They would inject each other with IVs and give shots to oranges.

But technology has provided training in the way of computerized manikins, designed to simulate almost any situation a student would encounter once they enter the workforce.

At The George Washington University campus in Loudoun, nursing students are provided training that goes far beyond the textbook.

The state-of-the-art nursing lab is filled with every computerized manikin a student might encounter, from pediatrics to obstetrics to general health care.

“The trend in nursing education and health care is safety of patients. We play into that in multiple levels in the nursing education field. Simulation has become an even greater part of that in order to be able to provide contextual learning for nursing students,” said Christine Seaton, clinical educator-instructor at GWU’s Loudoun campus.

The current class learning in the lab has 48 students. A new class of 44 began this week. In all, the school has graduated three classes, including the last one of 65 students. 
Students spend two semesters at the school before going on to their clinical settings.

The growth of health care simulation

Simulation has been around for health care students in a variety of fields for years, Seaton said, but it was usually for those looking to become certified as doctors. For nurses, simulation has been going strong for about 10 years, but the manikins were not nearly as complex as they are today.

“It depends on [the school’s] resources, how much they are able to provide … and the hospital because hospitals are able to train their staff using simulation,” Seaton said. 
Students start the program with the basics – how to provide outpatient assessments such as blood pressure, body temperatures and heart rates –  and progress to more complex situations, Seaton said.

Once they’ve mastered the basics, it’s on to the high-fidelity manikins – those that have computerized functions that can express pain, the sounds of lungs, bowels and the heart and simulate everything from vomiting to a seizure to childbirth and childbirth complications. The manikins have IVs in them complete with drains to provide realistic assessment details needed in a learning situation.

“We have a diversity. We like them to see the diversity not only culturally, gender, age and in the fidelity – the complexity of what the manikin can do,” Seaton said.

One manikin is named for Minnie Paxton, the supervisor for GWU’s nursing school in the 1920s. The school had to close during the Great Depression during her tenure.

Paxton is one of the manikins students see from the beginning, Seaton said, with the fundamentals all the way through their capstone experience before they go on to preceptorship – where students chose a nursing specialty and have one-on-one training with staff members in a real hospital setting.

Instructors sit in a control room and throw simulations at the students. For example, one student might believe their patient is taken care of, but instructors want to see how they act under stress. So they make the manikin’s blood pressure spike or simulate a heart attack.

“We’ll embed errors for them to find and to know that they should paying attention,” Seaton said.

Seaton, to check her students’ skills, will even sneak around and saturate a patient’s wound with fake blood to teach them to check dressings often.

The control rooms allow instructors to video tape the students in action and later replay the scenarios, pointing out mistakes that can be corrected.

Instructors will also live-stream to the classrooms so other students can see their peers’ performance.

Even at a simulated nursing station within the classrooms, students are watched from behind glass windows. Instructors want to see how students are utilizing their time, Seaton said.

The school runs a virtual hospital, where eight to nine students take care of their own manikin patients at a time.

Communication and home health care skills

Training goes beyond just knowing how to properly use medical equipment.

“A lot of it is also knowing how to communicate because communication is key in nursing as well. We’ll have them communicate with each other. We’ll have them phone as if they’re talking to physicians and learning how to provide essential details for effective care,” Seaton said.

Students also are exposed to community health settings where they evaluate a patient in a home setting.

“A lot of the trends in health care is to provide care in the home,” Seaton said. “It’s a very definite of the future.”

Health care professionals are seeing more patients in home settings because hospital stays are become shorter as medical expenses increase, said Billinda Tebbenhoff, assistant professor at GWU’s School of Nursing. Patients simply can’t afford to stay as long as they need to get complete care.

Mental health is also become more home-based, Tebbenhoff said, because many hospitals have shut down or provide only forensic beds.

“It’s amazing what people go home with … drains and IVs and medications and families are overwhelmed. I think nursing will see a huge push to community-based care,” she said. 
The school is looking also to begin a bridge program for military veterans that specialized in health care in the fall, Seaton said.

“Many of graduates are either EMTs, paramedics and they’re coming back. They may have a degree already, but they’re coming back for the BSN and to go forward even more for bachelor’s or doctorate degrees,” she said.

The biggest goal for the school, Seaton said, is to make sure students comfortable and ready for the workforce.

“The essences of where nursing education is is combining what they learn in the classroom, how they do in the experiential, the kind of learning they can’t necessarily get as frequently as they used to get in the hospitals many years ago,” Seaton said.