It’s just after 1 p.m. on a Wednesday and Emilia is in labor. Her physician has been paged, but is an hour away and fighting Houston traffic.
Emilia’s labor pains intensify. She groans louder. There’s no time to wait. Three nurses spring into action, preparing supplies and putting on gloves and gowns.
“It’s OK, it’s OK,” Rene Bryan, RN, an education resource specialist, says in a comforting voice to Emilia. Bryan turns to her colleague, Jessica Oliveira, RN, manager of clinical education and training.
“Can you set up the baby warmer?” she asks.
“Absolutely,” Oliveira responds.
“Alright Ms. Emilia, we’re going to have a baby, OK?”
Bryan tells her patient. “So in just a minute I’m going to tell you to push really hard.”
She turns to Oliveira.
“Do you have the warmer ready?” she asks.
“Almost,” Oliveira replies.
“Push, push, push. All the way down. Push, push, push. That’s the head. Awesome. Now, take a deep breath, let me check for the baby’s umbilical cord. OK, are you ready? Push. Keep pushing. You’re doing a great job. Here he is. “Yay!” Bryan cheers.
Emilia successfully delivers a baby boy. But something’s wrong – the infant is turning blue. The newborn is whisked away to a warmer. “Can you get a heart rate?” asks Sophie Harris, education and resource specialist.
“34,” Oliveira replies.
Bryan rushes to reassure the mother.
“They’re helping your baby. Just continue to take deep breaths,” she tells her.
The two nurses provide resuscitation and continue to check the newborns vitals for improvements, when suddenly, the sounds of the baby’s breaths are audible from Emilia’s bedside.
“He’s great. Let’s transfer him to mom,” Harris says.
The room erupts into applause. Three Memorial Hermann nurses have worked together to successfully manage a precipitous childbirth situation. However, in this scenario, the patient and her baby were actually training mannequins, and instead of in the Labor and Delivery Unit, this birth occurred in Memorial Hermann Health System’s new state-of-the-art simulation lab.
SIMULATED REALITY FOR REAL-WORLD CARE
Memorial Hermann’s simulation lab, which opened in August 2019, aims to strengthen the curriculum of Memorial Hermann’s specialty classes provided to nurses and other clinicians through the application of practice scenarios. Simulated learning activities focus on clinical competency, team dynamics and communication skills.
The lab boasts three computerized mannequins – an infant and two adults – which simulate real-life medical conditions and responses to different treatments and interventions. The mannequins are used to practice cardiac defibrillation, needle decompressions, intubation, wound care, chest tubes and other procedures in a controlled environment with much lower-stakes than a real hospital room.
“The mannequins allow nurses and clinicians to learn new skills or improve their current skills using simulated technology without the risk of patient harm,” said Seleria Fletcher, Chief Nursing Officer at Memorial Hermann Sugar Land Hospital.
From the pregnant patient whose baby is wedged in the birth canal to an adult male diagnosed with blood poisoning, the simulation lab mimics real-world medical conditions and complications nurses may see in their daily lives on the units.
While the mannequins aren’t real, their responses are remarkably lifelike. Their pupils dilate. They bleed. They cry.
Emilia, the mannequin mother, can do just about everything a real pregnant patient can, with the exception of walking on her own. Her chest rises and falls as she breathes. She has an IV line and a pulse. Her vital signs and electrocardiogram readings fluctuate. Tiny microphones and speakers hidden inside her ears allow for two-way communication between the educators controlling the mannequin and the nurses who are practicing.
“There are feedback mechanisms built into the high-fidelity mannequins,” says Oliveira.
“For example, if a mannequin does not receive enough oxygen it will begin to turn blue. If the learner does not make oxygen adjustments the mannequin’s condition will continue to deteriorate until his heart stops, which is essentially what would occur in real life. If a learner places the oxygen apparatus onto the mannequin and selects the correct intervention, then his vital signs and condition will improve.”
INNOVATIVE FUTURE-MINDED TEACHING
Funded by a gift from the Memorial Hermann Foundation, the simulation lab rotates through nurses and other clinicians, giving them a chance to put specialty patient care skills into practice.
It’s particularly useful for nurses enrolled in Memorial Hermann’s Nurse Residency Program (NRP). A majority of the nurses in the NRP have been practicing for less than a year although there are some who have been licensed for a longer time period.
“There are several layers to the NRP and incorporating the simulation lab into the curriculum helps newly licensed nurses further build their clinical decision-making skills,” Oliveira says. “As part of the nurses set curriculum within the NRP, they work at their respective Memorial Hermann hospital campuses working hands-on with patients and side-by-side with clinical experts, then they come to the simulation lab two to three times a month for two to three months. The nurses attend sessions at the simulation lab in groups – some nurses complete didactic learning while others complete hands-on training with the mannequins, and then the groups rotate within their daily shift,” Oliveira said.
Eventually, the plan is to expand the simulation lab to include more mannequins capable of a broader range of clinical scenarios, giving clinicians even more opportunities to practice.
“Being able to do simulation with virtual reality is certainly a state-of-the-art opportunity not only for nursing practice, but also physician practice and other advanced practice providers who would be able to experience that level of learning in the lab in the future,” Fletcher said.
WHAT IS MEMORIAL HERMANN’S NURSE RESIDENCY PROGRAM?
In response to a national demand to better prepare nurses for a transition from school to the workforce, Memorial Hermann’s first formal nurse residency program launched in January 2010 at Memorial Hermann-Texas Medical Center (TMC).
In July 2015, Memorial Hermann expanded the Nurse Residency Program (NRP) throughout the System. Graduate nurses entering various specialties within Memorial Hermann can apply for a spot in the NRP, which typically attracts more than 1,000 applicants Systemwide.
The personalized approach of the NRP underscores Memorial Hermann’s reputation for investing in nursing careers, which is especially critical in a region like Greater Houston, where the market for nurses is highly competitive.
Since its inception, more than 1,600 nurses have graduated from the program. The NRP has a high success rate of nurses who are able to be self-proficient on the unit following completion of the program. The average first-year turnover is below 3 percent compared to the national average which is more than three times that amount.
Today, the NRP is accredited with distinction by the American Nurses Credentialing Center’s Commission on Accreditation in Practice Transition Programs, which sets the global standard for residency or fellowship programs that transition registered nurses and advanced practice registered nurses into new practice settings. The accreditation means Memorial Hermann’s NRP delivers the knowledge, skills and professional behaviors new nurses need to deliver safe, high-quality care.
Interested in learning more about the NRP?