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AACC nursing class simulates emergency room environment

Nursing is community college's first career degree program

By Joe Burris, The Baltimore Sun

5:05 PM EST, November 23, 2012

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During Anne Arundel Community College's emergency department simulation, nursing professor Kathy Jo Keever played a patient brought to an emergency room after falling from a tree stand while trying to shoot a 14-point buck.

After having her belongings — including a crushed beer can and fake pistol — removed, she was wheeled into a chaotic, crowded ER: Every patient bed was taken, some occupied by mannequins with voice commands, while an actress patient pleaded for pain medication. Across the room, one actor playing a grandfather complained about why his grandchild wasn't being treated.

Conducted by the AACC nursing department, the simulation had all the trappings of a worst-case scenario in an emergency room, and it was the students' job to get it under control with little instructor supervision. AACC officials try to make the simulation as real as possible, with the aim of graduating nurses equipped to handle any real-life hospital crisis.

School officials say the simulation has bolstered the school's nursing program, AACC's first career degree program. Last December, all 41 AACC students who took the National Council Licensure Examination for Registered Nurses passed.

"One of the focuses here is communication with the other disciplines, with the health care providers, with the emergency medical people and paramedics bringing patients in," said Myra Dennis, AACC simulation coordinator.

She stood over a mannequin named Ervin Blooe, an elderly man with respiratory distress who was hooked to a heart monitor. Each mannequin's last name coincides with his condition; Blooe was chosen because the mannequin's complexion was blue.

The nursing department owns five mannequins, which are connected to a computer control room during the simulation. They can speak as well as simulate breathing, heart sounds and pulses.

"The students start using the mannequins from the beginning of the program and all the way through the program," said Dennis. "In first semester, the students do clinical work in longterm-care facilities."

Dozens of students occupy classrooms that serve as the ER and the hallway that serves as triage area. The entire setting is coordinated in a simulation room with a one-way mirror, where Dennis can watch and speak to students though the mannequins.

During the simulation on Nov. 16, Keever's bellows drowned out all others. "I don't like needles! I need to leave before 4 because you can't hunt in the dark," said the uncooperative patient to AACC student and registered nurse major Theresa Bobrow, who was tending to her. At one point, Bobrow struggled with her over a beer she had concealed.

Just then, a patient with traumatic stress dashed about the room, refusing to be restrained by another student-nurse tending to her as echoes of discontent from other patients filled the room.

Keever's performance was comparable to that of a seasoned actress, but she said she has no experience in that field, adding that her character is "sort of a compilation of obnoxious patients you ever took care of in an ER. And I come from a long line of hunters."

Keever said she often gives students clues during her act and enjoys watching whether they pick up on them. Those who were trying in vain to restrain the patient with traumatic stress should have sought help from other hospital staff, she said.

"You're constantly giving them hints," she said. "Sometimes you have to tell them you're hungry and sometimes you reach in your pocket, pull out something and offer them something to eat."

The instructors give the students leeway in solving problems, record their every move with a camera located on each bed. Later, students watch the video with instructors to see what they did correctly and what they can improve on.

"That's where a large part of the learning occurs," Dennis said. "They many times, from self-reflection, come up with the mistakes they made."

Bobrow said that she has never been a patient in an emergency room, but the experience was what she expected.

"It's organized chaos, fast-paced," Bobrow added. "It's kind of hands-on experience without a true patient. … It kind of gives us an idea of what the emergency department is like, how it runs, and how to work with the doctors and the EMS personnel."

joseph.burris@baltsun.com

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