Editor's note: This story first appeared in the spring 2019 issue of the Arbor Light, the official magazine of Concordia University Ann Arbor.
Sherrie Anderson didn’t expect to ace her first nursing simulation at Concordia University Ann Arbor. In fact, no one does. The goal of these carefully orchestrated hands-on exercises is not for learners to perfectly deliver clinical care as burgeoning students, but rather to present opportunities for rich discussion post-experience about where they went wrong and how they could do better.
Still, the rookie Anderson couldn’t have made a worse judgment call during her first attempt.
The Ann Arbor native was about a month into her experience at Concordia when she and a classmate were asked to assess and then treat a “patient” (a high-fidelity manikin) that was programmed to display signs of congestive heart failure (CHF).
Anderson, who will graduate in May with her bachelor’s degree in nursing, was a sophomore at the time. She and her classmate entered Concordia’s state-of-the-art simulation space to find the patient lying supine with a feeding tube inserted. He was coughing and wheezing, and his ankles were swollen.
What the two should have done was perform a head-to-toe assessment, notice the swollen ankles, and then bring the patient to a sitting position, supply oxygen, and elevate his feet. Instead, the perplexed pair decided that perhaps the patient was hungry. In their efforts to further insert the manikin’s feeding tube, they managed to stop his coughing … by increasing his nutrition levels to the point where he became overloaded with fluids.
That was two years ago, and Anderson has long since let go of the frustration and embarrassment felt in the moment on that day—she even gets a healthy chuckle when recalling her naivety—but she hasn’t let go of the lesson.
To be clear, Anderson now knows how to treat a patient with CHF, and should one find themselves the subject of her future care, they need not worry about being overloaded with fluids.
“What were we thinking?” Anderson said with a laugh while recalling the exercise. “That was so embarrassing, but we were brand new, and, ultimately, it was a learning lesson.”
And that’s precisely the objective of simulations: to help students experience learning in a way that causes them to never forget. Concordia’s nursing simulations are deliberately designed to mimic the high-stakes environment of a clinical setting.
CUAA nursing staff have even gone so far as to bring in actors who played the role of frantic parents rushing to the bedside of their coma-induced daughter, or students from CUAA’s justice and public policy program who acted as law enforcement so that nursing students could practice managing the emotions in the room—emotions including their own.
“We’ve had tears from students during simulations; they take the exercises very seriously,” said Betsy Cambridge, RN, BSN, one of CUAA’s simulation education specialists. “The goal isn’t to make them cry, but it’s not a bad thing either. When you’re emotionally involved in a situation, you never forget it.”
COMPLEX PROBLEM SOLVING
Beyond the emotional component of patient care, there’s a critical thinking muscle that students must learn to flex, ideally before a human life is at stake. Thus, simulation goes beyond simple “skill and drill” (that’s what lab time is for), and instead asks students to troubleshoot and solve multifaceted medical scenarios that sometimes do not have a single right answer.
“We’re dealing with medicine in 2019, where people have very complex illnesses,” said Anita Simmons, RN, MSN, director of simulation and interprofessional education. “Patients often have three or four different concerns going on when they arrive for care. Sometimes it’s not exactly cut and dry, and sometimes it’s knowing when do I need to gather more information?”
Simulations are not meant to replace the real experience. Clinical rotations, where students work in an actual medical environment under the mentorship of a licensed professional, are still very much a part of every CUAA nursing student’s requisites for graduation. But with technology bursting onto the medical scene in new ways each year, Concordia is in a powerful position to narrow the gap between nursing education and real-life care through its advanced simulation technology on campus.
In addition to keeping up with evolving technology, competition for clinical placements has long posed a challenge for nursing schools nationwide, but there hasn’t always been the research to back up simulation as an effective alternative. So when the 2014 “NCSBN National Simulation Study” showed that up to half of students’ clinical hours can be replaced in a high-quality simulation lab with no drop-off in learning, it came as celebrated news to nursing schools across the country. A more recent article—published in 2018 by the international, peer-reviewed journal “Clinical Simulation in Nursing”—takes it one step further even in its findings that high-fidelity simulation is not only equal to clinicals in some instances, it has been found to actually enhance learning in clinical settings.
Perhaps this is because simulations place otherwise unpredictable factors within the control of the teachers so that instruction and assessment become more standardized and efficient. Concordia’s nursing faculty like to point out, for example, that CUAA’s high-fidelity manikins can simulate birth as often as every 8 minutes if needed.
“Through simulation, we’re able to ensure that students have the opportunity to observe medical complications and have certain experiences that we just can’t guarantee in their clinicals,” Simmons explained.
A CUT ABOVE THE REST
There’s an art to creating a formative simulation experience, and Concordia’s nursing faculty and staff rival the Michelangelos of the field.
When Campus Dean of Nursing Cindy Fenske, DNP, RN, CNE, arrived in 2015, she said she marveled to see God at work through the incredibly gifted people He provided to lead simulation at CUAA. Fenske, a former faculty member of the University of Michigan’s reputable nursing school, had high standards for the people she would employ, and the four faculty members who make up Concordia’s Simulation Center did not disappoint. Simmons and Cambridge, along with Joseph Yaksich, MS, RN, ACNP-BC, CHSE, and Ben Oliver, BS, AEMT-P I/C, represent a combined total of over 100 years of experience in the health care field, with more than half of those years devoted to simulation.
