Nursing Capital of The Pacific

Gary Glauberman, dean Mary Boland and Natalie Anderson in the delivery room. Nathalie Walker photos

A cutting edge, $8 million teaching facility that opens in Webster Hall this week provides UH nursing students with robotic patients that simulate medical procedure, from childbirth to emergency surgery, redefining world-class and making Manoa the Nursing Capital of The Pacific

UH-Manoa debuts the most modern nursing simulation center in the U.S., and the beneficiaries will be the people of Hawaii

You think you had a rough day. Consider what we encounter at Webster Hall on the University of Hawaii-Manoa campus. As the elevator doors open on the third floor, we are thrust into a matrix of emergencies.

“Noelle” is in distress and hemorrhaging from the complications of childbirth. Baby “Pat,” just a few minutes old, is lying in an incubator with respiratory problems.

A few doors down the hall, “Mr. Kahui” is in the trauma room bleeding from his face and chest after a near-fatal accident. In another room is a disaster scene with folks wailing for help while health care workers cope with a chaotic situation.

Yet faculty, nursing students and administrators are walking around calmly, even smiling, as the whole scene unfolds. For them, it’s just another day at the UH Translational Health Science Simulation Center (THSSC).

Simulation specialist Andy Currivan is in control of the manikin. Nathalie Walker photos

(And you thought the biggest drama at UH involved the new head football coach.)

What appears as actual hospital or emergency room scenarios are part of a cutting edge center of learning that puts Hawaii at the forefront of simulated health care education. As a new year begins, the University of Hawaii gives birth to an $8million world-class facility for nursing students and health care providers.

The bottom line is saving lives.

Life is not a dress rehearsal. That is why the university invests in programs that best prepare students for life in the real world. Teachers and employers alike are constantly seeking solutions to the fundamental problem of the limits of classroom education.

Simulation education may hold the answer, according to Mary G. Boland, dean and professor of the UH School of Nursing and Dentistry.

If simulators work for pilots, why not nurses?

Simulation is imitating reality or, more simply, faking it. Translational refers to a natural progression in medical practice.

“Until recently, health care learning happened in a classroom or clinical setting where patients are at risk,” Boland says. “We never want to get away from handson experience. But there is a golden moment when we have the opportunity to take what we know about learning, to use technology to its fullest and provide a simulated experience that translates into real-life situations.”

Patient’s room from the control room. Nathalie Walker photos

That’s what the Translational Health Science Simulation Center is all about.

Top executives and invited guests are getting their first look at the landmark facility this week during a grand opening and blessing. MidWeek was given an exclusive media preview. We are in awe.

Let us take you on tour of Hawaii’s nursing simulation center at Webster Hall as an example of the groundbreaking work our hometown university is doing.

Replicated in an 8,000-square-foot space is a medical center-hospital facility, complete with reception-waiting room. The faithful reproductions are so exact that there is floor paneling like Kaiser hospital, a delivery room like Kapiolani hospital and an emergency room like Queen’s.

What students experience here, restaging actual patient situations, translates into what they will do on the job and do so with critical thinking and confidence.

As UH envisions its leadership position as the “hub of quality health care,” it does so with the help of Hawaii’s top stakeholders in the field. Recognizing the opportunity “they got it” founding partners of the venture are HMSA Foundation, Hawaii Pacific Health, The Queen’s Medical Center and Kaiser Permanente Hawaii. Support also comes from First Hawaiian Bank and J.M. Long Foundation.

“Our simulation center was designed after Hawaii’s leading health care agencies and best practices in nursing education,” says Lorrie Wong, Ph.D., associate professor and director of THSSC.

Michelle Radouan and Jeremy Agno in a home visit situation doing patient education

There are seven simulation rooms with high-fidelity manikins (medical mannequins) playing the part of patients. In these fully equipped rooms, including professional medical apparatus, are staged emergency/trauma cases, childbirth labor and delivery, adult intensive care, neonatal intensive care, pediatric intensive care and a homecare setting.

