Wired Hospitals: UCLA Medical Center and High-Fidelity Manikins

Lights! Camera! Action! Septic Shock?

Many nurses and doctors surround a simulation where someone is receiving emergency treatment. Many people are in different roles, like one person is giving CPR

It was bloody. The first big simulation Kenneth M. Miller, RN, MSN, CCRN, CHSE, ran as nursing simulation program coordinator at Ronald Reagan UCLA Medical Center was a hemorrhagic splenectomy in the operating room. He did everything he could to make it look real, draping the patient with a central line and filling 4x4s with blood. “It looked like actually cutting somebody’s abdomen open,” he recalls.

Today, Miller’s program boasts two simulated patient rooms and several high-fidelity manikins, including the Laerdal SimMan 3G, a wireless simulator that can mimic a real adult patient, complete with body fluids, pupillary responses and the ability to convulse.

There’s also Premature Anne, a 25-week-old preemie simulator that can cry, turn blue and replicate abnormal breathing sounds. Miller’s team runs a variety of staff training scenarios: patient falls, atrial fibrillation with chest pain, blood transfusion reaction, infected wounds, septic shock, myocardial infarction — you name it. These exercises are an opportunity to refine teamwork across multiple disciplines in a nonpunitive environment.

Operating Room Theater

Ronald Reagan UCLA Medical Center’s advanced manikin and sim technology is great, but Miller says there is one thing no technology can replicate. “It lacks humanism,” he explains. “We forget there is a patient there.” To address that, Miller has developed an innovative way to bring a human touch to his training simulations: hiring improvisational actors to play the roles of patients.

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With a background in acting and directing as well as a master’s degree in nursing education, 35 years of nursing experience and certifications in critical care nursing and healthcare simulation education, Miller is well-qualified for this unique blend of creativity and medicine.

“I audition them,” he says. “The actors are miked, and I give them directions, such as, ‘Increase your pain to a 10.’ The feedback from the actors is organic. It reflects what happened in that simulated experience.”

While manikins are good for teaching technical skills, also working with live “patients” helps to remind nurses that at the end of the day, their work is about people, not just mechanical tasks. “Everybody has a story,” Miller says. “You have a story. I have a story. So much is taken away from the patient.”

Training Scenarios

Among their other training activities, Miller and his colleagues coordinate a two-day orientation for newly hired nurses. The orientation’s goal is not to verify competency, but rather to help nurses transition smoothly into their roles in an organization with an emphasis on relationship-based care. A veteran UCLA Health nurse is embedded into each scenario to ensure safety.

RN Career Events

“In this orientation, [new nurses] get a feel for what that patient experienced,” Miller explains. “The feedback they get — sometimes you don’t hear that from a patient.”

The same scenario can play out in a number of ways depending on what someone chooses to say or do. Nurses learn how little things — a touch on the shoulder or an inadvertent hasty comment — can affect the patient. Every simulation is followed by a debriefing for reflection.

Miller also runs simulations on the units, including some unannounced scenarios. “A simulated emergency can look at process and see flaws, such as how long does it take to get blood to the patient,” he explains. “Kind of like a secret shopper — you can really find details.”

New Frontiers

With simulation, the possibilities are almost limitless. Miller even runs an end-of-life scenario, having the patient engage in a dialogue that presents nurses with an ethical dilemma. Miller loves his work, and is constantly challenging himself with the same perennial question: “How can nursing simulation play a role in identifying what we can do better?”

DARIA WASZAK, RN, DNP, CEN, COHN-S, is a Long Beach native and SDSU and UCLA alumna. She has over 20 years of clinical and leadership experience and is currently an RN/BSN faculty member.

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