The four individuals have lent their expertise on multiple occasions to national and international audiences, either through scholarly presentations or, in Oliver’s case, to help a partner institution in Ghana set up its own state-of-the-art simulation lab. The overseas lab was so lauded within the developing country that the First Lady of Ghana attended the May 24, 2018 open house.
Last fall, the sim team’s proficiency and innovative thinking also notably caught the attention of a Yale University instructor who was impressed with how the team is incorporating students from other disciplines into simulation experiences. Following a global webinar presentation that Simmons, Cambridge, Yaksich, and Oliver delivered last October, Yale University faculty member Mary Showstark, MS, PA-C, invited the CUAA team of educators to observe an upcoming interprofessional education virtual exercise among Yale, University of Southern California, George Washington University, New York University, and Georgetown University students.
Concordia’s nursing, child life, and justice and public policy students afterward were invited to join the elite Ivy League learning exercise, which happens annually. Concordians will first participate in one this upcoming November.
And the list of accolades goes on. It’s the type of team any university would envy, and it’s one that Fenske is confident in saying is in a league of its own.
“We’re the best there is when it comes to simulation,” said Fenske. “The simulation team we have at Concordia is amazingly creative. I think some of it is experience and some of it is that it’s just within their nature to be innovative. They’re willing to try new things, and they put in the work to go to trainings and conferences to continually expose themselves to the latest and best ideas.”
Add to their academic achievements a deep passion for the mission and vision of Concordia University. As a result, Concordia has been able to combine an intentional focus on Christian care with a standard of excellence that is arguably tough to achieve for any new program.
For Sherrie Anderson, the fruits of that combination have been apparent through her professors’ personalized, caring, and intentional approach in all of her classes—even when she made blunders like trying to feed a CHF patient who is actually short of breath.
“When they saw I was getting defeated, I could tell that they’d work to adjust their approach with me and go a route that actually helped me instead of made me feel even more discouraged,” Anderson said. “It’s not that they were giving me a shortcut. I think they’re just really good at understanding everyone’s learning styles, and they care enough to expect the best out of you.”
The faculty’s Christian approach extends to all aspects of CUAA’s nursing program, including simulation. In the first year of nursing courses, for example, students are presented a simulation scenario that has an ethical component woven in: a patient has cancer and has just
decided that she wants to forgo further treatment, but her husband is resistant to her decision. Students are then asked to rehearse how they would engage with the husband to help him come to terms with the patient’s choice.
Cambridge notes that many students, without being prompted, will respond by asking the husband if they can pray with him. When they debrief the exercise, it provides a chance for the whole group to discuss the approach, as well, and perhaps become more comfortable with incorporating prayer themselves in future simulations.
Not all students are required to pray, but at the very least they see it as an option for care, said Fenske.
“It’s a real gift to be able to incorporate our Christian values into the curriculum instead of having to eradicate it from what we’re trying to teach,” Fenske said. “We have a team that is committed to doing their job excellently so that our students can go out and do their job with equal excellence, and that means everything from properly intubating a patient to extending Christian love and care that surpasses patients’ expectations.”
THE ALPHA CLASS SOARS
In fall 2016, CUAA launched a new School of Nursing and began to make good on a strategic university vision to prepare more Christ- inspired nurses for the Church and world. Following the December 2018 commencement, the university began to see the first fruits of this effort with its inaugural cohort of nursing graduates out in the field. Read about one of the original nursing graduates below, and see how the rest of the Alpha Class is impacting the world here.
Aubrey Alfano will be the first to say that CUAA’s simulations are no joke. In fact, the accomplished Alfano—who served as the December 2018 student commencement speaker—was so shaken by one experience that she cried in the simulation room.
The Michigan native was two years into her nursing program when Concordia’s sim team charged her and her classmates to hang a secondary bag on an IV pump. According to the sim team, the four nursing students stood huddled around the pump for a solid eight minutes before someone finally noticed their patient had flatlined.
“He just arrested right in front of us, and none of us even saw it coming,” Alfano said. “The first couple of seconds when someone loses a pulse are so crucial, and we just completely missed it. I felt like a failure leaving simulation.”
Had that experience never happened, however, Alfano might not have been able to send a triumphant text to Chief Simulation Specialist Ben Oliver on Jan. 22, 2019.
Fresh off the commencement stage and a week into her new job at Ascension St. Mary’s Hospital in Saginaw, Michigan, Alfano was in the midst of her very first day in the surgical ICU when a patient went into cardiac arrest. Alfano hustled to the patient’s room and participated in her first real-life code. She assisted the medical team by administering compressions.
“When I told my colleagues afterward that I hadn’t done compressions before, they were all really impressed because some people’s technique is really not up to snuff when they first start out. It’s a lot harder than people realize to do proper compressions,” said Alfano.
“I couldn’t help but think of my CUAA professors and all the times they coached me through the feel of a proper compression in simulation. I know that there are other programs that don’t teach those things, and it just makes me so grateful for my Concordia experience.”
Become a student in Concordia’s exceptional nursing program. Visit cuaa.edu/nursing.
The spring 2019 Arbor Light hit mailboxes the beginning of May. View a PDF version of the magazine here. If you are not on our mailing list, but are interested in receiving a free copy, call 734-995-7317 or send us an email.
— Photography by Kelly Cieslak (’13)
— Kali Thiel is director of university communications for Concordia University Wisconsin and Ann Arbor. She may be reached at email@example.com or 262-243-2149.
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