Gundersen nurses hone skills on new, lifelike infant, toddler simulators

Gundersen nurses hone skills on new, lifelike infant, toddler simulators

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Pediatric simulator toddler

A team of pediatric neonatal intensive care unit nurses, including Brittany Schultz, clockwise from lower left, Marbeth Johnson and Brittany Viner, and respiratory therapist Courtney Snorek practice their craft with a new pediatric simulator that models a toddler Tuesday at Gundersen Health System. The scenario: The simulator, called Hank, was suffering from a 12-inch laceration and other injuries suffered when a boat propeller hit him.

If you weren’t tipped off in advance, you might think that doctors, nurses, med students and others bustling around Tory were saving a real, live newborn in the Simulation Lab in the ICE House at Gundersen Health System’s main campus in La Crosse.

Tory might as well be alive, because they treat her ailments with the same urgency and care as they would a baby as they hone their skills for procedures they must master.

Gundersen's Sheila Chapel

CMN Hospitals donated Tory (who can become a male with a quick change of, uh, apparatus) to the Sim Lab because the previous infant model was 6 years old, in failing health and about as realistic as the hard, plastic CPR dummies used in many first aid classes.

“When you’re working in health care and working in simulations, you’re well past the training stage,” ICE House manager Sheila Chapel said Tuesday as Gundersen staffers demonstrated Tory and a toddler-sized pediatric simulator named Hank, which Children’s Miracle Network also donated.

Best place to learn from mistakes

“You have to have the realistic situations to do what they do,” Chapel said. “If they make a mistake, they can just start over. This is the place to make a mistake and learn from it.”

Tory, which weighs a realistic 8 pounds, has lifelike features such as a pulse on its head and umbilical cord, as well as all the other right places; a chest that rises and falls as if breathing; arms and legs that replicate the movements of an infant; a mouth that puckers as its lips move; eyelids that open and close; eyes that can be checked for alertness; heart sounds that imitate conditions such as murmurs and other ailments; electrodes to practice procedures calling for such monitoring; a realistic throat on which they can practice intubation; and tissue that allows nurses to insert IVs, among other common treatments.

Monitoring devices also keep track of heartbeat, oxygen and other bodily functions as doctors, nurses and staffers treat the simulator for conditions they might encounter on duty.

Asked whether the simulator eats, Chapel laughed and said, “No, and it doesn’t poop — that is the best part.”

The team of Gundersen staffers who demonstrated on Tory were told that she had had been delivered by emergency cesarean section, which left her with a low score on the Apgar scale that is used to assess newborns.

They worked quickly and calmly under crowded conditions, their motions an efficient byproduct of teamwork and knowledge of their roles.

The simulators are portable, allowing nurses and paramedics aboard MedLink Air to take them aloft and practice procedures under realistic conditions, as well as letting Gundersen Tri-State Ambulance crews perfect their skills on rides that might include navigating the crater-like potholes of spring, Chapel said.

The staffers treated Hank, who also can be converted to a female tot, for a 12-inch laceration suffered during a scenario in which he was hit by a propeller blade on a boat on the Mississippi River. The simulators don’t bleed, but the emergency team still had to perform all sorts of procedures on Hank before he could be sent for surgery.

In addition to monitoring blood pressure and inserting IVs, team members had to bag and intubate Hank, as well as take off a neck brace installed in the field and put it back on, maintain his heart rate and oxygen and call for an X-ray and other tests, among other things.

CMN's Heather Gilles


The previous simulator had reached its normal service expectancy, Chapel said, so the Sim Lab had sought a $20,000 grant from CMN to be used toward buying two new ones. She was pleasantly surprised CMN donated $87,000 instead to pay for Tory and Hank.

The steering committee for CMN, a service of the Gundersen Medical Foundation, opted to pony up the larger amount — it probably could cover a year’s tuition by the time Tory reaches college age — because of the educational potential, said CMN director Heather Gilles.

“For us, the amount of impact for the dollars made it a yes all around for the committee,” said Gilles, who noted that CMN contributes to such services once patient needs are met.

“We like to touch students and staff and nurses and doctors,” she said.

Sim Lab hosts 8,500 people

The Simulation Lab hosted educational events and training for more than 8,500 people last year, including 700 high school students, Chapel said.

Among the pediatric training sessions at Gundersen are certification courses such such as Neonatal Resuscitation Program and Pediatric Advanced Life Support.

“It’s amazing the need and what we can do. We’re small but mighty,” Chapel said of the compact lab setting on the lower level of the ICE House, which was the ice house for the Gund Brewery in the late 1800s and early 1900s whose acronym for its name as the Integrated Center for Education pays homage to its historical origin.

Six years ago, the Sim Lab began with just surgical procedures but has expanded to include birthing simulations, which have been used 3,500 times, and other services and procedures, including training hospital personnel about helping people with advance directives.

Infant simulator at Gundersen

Pediatric neonatal intensive care unit nurses perform a resuscitation exercise Tuesday at Gundersen Health System on a lifelike simulator of an infant, named Tory, born during an emergency cesarean section. Their treatment included intubating the simulator, which moves and appears to breathe like a newborn. Children's Miracle Network gave the Simulation Lab $87,000 to buy Tory and a toddler-sized simulator called Hank.

CMN steering committee member Joan Meyers of Coon Valley, who endured complications after her water broke at 23 weeks and whose son was delivered via cesarean section at 28 weeks nearly 18 years ago, was impressed with the new simulators.

“He was born infected, with many infections, including seven at one time,” she said, adding that he had his first surgery when he was 6 days old and had a total of five during his 81 days in the neonatal intensive care unit.

Soon to be 18, Jake is a senior at Onalaska Luther High School and plans to attend Western Technical College, Meyers said.

As for the simulators, Meyers said, “I thought they were amazing. Could anything be more realistic?”


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