The figure lying motionless in a patient room on the fourth floor at Holy Family Hospital draws considerable attention from nursing students and hospital staff, yet still suffers regularly from a variety of rapidly intensifying health ailments.

He even dies frequently, only to be brought back to life.

He's able to do that because he's SimMan, a $50,000 computerized patient simulator designed to mimic assorted human conditions that nurses and other health-care providers are likely to encounter in real-life settings.

SimMan breathes and talks, has heart tones and a measurable pulse, makes bowel noises, and can be given intravenous fluids or have bodily fluids drained, the latter being fake blood, or urine made from orange juice and water. He can be programmed to simulate heart failure, but also to respond to cardiopulmonary-resuscitation efforts—if the computer program operator so desires—and even can respond to electrical jolts from a portable defibrillator.

"I haven't yet come up with projectile vomiting, but I'm working on it," quips Lynn Stapleton, clinical nurse educator at Holy Family.

SimMan is a key part of a training program that Holy Family launched collaboratively with Gonzaga University's nursing department three years ago and also is being used to help veteran nurses at the North Side hospital polish their skills.

"Simulation in the nursing world has really taken off, but it's normally in the academic setting. It's pretty unusual to have a 'sim' lab on a hospital campus," Stapleton says. "I think having the SimMan has put us to a whole different level of education."

She's such a believer in the simulators, manufactured by Norway-based Laerdal Medical AS, that she says she now covets Laerdal's pricier, next-generation model, called SimMan 3G, which is wireless, portable, and offers more human-like features, responses, and treatment scenarios.

Founded in 1940 as a publisher of greeting cards and children's books, and later a maker of realistic play dolls and other toys, Laerdal might be best known as the inventor of SimMan's mother, Resusci Anne, a mouth-to-mouth ventilation trainer, which it launched in 1960. The success of that product led the company to refocus its efforts on advancing resuscitation and emergency care.

It claims on its Web site that more than 9,000 of its patient simulators now are in use globally, including more than 5,000 SimMan models, and that an estimated 300 million people have been trained on its products.

Gonzaga is awaiting delivery of one of the latest SimMan models and plans to use it in an on-campus nursing department lab as a supplement to the training being done at Holy Family, including hopefully attracting hospital nurses to the campus for added training, says Mary Sue Gorski, department chairwoman.

"The simulator is sort of the new level of excitement. There's something about the technology that gets people excited about education," she says.

Sacred Heart Medical Center has a simulation lab and some older, limited patient simulators, but has ordered one of the new SimMan 3G models and expects it to be shipped here in January, says Dodie Ruzicki, the hospital's director of education services.

"We're really excited about it. We see it as an opportunity to do team training across the different disciplines," including with resident physicians and nurse anesthetists, Ruzicki says.

Similarly, the Washington State University College of Nursing, which is just moving into its new building on the Riverpoint Campus, has a simulation room there that it is equipping for such simulators, says Senior Associate Dean Anne Hirsch. The college currently has three SimMan models and a SimBaby, and has ordered a SimMan 3G model that it expects will arrive here in May.

Holy Family's Stapleton says simulation training, which ironically dates back to the military's switch from bull's-eye targets to human-like targets during World War I to get soldiers adjusted mentally to shooting at people, can be pivotal in improving patient outcomes.

No risk to patients

One of the chief advantages of patient simulators is they provide an opportunity to train nurses without risk to patients, she and others say. Also, they promote confidence—and competence—as participants learn to manage increasingly complex medical situations, then get constructive feedback during debriefing sessions that help reinforce the learning process.

"The important part of simulation is the debriefing," Stapleton says.

The SimMan at Holy Family is located in a fully equipped patient room that includes a computer screen—like that typically used in intensive-care units—displaying the simulated patient's vital signs, such as heart rate, respiratory rate, and blood pressure.

"You have to have a realistic buy-in," and the accurately rendered environment helps promote that realistic feel, Stapleton says.

During simulation exercises, she manipulates SimMan's health status, reactions to treatment, and verbal responses, using a laptop computer loaded with specialized software in a tiny room next to the bed where SimMan lies.

"It's a little like (playing the Wizard of) Oz," Stapleton says. "I stand behind the curtain, but say, 'Don't look behind the curtain.' I create a reality that they have to work out, so it's very exciting. I love it."

She says, "I'll start with a benign diagnosis that exacerbates into a crisis. One of the benefits of this is teamwork. Nurses work as teams," so the fabricated scenarios focus on developing or strengthening that discipline.

"When you do a simulation, it's a little like (watching) a horror movie. Your body reacts physiologically to that stress," through the release of epinephrine, or adrenalin, even though you know that what you're seeing isn't real, Stapleton says. Part of the students' learning process is being able to stay in command of their critical-thinking skills despite that physiological reaction, she says.

"Some will call for help in the first 30 seconds," she says, while more complex scenarios typically have to be created for veteran hospital nurses who have seen and learned to handle virtually every type of health condition and medical emergency.

Of SimMan, Stapleton says, "He does die, but I bring him back to life. That (lead up to heart failure) is where the learning really goes off the charts. Usually the reason I kill him is I want them to go to that worst-case scenario," and to benefit from it.

Staff nurses who are put through simulation training sometimes are anxious about it beforehand, but it's made clear to them that their performance with the simulator will play no role in job evaluation and that the sole focus is on improving patient outcomes, she says.

"I have yet to have anyone go away upset," she says, adding many participants feel so energized and validated by the experience that they spread positive word of mouth, causing other nurses to want to try it.

Betty Woodard, Holy Family's educational services coordinator, says, "Outcome—that's what makes it worthwhile. Our patients are safer. It's exciting to me that the training we're providing is useful. The hospital is always looking at safe ways to train, and this is just phenomenal."

Woodard was one of the main people involved when Holy Family and Gonzaga teamed up to acquire SimMan as part of what Stapleton describes as "a very different model of educating nursing students" that the two launched at Gonzaga's behest.

Normally in clinical settings, there is one instructor for 10 students, Stapleton says. The model that Gonzaga desired, though, involved providing special training to staff nurses at the hospital who were willing to work with undergraduate students, essentially making the nurses GU adjunct instructors, and reducing the teaching ratio to one staff nurse per two students, she says.

The arrangement "requires a greater degree of commitment from the hospital and those nurses" involved in providing the training, but is working out well, says Stapleton.

Woodard says, "The thing that's so unique about it is that they (the students) become integrated as part of a culture. They learn more about teamwork. They learn to delegate. They learn to become leaders."

To its own nurses, Holy Family offers a Professional Nurse Practice Program that uses what's called a "stacking" method of education, based on its three distinct parts.

The first part involves participants' use of an interactive computer scenario designed for the assigned topic, and the second part involves training with the patient simulator. The final phase involves a summation on the topic, designed to encourage discussions of the learning objectives and their relevance to bedside nursing.