Training Tuneup
To keep in step with practicing clinicians, nursing schools introduce students to the latest tech tools

By Ed Frauenheim
February 21, 2003

For Linda Mitchell, RN, it's no longer a question of when the Internet Age will start to influence nursing. She believes it's already happening.

Mitchell experienced firsthand this growing connection between nursing and high-tech while earning her baccalaureate degree at Rush University in Chicago. In the course of her studies, Mitchell had to assess the usefulness of medical Web sites. The assignment was a way to help would-be nurses become familiar with the range of information patients might find in cyberspace.

"[The faculty] realize that so many people are using the Internet," she said. "You have to be able to help them weed out the bad stuff."

Mitchell's experience is part of a broader movement in nursing education to use technology in the training of future RNs. Some nursing schools are using state-of-the-art electronic mannequins to teach a variety of skills, while others are experimenting with more Internet course work. Students also are training to care for patients with the same kind of cutting-edge health informatics technology used more and more by practicing nurses.

It's difficult to make a blanket assessment of the state of technology in nursing schools. But Barbara Grumet, JD, executive director of the National League for Nursing Accrediting Commission, suggests that schools deserve a passing mark at least. "Nursing programs are moving rapidly to embrace technology and keeping abreast of changes in technology that are going to affect the profession," said Grumet, whose group provides accreditation for about 70 percent of the nation's nursing school programs.

One factor in the schools' favor is that nursing education involves training in hospitals and clinics, where students routinely encounter new medical gear. But faculties have to do more than simply expose students to the latest gadget, Grumet said. "The trick is to educate the students on the use of the technology, and more importantly on the uses of the information that the technology is providing you."

Almost human

Electronic mannequins can help nursing students before they even reach the clinical setting. These devices are essentially the ResusciAnne dummies with enhanced physiques and plenty of computer smarts. They allow nursing students to learn procedures and practice patient care in simulated scenarios.

Laerdal Medical, which produced the first ResusciAnne in 1960, now offers "SimMan," a life-size mannequin on which students can practice techniques such as intubation, needle cricothyrotomy, using defibrillation equipment and establishing an intravenous line. SimMan simulates breathing as well as heart and bowel sounds, and its software generates patient monitoring data such as ECG, blood pressure and temperature information. What's more, instructors can set up different patient scenarios, such as an airway complication or drop in blood pressure.

Medical Education Technologies, meanwhile, has developed the Human Patient Simulator, or HPS, which also enables instructors to train students with different scenarios. The HPS "blinks, speaks and breathes, has a heartbeat and a pulse, and accurately mirrors human responses to such procedures as CPR, intravenous medication, intubation, ventilation and catheterization," according to the company.

The HPS is so lifelike, the company said, that students have been known to cry when it dies. The company also offers a portable mannequin called the Emergency Care Simulator (ECS).

A key benefit of electronic mannequins is that they allow students to learn at a slower pace than is possible in managed care settings, Grumet said. But the high-tech mannequins can have a high price. The basic SimMan costs $28,980, the lowest-priced HPS model sells for $160,000 and the ECS sells for $37,750. Grumet estimates that less than half the country's nursing schools use electronic simulators. So far, about 90 U.S. schools of nursing have bought the SimMan, while 16 have purchased the HPS and one has bought the ECS, according to Laerdal and Medical Education Technologies.

Of course, patient simulators have limits. Carol Loveland-Cherry, Ph.D., RN, FAAN, executive associate dean for academic affairs at the University of Michigan School of Nursing, notes that her program hires human models for training students in pelvic and genital exams. "To be able to do that on a dummy isn't quite the same," she said.

Drawn into the Web

Michigan and many other nursing schools also are taking advantage of Internet technology to teach students and introduce them to patient education, 21st century style. Professors are now able to use the Web to do such things as post assignments, upload multimedia files such as respiratory sounds or fetal heart tones, set up student discussion forums and administer tests.

At Rush University, for example, Mitchell used networking technology to research course assignments from home. She lives 30 miles away from the Chicago campus, but Rush set up a computer link that allowed her to connect to the school's library. Moreover, Mitchell's training on evaluating Internet medical information sites prepared her for a clinical situation.

She had a patient recovering from a mastectomy and looking for exercises. Mitchell and her patient went to an Internet terminal at Rush-Presbyterian-St. Luke's Medical Center, where they found an appropriate Web site that provided exercise directions. "It really helped guide her after she left the hospital," Mitchell said.

Grumet believes Internet learning can be a great tool to help rural RNs with associate degrees earn BSNs. But novice nursing students should not do all their course work online, she said, because they need real-life interaction with professors to pick up skills such as communicating with patients and handling stressed-out doctors. "[It's] called 'socialization into the profession,' " Grumet said. "You really do need face time for that."

