Griselda Manzo De Garcia, RN, works with first year students Brooke Bartlett and Tiffany Turner during a skills class.
Photo by Mark Gibson
March 20, 2013
The Dalles — Nursing students at Columbia Gorge Community College had a tough time going against their healing instincts Tuesday to help a terminally ill “patient” die with dignity.
“This doesn’t feel like a very successful simulation,” said Shayla in a debriefing session that followed the death of “Alice Nyman,” the name given the mannequin patient. The last names of students have been withheld to protect their privacy.
The scenario playing out with the life-like figure was that she had opted to forego treatment for an aggressive form of lung cancer. The job of the second-year students was to make it easier for Nyman to die by providing her with medication to dull the pain and keep her positioned to rest easily.
The adult model was computerized to breath, have a heartbeat, and speak — although she had little energy in the dying process to do more than moan her discomfort or answers to the nurses’ questions.
When a distraught family member showed up and refused to allow Nyman’s last moments to be peaceful, the second-year students were faced with an added challenge. Linda Quackenbush, who played the part of Alice’s daughter, accused them of not doing enough to help her mother and then pleaded with Nyman to not abandon her family.
“Hey mom, just fight this some more – we’re not ready to let you go,” said a tearful Quackenbush, a retired employee of Columbia Gorge Community College.
The team of three student nurses called in a chaplain to deal with the weeping woman as Nyman’s vital signs began to drop and she developed the “death rattle” in her throat that signaled death was near.
“We’re making her as comfortable as possible,” Gabe, one of the team, assured Quackenbush.
Behind the one-way glass separating the hospital and control rooms, a panel of instructors manned computers that controlled the vital signs of the mannequin. They looked for opportunities to throw an unexpected twist in the scenario.
“As she’s doing that (a student was injecting morphine into Nyman’s intravenous tubing) decrease the respiration because that is going to help her breathe a little better,” said Maureen Harter, coordinator of operations at the Rural Simulation Center.
In a nearby conference room, other second-year students watched the drama playing out in the nearby room through a video feed. They agreed that the addition of an unexpected visitor to the simulation scenario had ratcheted up the pressure on their peers.
“It made it such a great experience because all of us just froze when she came in,” said Shayla after Nyman’s body had been prepared for viewing and transport to the local funeral home.
During the debriefing session, the 12 participating students initiated a discussion with Harter about the notification process for family members when one of their patients was near death. They also discussed the signs a person would exhibit when his or her bodily functions started to shut down, such as cold extremities and veins that are blue in color due to a lack of oxygen in the blood.
The end of life scenario was only one of four run Feb. 26 under the oversight of Diana Bailey, who supervises training for second year students. The sim lab was made possible by a $1.25 million in federal grants from the U.S. Departments of Labor and Education.
“I can turn on the light bulbs and connect the dots with the sim lab and that’s a very powerful gift,” said Bailey.
This spring, CGCC officials expect to receive almost $300,000 from a share of revenues generated by a statewide bond sale. That funding will be used to replace worn out equipment in the sim lab and install state-of-the art mannequins, including an automated child model, and an electronic medication administration system.
Bailey said sim sessions each semester are an important part of student training because “while it’s not real, we suspend disbelief.”
“It’s a powerful, powerful tool because students can tap into critical thinking and skills without putting a patient at risk. In the sim lab, mistakes are welcome because you learn from them,” she said.
Administrative assistant Angela Johnston runs the computer that regulates the patient’s heart rate, respiration and other vital signs. She also steps into the sim lab as a distressed family member when the occasion calls for it.
On the morning of Feb. 26, she was the elder sister standing by the bedside of her 6-year-old brother, Tenneson Miller, who had been struck by a car after riding his bicycle into the street.
Although pediatric trauma victims are typically transported to Legacy Emanual Hospital or the Oregon Health and Sciences University, both in Portland, Bailey wanted to provide nursing students with some exposure to these types of cases.
“We do have some fun with them (students),” said Johnston about the sim lab scenarios.
Overseeing the entire nursing program is director Doris Jepson, who has a list of applicants waiting to get into the college’s signature program. She said a maximum of 24 out of 90 applicants are selected to start the program each year and the pace of study for about 48 students in both classes is brisk, with a heavy emphasis on math and science.
“The interesting part of nursing is that you are there when the patients come in, you are there when they leave – and everywhere in-between,” she said.
Jepson was one of the original instructors in the program that began in 2001 and brings to her job more than 30 years of experiences in various nursing positions.
She said students must complete pre-requisite courses – good writing skills are also necessary — before they can even apply to get into the rigorous program.
“The process is very competitive,” she said. “We keep them quite busy; it’s all part of getting them engaged.”
She said the top 60 applicants are chosen by the essays they submit on the subject of nursing and these candidates are winnowed down to 40 by an interview panel. That number is reduced to the final 24 through further scrutiny and another 10 individuals are placed on a wait list in case one of the chosen applicants changes his or her mind.
Jepson said, even if a student makes it through the screening process, several individuals each year find out they can’t keep up with the workload — or handle the exposure to bodily fluids and trauma that is part of the profession.
For that reason, she said it is important to provide students with real-life exposure to patient care. She said that is only possible due to the assistance granted by the four hospitals and one surgery center in the Mid-Columbia region, as well as physicians and medical staff at numerous clinics.
As a result of time spent in clinical study, Jepson said CGCC’s graduate nurses enter the workforce with knowledge about most aspects of patient care.
“All of these people help make it happen,” she said. “We believe very strongly that hands-on experience is the best way to teach because people learn by doing.”
Jepson said the college instituted a nursing program in 2001 at the request of the medical community to meet the growing need for medical personnel. She said the program’s good reputation helped all of the 2012 find jobs in the field, despite the sluggish economy.
“You name a facility in the area and I would almost bet we have one or more graduates working there,” she said. If students decide to pursue their four-year degree, Jepson said the college has a co-admission agreement with Linfield College in McMinnville that allows for a seamless transition into an advanced study program.
In addition to Bailey, she said four other faculty members in the nursing program trained at CGCC, left long enough to get their masters and then returned to train others.
Some of CGCC’s graduate nurses have moved on to work in other states and one has even gone into a combat zone of the Middle East to provide medical care to U.S. troops.
“I think it really helps that this community understands the powerful thing that we are doing here; not only for the area but for the state and nation,” said Jepson.