Off the Charts

The baby’s condition is going downhill fast. A medical team surrounds the infant, tersely exchanging instructions. The gripping scenario has the participants’ hearts beating fast, but the baby on the table is SimBaby, a manikin with sophisticated robotics that’s used in health care simulation training.

As in a real situation, “there is adrenalin in a simulation,” explains Elaine Beardsley, MN, RN, clinical nurse specialist in the pediatric simulation program at Seattle Children’s Hospital. “Even though it is a simulated environment, people get nervous. People talk more.” However, Beardsley says, the structured communication training within the simulation “cuts the chatter.”

The November AJN Reports focuses on ways that SimBaby is helping teams of nurses and physicians at Seattle’s Children’s Hospital learn to avoid the kinds of communication breakdowns that, studies have shown, can lead to errors in stressful situations. The training includes creating a safe environment in which nurses and residents are encouraged to speak up to physicians “when they perceive mistakes being made.”

“Simulation, in my mind, is about getting us to communicate better,” says Jennifer Reid, MD, assistant professor of pediatric emergency medicine at the University of Washington School of Medicine and Seattle Children’s Hospital and codirector of the hospital’s ED simulation program. “Our training is such that physicians and nurses are usually educated, trained, and practice more or less in parallel. Simulation is an opportunity-a rare one-for us to learn and train together, working consciously on our communication skills. When else do I ask a nurse directly if she has any idea what I as the physician am thinking? When else do physicians and nurses actually sit face-to-face and talk about what it felt like to be a part of that team and the elements of communication that helped or frustrated them?”

Simulation training is increasingly big now in most nursing schools, as well as in some hospitals. Does it increase a team’s ability to work together and to make sure they are always on the same page? Can it help nurses become more confident about alerting a team to potential errors? And what, we wonder, will the future of simulation training look like just ten years from now?