Nurse Caroline Ferzoko bustles into patient Carl Shapiro’s room where he lies in a hospital bed hooked up to an IV and a vital sign monitor. A blue blanket is wrapped around him and tucked beneath his chin.
Fluorescent light shines throughout the room and the only sounds to be heard are the steady beeping of the monitor and the squeak of Ferzoko’s sneakers.
Ferzoko introduces herself to Shapiro and asks him to tell her his symptoms.
Shapiro complains of shortness of breath and chest pain. “Caroline, help me! My chest feels so tight! I feel like there’s a belt around my chest.”
Ferzoko looks at the vital monitor. She then takes a stethoscope to listen to his heart and lungs.
Shapiro’s heart rate is at 99 bpm and dropping. His blood pressure is 120/67 and rapidly declining.
Shapiro yells, “Caroline! I can’t breathe!”
Suddenly Shapiro is unconscious. Ferzoko shouts, “Can I get a little help in here? I’m calling a code.”
Another nurse, Michelle Pinto, rushes into the room to assist Ferzoko in administering CPR. Ferzoko rests her knees on the edge of the bed and presses methodically on Shapiro’s chest. She counts out loud with each compression to 20 before briefly pausing. Pinto holds the bag valve mask to Shapiro’s mouth as Ferzoko continues to administer the compressions. A disembodied voice calls out, “Your compressions need to be a little deeper.” There’s a pause and Ferzoko repeats her count to 20. The voice calls out again, “Perfect. Congratulations! You two saved your patient. He has regained consciousness. Great teamwork!”
The voice belongs to Master of Science in Nursing (MSN) student Angela Sesin. She is hidden behind a one-way mirror where she can watch nurses and MSN students like Pinto and Ferzoko work with their patients.
However, Carl Shapiro isn’t a human being. He is a manikin outfitted with technology that gives nursing students the opportunity to treat him, respond to his symptoms and practice resuscitating the patient.
The two women working to resuscitate Shapiro are both licensed nurses, but this isn’t taking place in a hospital – they are working in the Clinical Simulation Laboratory at Framingham State.
The simulation lab is part of the MSN, which is a two-year master’s program offered at FSU that licenses nurses to teach nursing.
Cynthia Bechtel, professor and coordinator of the MSN program, said it is a hybrid that gives students hands-on experience with the simulation lab as well as online courses so students can work full-time while getting their MSN.
Located in Hemenway Hall on the third floor, a suite of classrooms are designed to look and operate as actual hospital rooms. In the rooms, five different manikins are used to train the nurses in different aspects of patient care from basic physical assessment of children to the Carl Shapiro simulation.
Shapiro can blink, breathe and talk. Inside of his chest are pressure sensors that transmit to a computer and tell the technician if the nurse is performing CPR correctly. His mouth moves so the nurses can experience giving oral medication to patients as well.
Today that technician, Sesin, is tucked away in the control room behind the one-way mirror monitoring the manikin’s response to Ferzoko and Pinto. Sesin controls Shapiro’s actions from two computer monitors that allow her to adjust his breathing and heart rate as well as his blood pressure.
During the simulation Sesin is Shapiro’s voice. From a small microphone by her side, she gives the nurses a taste of the different personalities they will encounter with real patients.
After Shapiro regained consciousness he joked, “Wow! Feels like someone sat on my chest! It still hurts … but not in the same way.”
Sesin said performing simulations like this helps nurses not only understand practicing medicine on live patients but also the range of personalities they may come across in their line of work.
She added, “Another helpful aspect of the practice is the dynamic of teamwork” that presents itself. The nurses can be evaluated on how they interact with one another during a procedure such as the code that was simulated.
She said a fun part of the simulation is having the option to choose how the patient reacts and what they say to the nurses.
Bechtel said she believes the simulation lab makes the learning experience richer for nurses who are pursuing a master’s degree. Additionally, she believes the program helps nurses so they are better prepared for real-world situations they may encounter in hospitals, schools or rehabilitation centers.
She said only 15 percent of nurses have their master’s degrees, but believes this program provides a fast-paced experience that all nurses should have, and the medical field would greatly benefit if there were more nurses with their master’s.
Bechtel said the simulation lab opened in 2016 and has expanded to give students opportunities to work with both “high and mid-fidelity” manikins to experience the full range of patient care.
She added the “high-fidelity” manikins, like Carl Shapiro, are the most interactive with the ability to blink, feel and respond to stimuli. A manikin such as Shapiro costs $35,000.
