On the spot: Disaster simulation heightens community health training
by rachel kossman; photographs by gary wayne gilbert
Hilary Von Glahn ’12 scans a chart in a black binder before she approaches a patient who is huddled under a blanket in her bed. “Mrs. Canton? How are you feeling today?” she asks.
“Oh, just okay,” sighs Mrs. Canton. “Where’s José?” she asks, repeating the question for the fifth time since Von Glahn arrived for her shift.
“José isn’t here right now, Mrs. Canton. He’ll be here soon, though,” Von Glahn responds. “Can I take you out in your chair for a walk?”
Kristen Yurewicz ’12, meanwhile, stands beside a nearby bed, listening to an animated conversation between Mrs. Hernandez, an elderly patient, and her granddaughter, Becca.
“What a great story!” says Yurewicz, dressed for duty in maroon scrubs and sneakers, her long hair pulled back in a ponytail. Slowly and gently, with the granddaughter’s help, she helps the older woman sit up and move her legs to the edge of the bed.
Then the room goes pitch black. An alarm blares. A red siren flashes. Flames lick the walls in a corner, and smoke fills the room. Several residents of St. Ignatius Long-Term Care facility scream. “What’s going on? Are we in Kansas?” cries a woman named Mrs. Johnson, who was traumatized as a child during a tornado. Another resident, curled in the fetal position, moans, her body shaking.
This “emergency scenario” is a fabrication—the centerpiece of a disaster simulation that unfolded in the main lab of the Connell School’s Learning Resource Center on the fourth floor of Cushing Hall. The flames glowed in an artificial fireplace, dry ice passed for smoke, and nursing school faculty and staff played the roles of incapacitated patients and frightened family members who were cared for by a small team of Connell School seniors taking part in the simulation.
The “disaster sim,” as it is most often called, is a pilot teaching and learning exercise introduced last year in the Community Health Theory and Community Nursing Clinical Laboratory, a capstone course required of all CSON seniors. It is designed to help students understand how to handle critical emergencies in community settings such as long-term care facilities, where patients may be too ill or scared to take care of themselves, according to Amy Smith, clinical assistant professor and director of the Connell School’s clinical learning labs and simulation center. The simulation’s goals, said Smith, are to teach students how to prepare for and respond in an emergency, to make tough decisions on the spot, and to learn something about themselves.
Sitting in a classroom hearing about an earthquake or tornado and what a responsible nurse should do, or working with computer-programmable mannequins during patient simulation exercises in a learning resource lab, are essential elements of contemporary nursing education, observed Smith. But confronting an unexpected, high-stakes simulated disaster is a vital learning experience as well, she said.
Told only to wear scrubs, bring their stethoscopes, and be prepared for a community simulation, Victoria Weiss ’12 and her classmates were shocked when they entered the resource lab (where they frequently work with mannequins) and saw real faces in the beds. “To be honest, my heart started to race a little when I saw [the real people],” she said. “At first I was thrown off, but then I was ready to play my role.”
That role—and the field of community nursing—has become increasingly complex in recent years, as patients are discharged earlier from hospitals than they were in the past, and child and family health care moves away from traditional clinical settings into schools and communities, said Donna Cullinan, a clinical assistant professor and community health practitioner for more than 30 years. Nurses are more likely to confront—and be expected to handle—emergencies and other chaotic events.
That is among the reasons the National Council Licensure Examination for registered nurses (NCLEX) now includes global health and disaster questions. The exam also focuses on two skills that are essential to disaster response—critical thinking and prioritizing care—both of which are learning goals of the disaster sim.
In a real emergency, everybody reacts differently, said Smith. Some cry, some laugh, others shake. Some patients shut down, while others experience intense panic. “We really wanted to design a sim that had [patients with] all those responses, to give students the exposure,” she said. Ultimately, she added, “We hope to provide exposure to a chaotic event where the students are not only managing an emergency situation but also organizing a team (even if they’ve never met some members of the team) and communicating with their colleagues.”
Recognizing that “disaster really touches different aspects of nursing,” Smith enlisted the help of a diverse group of faculty whose specialties include community health, psychology, and adult health to design a course component that meets contemporary students’ needs.
“The disaster scenario experience is really a springboard for the learning,” Smith said, much of which takes place during a debriefing session that follows the 10-minute simulation. “You really have to be activated or stressed and put in that situation to open yourself up to embrace the learning. I think that’s why it’s so powerful.”
Participating in the sim helps students realize not only whether they did or didn’t know how to respond, but how important it is that they learn the right way to react, she added. “It’s so chaotic and it’s so stressful that it’s an important experience for students to have in a controlled environment. To be sensitized to it, to have some tools to use if they experience it again—that’s crucial.”
“As soon as we were put in a state of emergency, I panicked a little,” Weiss recalled during her debriefing session. “My patient became unresponsive, and I realized I needed to prioritize everything that I wanted to get done. Do I try to calm down her granddaughter first? Do I enlist her help? Should I stop trying to wake up the patient and just get her in a wheelchair and out of the unit?”
What she learned during the debriefing session was invaluable, Weiss said. “We all realized that none of us called 911, a pretty important thing to do when there is a fire,” she explained, and added, “That will now be forever ingrained in my head!”