Nursing School Virtual Reality

Cedar Crest College New Graduate Simulation Center Gives Students a Hospital-like Experience

Cedar Crest College just finished celebrating their 150th anniversary and recently completed a multi-million dollar nursing graduate simulation center. What makes this particular exciting is that this center is opening at the same time that the school will begin to offer the Lehigh Valley’s only nurse anesthesia program, the first doctorally prepared degree offered at Cedar Crest.

We had the opportunity to tour the brand new facilities which offer simulated training that meticulously mimics what these nurses will eventually find in the real world hospital setting.

The portion of the facility that is now the Graduate Simulation Center was previously used by an outside group for years. It was the vision of Wendy J. Robb, Ph.D., Chair of the Nursing Department and Associate Professor and Certified Nurse Educator Eileen Fruchtl, M.S.N., manager of the Nursing Learning Resource Center to create an authentic hospital experience.

Fruchtl says that the faculty and staff in the department always envisioned this type of learning center. “Everytime we walked passed it, we would say ‘Wouldn’t it be great if we could do this?’ That was years of dreaming and envisioning what we could do if we had the space. It was a valuable commodity and we’re very lucky to have it.”

Fruchtl says that it was important to get the atmosphere of the center correct, to “feel” like a hospital in most every way. “The students start to act and behave like they’re supposed to in a hospital setting, not like a student sitting in a chair, but now they’re the Nurse Anesthetist in the OR.”

“Patients are so much safer these days because of this type of simulation,’ explains Robb. “When I was in nursing school 30 years ago, you learned these skills on the job, on patients. You did the best preparation you could do, but your first time was likely on a patient. That would never happen now.”  

Stephanie B. Woodruff, DNP, MSN, CRNA, Associate Professor and Program Director for the college’s new Nurse Anesthesia Program agrees.  “I went to anesthesia school ten years ago and my simulation lab was about half the size of one of these rooms and we were there for maybe four to eight hours in two years.”

Woodruff, who just came on board to the program in June, plans a far different experience for her students. The ten students she accepts into this fall’s first Nurse Anesthesia Program will be tested with a rigorous curriculum that includes long days in the simulation center.  The three-year program will see graduates leaving with a Doctor of Nursing Practice and be Certified Registered Nurse Anesthesia (CRNA).

“CRNAs have been providing anesthesia to their patients for 150 years,” explained Woodruff. “Nurse anesthetists safely deliver approximately 43 million anesthetics to patients per year in the United States.  CRNAs are well prepared to provide anesthesia and analgesia for surgery, labor and delivery, trauma stabilization, and pain management to the sickest of patients. They practice in traditional hospital settings, obstetrical delivery rooms, and different specialty offices.  In the vast majority of rural hospitals, CRNAs are the sole providers of anesthesia care. “

What is the difference between an anesthesiologist and a nurse anesthetist you might ask.  Woodruff explained it this way: “An anesthesiology is a doctor that has specialized in anesthesia.  A nurse anesthetist is a registered nurse that has a critical care background before returning to school for three years for specialty training in anesthesia.  In 2022, all nurse anesthesia programs will be transitioned into a Doctorate of Nursing Practice for an entry to practice. CRNAs can practice in every setting with and without anesthesiologists depending upon the state in which they practice.  Both anesthesiologists and nurse anesthetists are part of an anesthesia care team which provides high quality anesthesia care.”

She says this graduate simulation center is not the usual you will find in a school. “It’s spectacular, and I’ve been to many, many simulation centers. The state of the art mannequins, the task trainers, the operating room, the lighting, the A/V equipment, just the supplies, the medical equipment.”  

She went on to explain why simulation is so essential for proper training. “You practice and practice and practice, and then you practice some more. It decreases your anxiety so that by the time you get into the clinical arena you’re not so nervous, you’re not fumbling around, you know what you’re doing.” And no detail is overlooked, like wearing operating room caps and gloves, most every variable is accounted for.  

