Health care simulations ‘a necessary alternative’

EAU CLAIRE, Wis. — Miles Johnson isn’t the easiest patient to work with.

Retired from a hard life of farming 340 acres near Mondovi, his deeply tanned face has a stern look as nurses-in-training at Chippewa Valley Technical College suddenly appear at his bedside in a nursing home.

It’s 10:30 a.m. — time for a routine check of his vital signs, but he’s feeling pretty agitated.

Sitting up in his bed, he crosses his arms across his chest, occasionally shakes his head and pinches his brow into a squint. Miles asks about his wife, whether it’s mealtime and says he’d rather be back in his own home.

It’s going to take a good bedside manner to put him at ease before he’ll roll up his sleeve to let a nurse put a blood pressure cuff on him or get him to talk about how he’s been feeling lately.

Building up those skills is what Miles, who exists in the virtual reality world inside a computer, is there to do for CVTC students.

“It allows you to really think analytically,” said Stephan Linnaus, a nursing instructor at CVTC.

A few of his students donned Oculus virtual reality goggles and picked up small controllers last week so they could see, talk with and treat virtual patients in the college’s Health Education Center in Eau Claire.

In development for over a year, CVTC’s virtual reality simulation uses software from Wisconsin-based company Acadicus and scenarios designed by college faculty to simulate a variety of patients that students will likely encounter when they work in health care.

Scenarios that have been made to date include a person with chest pain, a 7-year-old recovering from a tonsillectomy and a non-English-speaking person who is having heart failure, the Eau Claire Leader-Telegram reported.

Five of those scenarios have been created already by the Open RN project team, which includes faculty and simulation professionals from around the state, including CVTC. The team’s goal is to have 25 scenarios created by 2023.

And like two nursing textbooks the Open RN team produced, these virtual patients will be open-source — free for all to download to advance health care education.

Students can interact with the patients via a computer, but to get the full virtual experience — wearing goggles and the ability to shuffle their feet around a virtual hospital room — they’ll need to be at one of five simulation centers around the state.

CVTC has one, with others at Gateway Technical College, Madison Area Technical College, Northeast Wisconsin Technical College and Moraine Park Technical College.

Kim Ernstmeyer, CVTC’s director of the Open RN project and former head of the college’s nursing program, explained that virtual reality is another step in the college’s use of simulation technology.

Simulations have been a part of CVTC’s health care programs for 20 years, she said. It started out with complex mannequins that stand in for patients in rooms at CVTC that mimic clinical settings.

A few years ago the college added augmented reality — using iPads that allow students to see images and videos relevant to the handson work they’re doing with the mannequins.

Then in March 2019, a Department of Education grant made it possible for CVTC to start work on adding virtual reality to its health care simulations.

Some virtual reality training happened during the spring, but it is starting in full force this semester.

“The use of simulations in this time is going to be valuable,” said Theresa Meinen, director of clinical education for CVTC’s respiratory care program and the simulation center’s coordinator.

With health care facilities and nursing homes keeping precautions in place to prevent the spread of coronavirus during the ongoing pandemic, it has become more challenging to get students into those settings to complete their required clinical experience time.

“With covid it’s become a nice alternative,” Ernstmeyer said of simulations.

But then Meinen said, “Honestly, it was a necessary alternative.”

Another advantage seen in virtual learning is that it is a setting where students can safely learn from mistakes without risking harm to actual patients.

“That’s what we really use simulation for is safety,” Ernstmeyer said.

A virtual scenario Linnaus recalled was a patient with a low potassium level who was accidentally prescribed a medication that would make that crucial electrolyte drop even more.

Either students catch the error before the drug is administered, he said, or they see what happens when a mistake is made and do what they can to get the patient’s condition back to normal.

“Most of the time we let them follow through with that mistake and then talk about it,” Meinen said.

In a real-life clinical setting, the professionals who are supervising students would stop them from making mistakes that would harm patients’ health.

There are limits to how much of a student’s clinical experience can be simulated versus a setting with real patients.

National standards allow up to 50% to be simulated, but CVTC’s programs have kept its ratio under 25%, according to Ernstmeyer.