There also is an eight-bed inpatient unit and adjacent two-bed unit with bedside electronic health records and mid-fidelity manikins. Three outpatient rooms, three research labs, a high-tech computerization and audio-visual control room, and four debriefing rooms complete the structure. The state-of-the-art facility can accommodate up to 190 people.

A large conference room has an impressive 6-by-25-foot LCD screen the multiscreen wall panel would make any Monday Night Football fan envious. It is used for telemedicine and telecommunications applications with Neighbor Island campuses and Pacific communities such as Guam and Micronesia.

Primary users of the center are UH nursing students, faculty, researchers and practicing nurses from the community.

Rather than practicing procedures on actual patients, although actors are used occasionally, nursing students work with life-sized anatomical human models. These are three-dimensional, computerized models of human beings, created for medical instructional purposes.

These high fidelity manikins, like the bionic Six Million Dollar Man, are electromechanically wired. Incidentally, it is indeed spelled m-a-n-i-k-i-n-s, not mannequins like the ones you find in store windows.

If you didn’t know any better, meeting a manikin can be a startling experience.

UH director of the Translational Health Science Simulation Center Lorrie Wong discusses a simulation with students in the multimedia room. Nathalie Walker photos

As we meet “Mr. Kahui” in the trauma room, we examine his pulse, feel the palpitations in his chest, observe bleeding from his face and body, wipe sweat from his forehead, trace his eye movements and even hear him speak.

In the birthing suite, manikin “Noelle” can simulate complications from childbirth, including hemorrhaging, breeched delivery and umbilical cord compression.

“This is a safe environment for learning where one can make a mistake and learn from it,” says Wong. “These scenarios give the experience, but the real learning takes place in the debriefing room, where students view instant-replay video and evaluate their performance. They do this without the pressure of testing or grading. It’s all about the dialogue. Once they make a mistake in simulation, they are less likely to repeat it in clinical practice.”

Dean Boland adds, “Health care providers are perfectionists by nature. But they operate in a culture that tends to be quite punitive. Mistakes and malpractice are constant concerns.

“When you look at where health care goes wrong, it tends to be errors in care delivery, medication administering, and communication,” she says. “Role-playing and learning from colleagues in an interactive way are basic to building best practices and narrowing the margin of error.”

The planning, development and construction of UH’s nursing simulation center has been a two-year fast-track dream come true.

“But this is just the beginning,” says Wong, a Kailua High and UH graduate who has been a university educator for 22 years. “There is so much we can do with simulation learning. We have taken the first steps toward a bigger vision.”

Ah, yes, the big picture.

But why should anyone care? After all, isn’t this all just a grand lesson for nurses in proper bedside manner?

Boland loves tough questions like that, especially when you use the word “care.”

She responds, “Health care touches everyone. At some time, each of us or someone in our family needs professional health care. The lay person really cannot judge good or poor care. They just have to trust that care is good. If that trust breaks down, patients seek solutions elsewhere.

“There is an unspoken sense in Hawaii that to get good care, you have to go the Mainland,” she says. “The university, along with the community’s medical professions, is building the capacity for quality care. Whether it is educating aspiring nurses or retooling skills of practicing nurses, we are confident in our facility and look forward to utilizing this tremendous resource for the betterment of the local health care industry.”

Factored into that big picture is a rapidly aging population, a health care system that must annually absorb millions of newly insured patients, and a third of current physicians about to retire over the next decade.

Industry observers say in all the discussions about adjusting the number of medical schools and training slots, rearranging physician payment schedules and reorganizing practice models, one group of providers has been conspicuously missing: nurses.

Nurses currently form the largest sector of health care providers, with more than 3 million currently registered. The handmaiden relationship of nurses to doctors, they say, is outmoded.

Change is in the wind. The UH nursing simulation center is part of that change. It’s a breath of fresh air.