Beep, beep beep beep A steady beeping echoes through the operating room’s wake room, breaking the background hum of the air conditioner.
The patient is lying in a hospital bed. He wakes up from anesthesia. The readings on the follow-up monitor are exemplary, and the patient’s condition seems stable.
Suddenly, the situation changes and the patient is visibly restless. The beeping of the monitor accelerates. The heart beats.
Since the heart rate is elevated, the likely reason for the patient’s restlessness is pain, conclude the third-year nursing students of Turku University of Applied Sciences Ada Smajic-Mumic and Sandy Barbosa.
They find out the intensity of the patient’s pain and medicate him according to the doctor’s instructions.
“I feel much better now!” the patient exclaims feeling better. It went well, so the students can move on.
In a situation that feels authentic, it’s about a new simulation exercise.
The patient actor in the simulation exercise wakes up in a hospital bed after appendectomy.
Elina Hiekkamäki, Ada Smajie-Mumic, Sandy Barbosa, Eveliina Anttila, Sanni Haloila and Kia Lähteenmäki sitting with laptops in front of them in the mini-hospital of Turku University of Applied Sciences and familiarizing themselves with nursing work in the operating room.
It’s about a new playful virtual exercise. With it, nursing students practice an authentic waking situation with a virtual patient actor.
“The simulation using 360 technology combines the methods of open video production and the learning elements of VR technology,” explains the Turku University of Applied Sciences lecturer Juha Saarinen.
The simulation exercise is produced entirely in English, because it is also intended for wider, international use.
Nursing teachers build a patient case and are able to modify it independently. The questions and progression paths in the exercise can be customized individually.
“Different questions and outcomes can be entered into the simulation, which can be more or less depending, for example, on the level of the student performing the exercise,” says Saarinen when presenting the new technology.
“Versatility guarantees that there may be some wild radiators ahead.”
The progression paths in the simulation exercise can be tailored so that the exercise is as useful as possible for the nursing student, says Turku University of Applied Sciences lecturer Juha Saarinen.
Exercise progress is also determined by the technical lottery: the simulation does not appear the same to all students, but the computer draws the course of the situation.
“During the exercise, questions appear on the screen that have to be solved. The answers lead us forward, towards the next treatment situations”, Lähteenmäki presents the course of the exercise.
He moves the view with the mouse and quickly gets a 360-degree overview of the situation. When there is a change in the patient’s condition, by moving the mouse, you can switch to examining values related to basic vital functions on the monitor.
Patient information, the drugs prescribed to the patient and the calculation instructions for scoring the basic vital signs were the same for everyone at the beginning of the exercise.
“From this you can see, for example, the patient’s weight and can calculate the right amount of medicine if the patient experiences pain or his blood pressure drops,” Barbosa shows from his computer screen.
The computer tells you if the answers or drug choices are incorrect. The same is true if treatment instructions are not followed. This, in turn, is reflected in the end points of the simulation exercise.
During the wake-up exercise, questions and tasks appear on the computer screen that must be answered and solved. Nursing student Kiia Lähteenmäki presents on her screen how the answers lead to the next treatment situations.
Simulation learning is already familiar to nursing students, but the operating room as an environment is still new to them. As in the “wake up game”, technology also plays a significant role in the simulation.
HS was also able to get to know the simulation of operating room operation by the teacher of operating room nursing Marjo Kaarron under. He guides future professionals in the use of new technology and simulation.
“The group is divided into two parts. Some of the students practice nursing work in the emergency room for a while, and some prepare for the simulation.”
When the simulation starts, the wake-up group becomes the follow-up group. At the end of the simulation, we go through the exercise together point by point.
“The group that followed the simulation observes certain pre-arranged things during the simulation. We then talk about them together,” says Kaarto.
He emphasizes that the purpose is not to look for mistakes, but the main thing is to learn.
“This is the perfect opportunity to learn operating room nursing authentically, in the right environments and situations.”
Marjo Kaarto, a nursing teacher at Turku University of Applied Sciences, observes future nurses in an operating room nursing simulation.
Nursing students has been cast as a real operating room team, which includes the one playing the anesthesiologist Sonja Lähteenmäkiacting as supervising nurse Jasmin Mäenpääacting in the role of instrument attendant Sonja Laaksonen and representing the patient Olga Elonen. The patient is escorted to the operating room by a nurse Essi Väisänen.
The simulation starts. The patient is brought to the operating room in a wheelchair. The attending nurse gives the report to the anesthesiologist, who directs the patient to a narrow bed covered with a green cloth.
Then it starts happening. The anesthetist has already placed the drugs in the syringes, and the supervising nurse prepares the operating room clothes and washing supplies for the surgical area for the instrument nurses.
Sonja Lähteenmäki, acting as an anesthesiologist, installs the necessary monitoring meters for Olga Elonen, who plays the patient.
Jasmin Mäenpää acts as an assistant nurse. He takes care of, among other things, preparation for surgery and washing the surgery area.
It’s quiet in the operating room. Only the packaging plastics rot and the air conditioner hums.
“Does the procedure hurt?” Elonen, playing the patient, breaks the silence with genuine concern in her voice.
Future nurses assure that the patient will not feel pain during anesthesia.
Lähteenmäki, who works as an anesthetist, installs the necessary meters for the patient: a blood pressure cuff, an oxygen saturation meter, EKG electrodes and bis sensors based on EEG curves to measure the depth of sleep.
“You can’t get inside my head with these, can you?” the patient inquires.
“Of course not, these ensure adequate anesthesia during surgery,” the nurse replies.
Students working as instrument nurses wear operating room clothes. Assistant nurse Jasmin Mäenpää works as an assistant.
Soon the patient is asleep. Mäenpää, working as a supervising nurse, washes the patient’s stomach with a clear disinfectant. After that, the area is washed with a browning disinfectant.
“This ensures that the entire area is certainly washed and clean,” Mäenpää reasons.
After this, the patient is “covered” with surgical drapes. Only the cut area remains visible.
Kaarto follows the team’s activities in the simulation mode, and the observation group in the next room watches the events on the monitor.
“These are really good and careful students”, Kaarto is happy.
The patient is anesthetized, the surgical area is washed and the patient is “covered” with surgical drapes. Only the cut area remains visible.
In the simulation, the student group is divided into two parts: one part works actively in the simulation, the other observes the actors in the next room from the monitor.
Saarinen and the training officer for nursing education Tiina Nurmela say that virtual technology is used in the “wake up game” and operating room simulations.
The wake-up exercise is built with an editor, in which the teacher has made alternative paths for the students to progress in advance. In the operating room simulation, the teacher can control the situation by adjusting the changes in the patient’s condition and thus the monitor’s views with the help of separate equipment.
“Students get excited to learn when the situation feels authentic and playfulness is added to the environment,” says Nurmela.
The future nurses nod: even though it is the first time they are training to treat a surgical patient virtually, the method seems interesting.
Students mention the English language as the only stumbling block.
“Part of the vocabulary of nursing is foreign, but you learn that too when you have to use a translator,” Barbosa reflects.
Even though the language seems difficult, the best thing about students is that they get to really practice.
“In the simulations, there are things to think about that you wouldn’t necessarily think about in the right situation,” says Smajic-Mumic.
Virtual technology is used in both the “wake up game” and the simulations. In both of them, authentic-feeling patient cases and their solutions are the main focus.
The computer the beeping on the screen has stopped. The patient is calm and seems well. We get to watch on the screen when the nurse in the bed ward fetches the patient from the wake.
The exercise is over.
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