, kinesiology, and speech pathology also spend time there, practicing hands-on skills relevant to their majors.

“We wanted a space where all health professions could participate in learning activities, not just nursing,” explained Laura Thielke, director of the HPLC.

Basic Care Lab

In the basic care lab, students watch their professors demonstrate practical basic skills in the classroom and master them in the lab themselves.

New high-fidelity equipment and technology mimics exactly what you’d see in a hospital setting. From the fully-functional headwalls and computer monitors to the automated medication dispensing system, students use the same techniques and practices implemented in hospitals and other health care facilities.

In foundational skills lab, mannequins serve as patients in each of the sixteen ward-style beds. Juniors learn how to transfer a patient, use lifts, put in urinary catheters, and administer medication through the ears, eyes, mouth and IV’s.

Instead of just reading about certain medications, students actually practice administering that type of medication to their patients.

“The only thing that’s different is that the medications students give to their patients are not real,” said Dr. Lockwood. “The products we use are for an academic setting so it’s not quite perfect.”

But it’s pretty darn close.

Acute Care Center

For many students, the most exciting part about the HPLC is the simulation area in the acute care center.

Simulation has been a vital part of the nursing department’s curriculum for many years, but since the recent renovation, the HPLC has much more space and better equipment.

The acute care center now features a larger isolation room, two labor and delivery rooms, and two pediatric care rooms.

New mannequins are capable of simulating natural childbirth and Caesarean sections, and all mannequins can simulate pupil dilation, breath sounds, and a pulse. They are also equipped with microphones so instructors can speak through them from a separate control room during simulations.

Juniors and seniors are separated into clinical groups, in which they go through rotations and participate in simulation labs together. During these labs, students are presented with either high-tech mannequins or human actors whom they must assess and treat.

Patients could show an array of symptoms for illnesses as common as influenza or for much more serious conditions.

“He kept hinting about how he wanted to commit suicide,” shared junior Ashlynn Deaton about one patient she assessed during a simulation. “He never out-right said it, but he would ask if he could take his medication with alcohol.”

That’s when Deaton knew she had to ask him an important question.

“Are you thinking about ending your life?”

“I was glad I got to see something like that before I see it in real life because, sadly, that is likely to happen in a hospital setting,” said Deaton. “We were tearing up because it felt so real. It wasn’t a robot saying all of this to us; it was a real, living, breathing human being.”

Senior Louis Acker would agree that simulation labs make for better nurses.

“In those situations, you’re not assisting the nurse, you are the nurse,” Acker said. “You have to think for yourself and assess your patient.”

While part of the class participates in the simulation, the others watch from a monitor in a separate debriefing room. At the end, everyone comes together to talk about what went well and what can be improved.

“The simulation lab really helps facilitate a strong bond among our cohort. You get to see each other make mistakes and learn from them,” Acker explained. This is a vital part of the learning process for the nursing program.

During clinicals, students may work at different hospitals, in different departments, under different supervisors, and treat different patients. Nevertheless, simulation labs standardize the experience among students.

Thielke explained that during simulations, “students see and experience the same exact patients. They can debrief at the end and talk about what went well, what didn’t, and coach each other.”

This type of learning environment makes it possible for instructors to introduce high-risk cases, like the one Deaton experienced, without the danger of a assessing a real patient.

“When students go to a real hospital setting with a high-risk patient, they’ve already experienced it,” said Thielke.

Better simulation makes for better nurses.

Beyond the Classroom

Students master more than just skills during their time in the HPLC. Faculty and staff ensure that students are learning according to the TCU mission statement:

“To educate individuals to think and act as ethical leaders and responsible citizens in the global community.”

“We’re teaching them about professionalism, safety, leadership and how they, as nurses, have a significant role in protecting patients,” said Thielke. “We also teach them about their responsibility when it comes to respecting patients and being aware of patients’ values, cultures, and rights.”

Many of the cases presented during simulations have some element of culture, ethnicity, ability, and diversity in populations that students must consider when making decisions about clinical care.

Above all, says Thielke, nurses must learn to speak up and advocate for their patients. “That’s part of what they’re learning as ethical leaders.”

In a community that’s becoming more and more global, we need more nurses who can lead the next generation of health care providers. While textbooks and lectures are vital aspects to TCU’s nursing curriculum, that’s not what makes a great nurse.

Exposure, practice, and learning from mistakes mold students into empathetic and responsible nurses capable of providing the best care possible to their patients. And that’s just what TCU students get at the HPLC.