Pinto said the Carl Shapiro simulation is available to her once a week, so she can practice different aspects of patient care.
She said while not every nursing program has an “advanced” set up similar to FSU with the simulations, the students here can then go out and teach the practices they learned to other nurses.
Another MSN student, Katie Kirkland, said all the scenarios are approved by the National League of Nursing (NLN), an organization that helps develop guidelines for teaching and providing information to nurses that can be utilized in their jobs.
Kirkland said because the scenarios are approved by the NLN, the simulations give these students the tools they need to go teach other nurses who may not have access to an interactive facility such as this one.
Because the simulations are performed the same way around the country, “everyone is getting those same expectations, objectives, topics, reinforcement based on using those provided simulations that are standard,” she said.
Kirkland added a huge part of the exercise is the debriefing. After each simulation, the nurses go into a conference room to “very specifically go through the simulation – ‘What were you learning? Was anything missed?’ It’s all the rational and the critical thinking part – not only doing the sim but the debriefing is the final, very important part of every simulation.”
Ferzoko said each simulation is updated and re-coded based on the “best practices” available at the time, so the MSN students are working with the current standard of patient care.
Additionally, the simulation can be programmed to focus on areas where students are struggling.
She said all nursing students must take and pass the National Council Licensure Examination (NCLEX) to receive their nursing license. The NLN collects data concerning what aspects of the exam students are failing and then that data can be used to reprogram the simulations to reflect the areas of study that need improvement.
Ferzoko said those who graduate with an MSN can then use the information that was provided in the simulation to teach the material in a way that will help improve the test scores. “Hopefully, with the next group that goes through and takes the NCLEX, you can see improvement.”
According to Bechtel the “mid-fidelity” manikins cost from $5,000 to $6,000. These do not have the same interactive capabilities as Shapiro, but offer nursing students an opportunity to experience another side of patient care.
While nurses Ferzoko and Pinto reset the simulation to conduct another code on Shapiro, down the hall other MSN students are preparing the other manikins for a different type of simulation.
Tucked away in a smaller room, four manikins are on display. One of them lies motionless in a hospital bed with another manikin holding its hand and resting
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its head on the bottom of the bed.
On a changing table to the left of the hospital bed is an infant manikin being tended to by one of the nurses.
MSN student Kathy Johnson is bent over the infant, a makeup wedge in one hand and palette in the other. She paints the manikin’s lips with a light coat of blue. “What I’m doing is called moulage. See, if a nurse came in and saw an infant with lips that are blue, we’d know the baby needs oxygen.”
Moulage is the process of applying makeup to simulate realistic injuries – this can include burns, cuts, sores, rashes and scars. The process is used to help nursing students identify additional problems that may occur when treating a patient. Because the manikins cannot actually sustain injuries, the nurses practice by applying the makeup to the manikins themselves.
After the injures are applied to the manikins, other MSN students will be responsible for identifying the physical injuries the patients have sustained as part of the simulation.
“Blue lips are abnormal. While these manikins can’t speak or respond to us, it helps us identify injuries that present themselves physically,” she added.
Sitting in a chair beside the infant is a manikin of a small child wearing a baseball cap and a Boston Red Sox T-shirt.
MSN student Cinthia Dos Santos-Mesquita is applying makeup to simulate a bruise radiating up the child’s leg. She grabs a brown pencil to simulate the appearance of cigarette burns.
The manikins being covered in rashes and burns are “mid-fidelity,” meaning they don’t speak, breathe or blink. However, they offer a realistic view of physical injuries the nurses may come across.
Dos Santos-Mesquita said practice with physical injuries is particularly helpful for nurses who end up working in family homes. “If they can identify injuries, not necessarily in the patient they are in the house to treat, that helps us protect the patient and the family.”
Johnson said moulage gives the nurses a 3-D “realistic view of injuries. We can make rashes or injuries that start to ooze, which is something you might see in a patient who isn’t taking care of their wound.”
Dos Santos-Mesquita said she had worked in a rehabilitation center as well as in a high school as a registered nurse, but knew she wanted a change.
After talking to Bechtel, she decided to enroll in the MSN program. “I like helping people and you can do that with nursing. … However, I knew I wanted to help teach other nurses too.” She will graduate in May of 2018.
Kirkland said she believes all nurses should have the opportunity to take a simulation course such as this one. “I have colleagues at work and they have never taken a course like this. To not have an education like this is a disservice.”