Univ. of Delaware Gives Nursing Students Real-World Training | Delaware News

By RACHEL SAWICKI, Delaware State News

NEWARK, Del. (AP) — Sophia Ciniglia enters a post-op patient’s room and takes a deep breath. Her patient has a tracheostomy, and cannot speak. Ms. Ciniglia hands her a whiteboard and EXPO marker and asks her to write down her name and birthday. She then asks the patient to list her pain on a scale of one to 10. The patient writes the number four.

Ms. Ciniglia proceeds to administer antibiotics, medications, and monitor her patient’s vital signs. She listens to the patient’s lungs with her stethoscope and hears “crackling,” indicating that the tracheostomy tube needed to be suctioned to remove secretions.

Ms. Ciniglia finishes the procedure and meets her fellow students outside the room and heads down the hallway to a classroom to debrief. Overall, her professor and classmates said she did very well, but listed a few mistakes like breaking sterility and giving the patient breaks between suctioning. Those mistakes, although minor in comparison to other things, have no chance of harming her patient, because she is an actor. The lungs Ms. Ciniglia listened to are fully simulated technology inside a vest, and the IV in her patient’s arm wasn’t really connected to her bloodstream.

Heiddy DiGregorio, director of Simulation and Interprofessional Education at the University of Delaware, said the baccalaureate program in nursing and master’s degree program and post-graduate Advanced Practice Registered Nurses certificate program at the university are accredited by the Commission on Collegiate Nursing Education. Additionally, the School of Nursing’s Center for Simulation Innovation, Interdisciplinary Education, and Entrepreneurship is one of only 230 programs across the world to be fully accredited in Teaching/Education from the Society for Simulation in Healthcare.

The University of Delaware is also one of only five schools in the country to adopt a two-to-one clinical-to-simulation hour ratio. There is limited research comparing simulations to clinicals, but a study done by the Clinical Simulation in Nursing determined the intensity and efficiency of simulation was demonstrated through the completion of more activities in higher levels of Miller’s Pyramid, an assessment that provides a framework for assessing clinical competence in medical education, in significantly less time than clinical. Basically, students who practice in simulation can learn skills twice as fast as students in real-life clinicals.

“I honestly couldn’t imagine just going right into the hospital and working on a real person for the first time without practicing,” Ms. Ciniglia said. “Being in simulation and all the labs we’ve done in the years leading up to this have given us so much experience and more confidence than going right to a real person. You pick up more little things doing it like this and then the patient gets to come out and tell you how they think you did.”

She added that going right into a hospital and opening up to a real patient is intimidating, but the simulations aren’t as high pressure, and can give her time to think clearly and calmly about her next steps. Ms. Ciniglia can practice her skills over and over until she is confident enough to do it for real.

The simulation on March 17 was the first time Ms. Ciniglia had to deal with a nonverbal patient. Because she had a chance to practice the scenario, she said that now she would feel much more comfortable communicating with an actual nonverbal patient.

Dr. Elizabeth Speakman, chief nurse administrator for the UD School of Nursing, said simulations provide the opportunity for students to practice their skills in low-frequency situations — things that happen in the hospital very infrequently — but can have a devastating effect. Simulation decreases those mistakes exponentially.

“When I look back at my own nursing education, we had a mannequin, which was not moveable, not pliable and everything was pretend,” she said. “It’s hard to translate that when you go into a patient’s room. So our state-of-the-art equipment really can mimic the clinical environment. There were many things I never had when I was in nursing school.”

Dr. Speakman noted that a turnover of nurses has been escalating for over a decade, and the pandemic only exacerbated it, bringing the crisis to the public’s attention.

“Nurses were asked to make some decisions about going in and not seeing their family members because if they took care of patients, they couldn’t go home,” she said. “There are nurses who have passed away from COVID. Nurses will be asked and challenged in ways that they never thought when they thought of their nursing career. But what it has done, and what we see in our nursing students who have just been incredible through the pandemic, is that they want to step up. So it actually I think has highlighted the value in nurses and has had a positive impact.”

Dr. Joanne Thomas, Simulation Laboratory Instructor, was a Cardiovascular Intensive Care Unit nurse for over 20 years at Christiana Hospital before coming to teach at UD eight years ago. She was also chosen for a one-year program for simulation leadership through the National League of Nursing. As students perform in their simulation, Dr. Thomas watches them from behind the one-way glass of a control room. There are cameras in each room to observe the students up close as well.

Dr. Thomas said there are four basic safety procedures the students must perform in every simulation.

“They have to ID their patient, introduce themselves, upkeep hand hygiene and always wear gloves,” she said. “They should get a full set of vital signs too. But sometimes they get so nervous, they’ll take the pulse but forget to count the respirations or put the pulse ox on. They always usually leave one of those out.”

Other things on the checklist are skills-based like listening to breath sounds and bedside manner. Although the students are not conducting procedures on real patients, Dr. Thomas said plenty of students have broken down in tears before their simulation. High-pressure situations are subjective, but Dr. Thomas wants her students to “fall forward.”

“We usually have to pull them aside and just ask what they’re worried about,” she said. “Sometimes it’s because they’re not comfortable with a skill that they know they have to perform. Sometimes they didn’t prepare thoroughly. A lot of the students would consider this high pressure because they just learned these skills (two days ago.)”

Ben Korleski, senior nursing major, is a teacher’s assistant for the class. He took the class himself last year and said the simulations are the highlight of his academics.

“It’s a controlled environment, it’s safe, and you can really do anything with it,” Mr. Korleski said.

“You can practice giving one medication this day, another medication the next day. In the hospital, you don’t have that opportunity because each patient is getting their own medication, specific to them, and you’d have to just wait for another patient to be within the expectations of what you would learn in here.”

The simulated experiences in the class that current students work through are the exact same as the ones Mr. Korleski learned from when he took the class last year. He said there are “hiccups” in the scenarios sometimes, reflective of the real world, but giving students hints would do more harm than good. Giving them the opportunity to make mistakes and learn from them is the most effective way for students to learn.

“I try to use my experience and help give them information that would help,” he said. “I wouldn’t tell them exactly what to do, because that would break the integrity of the simulation, but I’ll tell them to take a deep breath, be confident in your skills, and don’t be worried because it’s in a safe environment.”

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