Practising an emergency – how the team copes

Helene Simuli Magnusson has been admitted to Ward 1, presenting with acute abdominal pain. The chest of the simulation doll rises and falls slowly, and she will soon start to complain about feeling nauseous. Eight second-year students of nursing are getting ready: a simulation exercise for an emergency case is about to start.

Moa Wass pratar med simuleringsdockan på Clinicum

“This is when we pass from theory to practice, and now you take on your future role as nurse,” says Katarina Karlsson, simulation instructor at Clinicum, the clinical training and simulation facility in the Faculty of Medicine and Health Sciences.

Students are briefed before exerciseKatarina Karlsson describes the case to the students prior to the simulation exercise. Photo credit: Anna Nilsen
Half of the group start to deal with the patient, while the other half watch from behind the mirror in the observation room. Instructor Carina Hjelm is also in the observation room, and she lends her voice to the simulation doll Helene.

“The doll speaks and answers when spoken to, which enables the students to practise how they relate to the patient,” says Carina Hjelm.

She monitors the exercise and adds a new element – the patient feels a sudden need to vomit. The students react immediately, place the doll on its side and have a vomit bag ready for use. 

Observation room at ClinicumCarina Hjelm (to the left) lends her voice to the simulation. Photo credit: Anna Nilsen

Award-winning facility

In the Faculty of Medicine and Health Sciences all students taking programmes in medical care undergo scenario training using simulators. The nursing programme starts with simulation exercises during the first term. The students get to test different scenarios at different phases of their education, using either simulators or simulated patients. A simulated patient is an actor who takes the role of patient or relative, allowing the person undergoing training to receive valuable feedback about his or her demeanour. 

“During the third term we practised an admission scenario in which healthy people acted as patients. They were very skilled, and this was a useful scenario in which we could get the feel of what it’s like to interact with a person before meeting real patients in a live situation,” says Kristina Bergstedt Pettersson, one of the students practising today.

Simulation exercise Clinicum Photo credit: Anna Nilsen
From the hospital bed a weak voice is heard: “Has anyone phoned my husband?”. Helene Simuli Magnusson still has low blood pressure. The students start to deal with this. The scenario includes one team taking over from another, and one of the student from the first team has the task of reporting to the next one. What has been done, what are her current vital signs, and has anyone contacted her relatives? Works continues – someone orders a unit of blood and consults a doctor by telephone, while student Moa Wass explains calmly for the patient what will happen when they insert a feeding tube. 

“You were good at that,” says the patient afterwards, and Moa describes this in particular as one of the most rewarding elements of the exercise.

“The confirmation you receive during a simulation when the doll ‘talks’ is valuable: it gives a feeling of security when you receive immediate feedback on the work you do with the patient.”

Carina Hjelm interrupts the exercise when the patient’s condition is stable and her blood pressure has been raised. After Katarina Karlsson has briefly reviewed the medical situation and praised the team for keeping calm, the students gather for a debriefing. Analysis of what worked well, and what can be improved is a major part of the exercise.

The importance of communication

The simulation exercise has raised other aspects than the purely medical. Students nurse year two Teodor Lundblad, Kristina Bergstedt Pettersson and Moa Wass. Photo credit: Anna Nilsen

“It’s important to learn how to keep calm when faced with a demanding situation,” says student Teodor Lundblad. “And it may be a good way of getting the full benefit from an exercise by daring to test something that you feel unsure about.”

“Don’t just take on your customary role. Take the chance to test everything that is offered: remember that it’s allowed to make mistakes during a simulation,” says Moa Wass. 
“Yes, it’s now that you can test your wings,” says Kristina Bergstedt Pettersson. 

Kristina, Teodor and Moa agree that after today’s exercise they are convinced of the importance of communication – with each other, and with the patient, doctors and relatives. Don’t let the patient get left behind. 

“You realise that it’s important not to talk about the patient as if he or she is not there_ someone in the team, must be responsible for informing the patient what’s happening,” says Kristina.

Moa Wass agrees. “It’s our job to create security in emergency situations. In a true emergency, communication with the patient may be set aside, but there is always enough time for information and providing security.” 

Teodor Lundblad checks medication Student Teodor Lundblad works on raising the patient's blood pressure. Photo credit: Anna Nilsen



Award to Clinicum 

Earlier this year Clinicum was awarded an international prize for its work. The international organisation ASPIRE assesses higher education in the healthcare professions. Clinicum won in the category for simulation-based education.



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