There may be a danger in relying too much on the Internet in nursing education, but Jan Nick , Ph.D., RN, associate professor at the Loma Linda University School of Nursing in Southern California would like to see the Web used more. Nick said not enough class quizzes or exams at Loma Linda are on the Internet, given that students eventually take the NCLEX exam using a computer.

"We're not preparing them for the exam if we continue with pen and paper," she said.

Most Loma Linda professors are in their 40s, 50s and 60s, which Nick believes is tied to the old-school approach to testing. "They didn't grow up with computers," she said. "We can't just say use technology. We have to provide education and encouragement."

To do just that, Nick heads a committee on technology at Loma Linda's nursing school. The group has monthly meetings on topics such as using Microsoft's PowerPoint program or posting a quiz online with software from the educational technology firm Blackboard.

Loma Linda nursing school professor Katty Joy French, Ph.D., MS, RN, said she's grown accustomed to letting students submit papers via e-mail. But she is skeptical of using Internet chat rooms and e-mail exchanges as a substitute for classroom learning. "I love teaching," French, 67, said. "It just seems like the technology cuts me off more than keeps me in touch."

The University of Kansas School of Nursing is one nursing program convinced that technology generally helps more than it harms. The school pioneered online classes in the mid-1990s, and even acted as the Internet service provider for students in southwestern Kansas. Now, it is at the forefront of integrating health informatics technology into a nursing curriculum.

Last year, the school began a pilot program with clinical information software firm Cerner to teach students with a simulated electronic patient record system.

Growing interest

Called the Simulated E-hEalth Delivery System (SEEDS), the technology enables students to conduct hypothetical case studies with software like that used in actual hospitals. It also lets students take advantage of an "expert database" that issues alerts based on information entered into the system and informs health care providers about the best practices for particular maladies. SEEDS helps students bloom as sharp-minded nurses, said Charlotte Weaver, Ph.D., RN, vice president and chief nursing officer at Cerner. "You help them quickly focus on what's important," she said. "They learn the critical thinking skills faster."

Helen Connors, Ph.D., RN, FAAN, associate dean for academic affairs at the University of Kansas School of Nursing, agrees. According to Connors, the software prompted students to probe their professors as never before when given case studies. That's because professors' case studies didn't have as many data points as SEEDS called for. "The students were hungry for data," Connors said. "In the past, students hadn't asked any questions."

Cerner and the KU School of Nursing started their partnership partly in response to the now famous Institute of Medicine studies on error and waste in the U.S. health care system. The idea is that nursing students who graduate with a greater command of and appreciation for medical information technology can improve the quality and efficiency of health care.

Kansas City, Mo.-based Cerner isn't the only provider of clinical information systems. Other nursing schools train students on electronic medical records software as well, Weaver said. But she said the KU program stands out by offering students the ability to use the technology as they learn in their other classes.

That advantage doesn't come cheap: Weaver estimates it will cost a school of nursing about $150,000 to $200,000 per year to cover expenses that include Cerner's fee and the costs of technical personnel, training and computer hardware.

Even so, the SEEDS program appears to be taking root. This year, all students entering KU School of Nursing are enrolled in the program, and there is discussion about expanding SEEDS to other health care professional programs at the university.

Next year, The College of St. Scholastica in Duluth, Minn., will begin implementing a clinical information system developed with Cerner in the school's five health care divisions: nursing, physical therapy, occupational therapy, exercise physiology and health information management. Another 15 or so universities are interested in sprouting some variation of SEEDS, Weaver said.

Typically, schools of nursing are behind the push-a phenomenon Weaver said is typical of the nursing profession and its focus on patient care. "Nursing really is the driver of a lot of initiative and innovation," she said. "Nursing [schools] tend to be more open to rapid change than medical schools."

Those behind the SEEDS program believe the availability of cutting-edge information technology in nursing education can help solve the nursing shortage, both by helping nurses work more efficiently and by attracting high school graduates who have a greater sense of technology's benefits than previous generations did.

KU School of Nursing student Ann Barrows, for one, is sold on injecting health informatics into the curriculum. Barrows, 22, took part in the pilot SEEDS program last year and continues to use the technology this year. Despite minor flaws with the initiative, such as an initial lack of Web access to SEEDS from home, the program helped teach her medical terminology and made the process of learning to assess patients less intimidating, she said.

Barrows said the majority of her friends graduating from nursing school are working in settings with electronic patient record systems. She's glad to be preparing for that world. "It's a great system," she said of SEEDS. "I'm going to be a better nurse for it."

Contact Ed Frauenheim at eefiv@ix.netcom.com