Health Assessment Lab

The first stop on our tour was to the Health Assessment Lab where Fruchtl showed the capabilities of this classroom that is lined with hospital beds and mannequins on each. “This lab was set up as we dreamed it up, so it’s very convertible. Electricity outlets pull down from the ceiling to plug in laptops. We can rearrange the tables for different needs. We can do classes in here and we have the technology that streams our information from room to room and onto the internet so we can collaborate with outside groups.”

This room also includes a simulator machine that uses joysticks and looks like you’re playing a video game, when really the student is practicing how to intubate a patient.

The internal camera image projects onto a big screen so while one student practices the timed drills, others can watch. “This technology focuses on an identification of structures,” explains Woodruff. “It’s asking you where are you? So the student learns to identify the markers of the anatomy. The computer can create abnormal situations. A student is going to find a tumor, an obstruction, a spasm and they can practice all of these variables before they need encounter those situations on a real person.”

Life-Like Mannequins

“Feel across the bones,” encourages Fruchtl, “just like how your back feels.” Within this main study room, surrounding the classroom tables are rows of beds each with a unique “patient” atop each bed.

These mannequin patients are the star of the show in simulation. At first glance, they look like what you’d see in any CPR class, until you see all the buttons and features on them. These are high-end high-tech mannequins. Touching the mannequins neck, you can feel a pulse. Touching their skin feels like real human flesh. Running your fingers down their back, you can feel a realistic spinal column. The plastic “flesh” of the mannequins means they can keep getting stuck with needles all day long without degrading as quickly as a traditional mannequin. They are also ultrasound capable.

These mannequins are airway trainers and spinal epidural trainers. Practice intubation on the airway training mannequin and his lungs will inflate. There are mannequins of all shapes, sizes and ethnicities. “As we think about the population, we need students to practice on mannequins that are all different,” adds Fruchtl. “This is unusual to have this many mannequins,” says Woodruff. “Eileen asked me what I wanted. I can’t ask for anything else. We’re very fortunate.”

There’s also an infant mannequin that moves and cries and sounds just like a real baby. “When it cries, it’s meant to feel real and when you see baby whose face is moving like that and making those sounds, you want to help it,” says Fruchtl. The baby is so lifelike, the urge to soothe it is strong.  

Critical Care Room

The next stop on the tour is the critical care room. Moving from one room to the next, it’s hard not to feel like you are, indeed, on a  hospital floor. The critical care rooms looks just like one, with a patient mannequin laying on the bed surrounded by tubes and monitors. “If you put your hand over his mouth, you can feel him breathe.” shows  Fruchtl. Sure enough, the “patient’s” chest rises and falls and be what feels like a breath comes out of his nose and mouth.

This mannequin can be put on a ventilator and he’s completely mobile which means they can create an emergency trauma situation (by just going into the small control room and changing his vitals on a touchscreen), intubate and wheel him into the operating room. All the while, the A/V network would allow other classrooms on campus and online to watch the whole scenario play out.

This type of practice is essential for nurse anesthetists, as Woodruff describes anesthesia as an art form and nurse anesthetists as airway experts. “We basically breath for you. We can speed up your heart rate, lower your heart rate, lower your blood pressure, raise your blood pressure, raise your temperature, lower your temperature. We can do all these different things and bring you back to life and you wake up. So we’re very, very safe. Certainly what I will teach in this program is safe anesthesia.

There is also a full scale operating room in the simulation center, with everything a real OR would have, from medical supplies to oxygen tanks to monitors. Go to our website to see the operating room and Woodruff intubating a mannequin patient in this setting.

The simulation center space is shared between the Doctorate of Nursing Practice and the graduate nurse practitioner programs. Robb sees this as an opportunity for collaboration and further “real world” experience. One of the visions she and her team have is that the full-time nurse anesthetist students and the nurse practitioner students along with their undergrad, pre-licensure students, will have the opportunity to all come together and work as a team in the simulated operating room. “Because that’s what it’s like in the real world,” says Robb. “There’s the teamwork and communication, when do I speak up, when should I be quiet. And we can run through those intangibles which are just as important as using the mannequins.”

The future is promising for both the simulation lab and nurse anesthetist program. There are plans to involve the community more in the space and offer workshops for nurses and nurse anesthetists. “We live in this hub of healthcare and this seemed only natural to be able to offer this to the community,” added Robb.