Sitting at her father’s bedside, the woman was becoming more and more agitated. Her 86-year-old dad was near death. Sedated with morphine, a diabetic with failing kidneys, his heartbeat was all over the place. He coughed and wheezed as two nurses tried to make him comfortable.
As they took his vital signs and swabbed his parched lips, the daughter barked out a series of panicked questions.
“His hands are cold. Is that normal?” she demanded. Then, as the nurses prepared an insulin shot: “Why are you going to poke him? He’s dying. I don’t consent! He doesn’t need any more pain!”
The nurses explained what they were doing, and asked if the daughter would like to have a doctor come talk to her. Then they asked her if she wanted a visit from the priest.
But the priest would never come — because the panicky daughter and the two nurses were all students in the nursing program at Normandale Community College in Bloomington. And the dying old man was a high-tech, animated mannequin used to enact scenarios that the students might face in real life.
“The mannequin allows them to practice skills where it’s safe to make mistakes,” said Jon Moe, a registered nurse and a member of the Normandale nursing faculty. Moe maps out the scenarios with students in advance, assigns them roles and operates the mannequin from behind the glass in a separate control room. Moe can change the “patient’s” vital signs, create a variety of alarming bodily noises and even give it limited speech and movement.
The college keeps its mannequins busy with as many as 20 scenario enactments a week for students in the two-year nursing program. About 180 students are enrolled in the program, and it’s a time of great change for the nursing profession, Moe said.
“Nursing is completely changing,” he said. “Everyone used to think that you got your degree and went to work in a hospital.” But today, only about 60 percent of nurses work in hospitals, he said. And because of the pressure to cut health-care spending, the primary focus in nursing has turned toward wellness — and especially, managing people with chronic diseases to keep them out of the hospital.
The scene enacted by Moe and his students on this day focused on end-of-life care, another area that’s getting a lot of attention in nursing.
“End of life is a very big shift in health care,” Moe said. “We’ve moved away from the idea that death is a failure, to the philosophy that it is a natural part of life.”
Given that shift, students are encouraged to speak frankly with patients and families about end-of-life care. For example, a patient near death may not have a need to take cholesterol medication any longer.
After the scenario ends, Moe gathers the students and they discuss medical, cultural and spiritual issues surrounding death.
Most of Normandale’s nursing students will go on for a four-year degree leading to licensure as a registered nurse. Through the Minnesota Alliance for Nursing Education, they can transfer seamlessly to Metropolitan State University to complete their baccalaureate degree.
That’s what Pamela Peterson, one of the students in the scenario, plans to do. At age 38, Peterson started in nursing as a young woman, but marriage and three children sent her down a different path. Now she’s back to finish what she started.
“The scenarios, are extremely helpful,” she said. “You can read all you want in books, but it’s just not the same.” Then, turning to Moe, she said, “You’re going to have to educate me on dealing with the irregular pulse — and with those cruddy lung sounds!”