Study shows simulator aids in training nurses to react in high-stress situations

  • Published
  • By Mike Frangipane
  • 88th Air Base Wing Public Affairs
WRIGHT-PATTERSON AIR FORCE BASE, Ohio --  A severely wounded young man is lying on a stretcher in the middle of a dimly lit room. A nurse is attending to the young paratrooper, examining his twisted and bloody ankle, broken when he came down hard on it after landing. She has not yet discovered that he has also taken a blow to the head in the fall. An Army Ranger, the paratrooper is concerned for his men, screaming over and over, "Where are my men? Where are my men?"

Suddenly a deafening sound fills the room. A helicopter is landing outside, bringing in more casualties. The nurse's adrenaline begins to flow as, over the din of the chopper, she tries to settle the man down and to get him to respond to her questions concerning his condition. Will the nurse notice he has lost the pulse in his foot and, if she does, will she recognize that he is likely going into shock? Her quick diagnosis and clear-headed management of his injuries are vital to the trooper's survival.

This stress-filled scene could have taken place in any field station in Iraq or Afghanistan, but actually happened in a room in the ICU at Wright-Patterson Medical Center. The exercise was part of a study of a new approach that trains Air Force nurses through the use of Meti-man, a human patient simulator produced by Medical Education Technologies, Inc.

Begun in 1999 at Wilford Hall, Lackland AFB, Texas, and repeated here at Wright-Patterson Medical Center from 2006 on, the study demonstrated conclusively that the use of the Meti-man simulator significantly increases a nurse's ability to think critically and to manage trauma patients effectively in high stress situations.

The results of the study were presented Feb. 26 at a gathering in the medical center staff dining hall by Dr. (Col.) Elizabeth Bridges, an Air Force Reserve nurse and University of Washington principal investigator and study overseer.

"What we are trying to do is put the nurses into a realistic scenario," said Bridges. "The goal is to help them learn to think through difficult situations when things are going wrong, when all the supplies and equipment are not available and the doctor isn't there. That is what simulation can do in this environment. We can even add to the confusion by having helicopters land during the scenario making it difficult to hear the patient's responses."

Meti-man, the computer-driven patient simulator that was the centerpiece in this re-created field hospital environment, is referred to as "Capt. Patt" and breathes, talks, bleeds and blinks his eyes. The simulator is physiologically reactive; that is, if the simulated patient has had major trauma and is losing blood, it will manifest the vital signs of someone who is losing blood. If the mock patient is given fluids, then its blood pressure will return to normal, just as a living patient's would.

"The simulator actually reacts to what the nurses are doing," said Bridges.

The physical aspects of the trauma Meti-man has endured can also be manifested in its body, such as broken limbs, bones protruding and bloody, skin burned and blistered. Meti-man can simulate all of these and more as required to depict a particular trauma injury and to add realism.

The simulator provides what other methods of training cannot -- an experience that allows the nurse to build confidence under duress. The study revealed that the comfort level in the experimental group was considerably higher after the training.

"It was a little nerve-wracking (using Meti-man) the first time," said nurse Maj. Joyce Hale, flight commander of the medical inpatient unit and study participant. "Then you get the training and go back a second and third time, and you feel more comfortable. It is more ingrained."

The Meti-man simulator, which costs about $30,000, will be gifted to Wright-Patterson by the TriService Nursing Research Program, the funding agency for the study.

While the study dealt with one nurse at a time attending to Capt. Patt, the post-study plan is to use the simulator to train full medical teams comprised of a physician, a nurse, a respiratory therapist and a technician. The near-living patient will enable each of them to play out his or her part in the management and treatment of the patient with a variety of injuries and illnesses.

After her review of the results of the human simulator training study, Col. Debra Doty, 88th Medical Group chief nurse, said that the plan now is to "tie this into a training platform intended to increase critical thinking among all of our nurses and to better prepare them for the wartime casualties they are going to be seeing.

"We hope to add the training simulator to our current training models and readiness verification. In that way, we can give (our military nurses) the best training possible to prepare them for deployment."