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When a Simulated Patient Can Tug on Our Hearts

A popular part of nursing education today is becoming the hours that one spends in a simulation lab filled with human-like manikins built to replicate scenarios. This can allow nurses to get hands-on experience with complex situations before treating patients encountering those situations.

As an educator, I have spent countless hours in simulation lab. I enjoyed how it allowed me to stop a scenario and immediately problem solve or reflect with students on a Plan B approach.

A common situation I would run was a shock crisis with a pediatric manikin. This ran the students through a typical Pediatric Advanced Life Support (PALS) algorithm that called for saline boluses and other efforts.

One of the the concepts about shock I liked to teach is that there are early signs and late signs. An early sign is decreased urine output and subsequent tachycardia due to the heart increasing its efforts in circulating output to compensate for a lack of volume (dehydration). However, a late sign is hypotension and bradycardia. If the low urine output is not caught and addressed as a sign of dehydration the heart will continuously make efforts to increase circulation to no avail due to the lack of volume. Increasing volume through IV fluids is one way to prevent the dehydration from worsening and resulting in hypotension and bradycardia.

Another important concept to a PALS algorithm is that if a child gets bradycardic to <50 heartbeats per minute, the correct nursing action is to start chest compressions to increase the rate of blood circulation to improve organ perfusion. One doesn't have to wait for a complete lack of heart beats on a child.

On the typical summer day, my students were probably already thinking about hitting the beach after class and forgot to start chest compressions. After several minutes of manipulating the manikin to decrease its heart rate and waiting for them to catch on, they forgot. None of their other interventions were going to make much of a difference in real-life. Eventually, I stopped the computerized vitals and flat-lined the simulator to drive home my point.

As I stepped into the room to debrief them, I was flabbergasted to find them all in tears. I quickly realized as much as we acted in scenarios, it simulated real events and real emotions. I was the one that learned the lesson that day, "Never ever pull the plug on the simulator!"

When you are bogged down in the stress of life and studying, remember that you thought long and hard about going into this profession. I am sure you had some great reasons. Remind yourself of those now and keep them in front of you to provide motivation when the going gets tough!