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t m c ยป p u l s e | d e c 2 0 1 7 /ja n 2 0 1 8 38 During a recent simulation exercise, a nursing student administered too much morphine to her patient. The instructors directed the student playing the patient to become drowsy and difficult to arouse so that the nursing student would realize the mistake on her own. The nursing student had to play out the scenario by speaking to a provider about the error, ordering and administering an antidote and filling out an incident report. "She was visibly shaken," Ayers said. "It really created quite a learning experience for her." It was an invaluable opportunity to learn from failure with no harm done to the patient. That nursing student will likely never make a mistake with morphine again. Foster summed it up perfectly: "At NASA, you never tried to purposely kill the crew, unless they hadn't learned something that would kill them." That ability to fail in a real-world environment without real-world conse- quences is what makes the program so unique. "The model that we use nowadays, where we place students with a precep- tor in the hospital, the preceptor is so into her own job that she doesn't really talk to a student as an instructor might. So they're not thinking through things, they're not saying, 'Well, we're going to hang this IV and this is how you hook up the tubing and this is the reason we hook up the tubing this way,'" explained Maharaj. "The students in the SIM, they're actually having to do it. They're having to fumble through it and work through and critically think, 'How am I giving this IV push? How fast am I giving it? How fast am I supposed to give it?'" "I think the beauty of that is that it causes self-reflection, which is so crit- ical," added Wayne Brewer, PT, Ph.D., MPH, assistant professor and profes- sional program coordinator for TWU's School of Physical Therapy. The simulation training invites students from other disciplines to participate, including those on physi- cal therapy, nutrition and health care administration tracks. The scripts are tweaked to require their expertise. "Every accrediting body for a health care-based field requires inter-professional education now, some interaction between disciplines," Brewer said. "This is so real that it's no longer just a class, but it's like we're actually going over real cases. And the debriefing is a chance to learn what everyone does, which I think is phe- nomenal. The PT students don't really get a chance to know what nursing does, and vice versa, until you actually sit down and share knowledge." The professors also enlist support from outside agencies, including the Medical Examiner at the Harris County Institute of Forensic Sciences and an ethicist from The University of Texas MD Anderson Cancer Center, to make the experience that much more realistic. "We'll have an ethical dilemma with one of the patients; the family wants the mother to continue on with chemo and the mother wants to die, so the eth- icist comes in and talks through that," Maharaj said. "It's pretty powerful and by the end the students are practically crying." In some ways, playing the patient has just as much value for the students as practicing the role of the nurse. "The patient experience is meant to be an empathy-building experience for the students as well," Ayers said. "It forces them to step up their game from a professionalism standpoint, which is another aspect we have to work very hard at, these soft skills, besides just the hard, clinical skills." Student feedback regarding the pro- gram is overwhelmingly positive. Ayers said her students came back from job interviews raving about how prepared they felt because some of the questions asked them to consider nearly identical issues they'd handled during the simu- lation. And although they describe the 72-hour period as challenging, it's the first opportunity they have to be fully independent nurses, to think on their own, and to really, truly, learn. "You jump in and you either succeed or you learn how to succeed," said Taylor Duck, the nursing student who played Francine Hines, the elderly patient with the hip replacement. "There's really no failing option here." ++ # *+$$$% +"&(+ !%*+ #!'%$ #+ + %$ +#+$$+$ )++Certified #!) + ( %!#* + % ++"#+#(+