What lurks in the School of Nursing’s state of the art basement

It was a dark, quiet evening at the School of Nursing, the kind where shadows stretch long and every sound seems to carry an eerie echo. The halls were nearly deserted.

With the soft hum of fluorescent lights flickering overhead, one lone housekeeper made his nightly rounds, pushing his supply cart through the hallways of the Center for Simulation Innovation when he heard it - a faint, unsettling moan coming from one of the rooms.

Heart pounding, the housekeeper froze. The sound grew louder the closer he crept toward the door. Slowly, he peeked inside.

There, on a gurney, lay a figure. Motionless at first glance, but then… it stirred.

The housekeeper's breath hitched, a chill running down his spine as the figure let out a soft, low groan.

The dim lighting cast shadows on its face, making it seem all too real. Panic gripped his chest, and before he could think, he let out a blood-curdling scream, abandoning the cart and bolting down the hallway.

Later, campus police would say the gentleman had refused to return to his post that evening.

The culprit behind the haunting? One of the school's most advanced medical manikins, left powered on after a long day of training students in realistic patient care scenarios.

As spooky season descends, true stories such as this add a playful twist to the essential work happening inside the School of Nursing's Center for Simulation Innovation, where some of the most sophisticated medical simulators are helping to prepare practice-ready nurses.

LouAnn Click, BSN, RN, removes the tip of Hal's finger to show it can be pricked by students for a blood glucose reading. The manikin, Hal, represents a five-year-old male patient.

LouAnn Click, BSN, RN, simulation lab manager, fondly recalls moments like this - where the realism of the manikins has even fooled nursing staff and, occasionally, students.

"Our simulators are so advanced, they can mimic nearly every aspect of patient care," said Click, who has been with the school for nearly 25 years. "We have manikins that can track you with their eyes or exhibit real-time changes in heart rate and lung sounds, they offer invaluable training experiences."

In fact, one manikin, known as Miss Vivian, even had a run-in with U.S. Customs and Border Protection officials who mistook her for actual human remains due to her lifelike appearance when she was shipped from overseas in a coffin-like pine box.

"You've got to love British humor," said Click recalling the memory.

More than a spooky surprise

The school's simulation center is home to a variety of manikins that enable students to gain hands-on experience in a risk-free environment. Low-, mid- and high-fidelity simulators can replicate scenarios from routine check-ups to critical emergencies, allowing students to practice their skills before interacting with live patients.

Nursing students assess a newborn manikin just delivered by Victoria during an obstetrics simulation.

"We have simulators that breathe, bleed and even deliver babies," Click explained.

One of the most popular simulators, Victoria, allows students to assist her in childbirth. She provides them, male students in particular, the opportunity to experience something they otherwise might miss out on due to cultural or privacy concerns.

"It's not common that you can have a real patient deliver on demand," said Click. "Victoria can deliver her baby in under 10 minutes."

She's not the only star of the center. Its inventory features a range of simulators, including pediatric and geriatric manikins, each designed to help students master different aspects of patient care.

Miss Vivian, the geriatric manikin who startled customs officials, is a particularly important teaching tool.

"She's so lifelike that our vein finder can detect her veins, allowing students to practice starting IVs," Click said.

A sophisticated learning environment

Nursing education goes beyond access to lifelike manikins; it's about creating an immersive environment where students can hone their skills with the latest technology. Not long ago, the center added virtual reality (VR) training to its repertoire, enabling students to practice interacting with virtual patients before moving on to the manikins.

A close-up of Miss Vivian's hand shows the extreme detail of her design.

"Students wear VR headsets and walk through a patient scenario, interacting with both the patient and family members," said Click.

This helps them prepare for the emotional and technical aspects of patient care, including how to communicate with family members in stressful situations.

Once students complete the VR scenario, they transition to the physical manikins, where they perform hands-on tasks like changing wound dressings or administering medication. This multi-stage approach ensures that students are thoroughly prepared for real-world nursing situations. The simulators can even be programmed to respond to different medications, allowing students to see the effects of their interventions in real time.

"A nurse can do everything perfectly, the same way they've done it multiple times and all of a sudden, a patient responds differently. We want to see how they react," Click said. "Do they call a doctor; do they try something else? We have to practice that."

The school also conducts special simulations, such as The Virtual Dementia Tour, which offers students and caregivers the opportunity to live with dementia for eight minutes. Participants' senses are temporarily impaired while they are instructed to complete a series of tasks.

The Virtual Dementia Tour participants are outfitted with a padded glove to impede dexterity, thick glasses to distort vision and headphones to simulate hearing loss.

"They are only given the instructions once," Click said. "We sometimes have participants who come out of the simulation feeling guilty for how they might have treated a loved one. It's not until you experience similar symptoms do you really understand how debilitating dementia can be."

The school also runs the Hearing Voices Simulation, demonstrating schizophrenia. It's also an eye-opening experience according to Braulio Amezaga, the lab's manager of audio visual and teaching support services.

"Participants are given a list of tasks to complete in different areas of the school," Amezaga said. "They must try to complete them while wearing headphones the entire time. The sound coming from the headphones simulates the voices someone with schizophrenia might experience."

Amezaga said the voice starts off by softly humming but vastly changes by the end of the simulation.

"We warn participants that the voice becomes quite rude," he said. "The simulation was created by Dr. Patricia E. Deegan, a researcher and educator in mental health recovery who was diagnosed with schizophrenia as a teenager, so it's very realistic and participants find it extremely hard to concentrate."

A glimpse of the future

As health care technology continues to advance, the Center for Simulation Innovation remains committed to staying on the cutting edge.

Click holds a manikin "skin" used to transform simulators' appearance for different training scenarios.

"We are always looking for new ways to improve the learning experience for our students," said Amezaga, who mentioned that the school is preparing to add artificial intelligence to its tool belt.

A special smart speaker will soon allow the school to use conversational AI, permitting students to practice patient communication skills across several scenarios. The system will offer real-time feedback on communication effectiveness and includes preloaded scenarios such as abdominal pain, chest pain and allergic reactions.

"We'll be able to program medical history and a personality to our manikins," Amezaga said. "When students interact within a simulation, the AI can take over and respond randomly. It will make the scenarios that much more lifelike."

Whether it's through AI, VR, advanced simulators or even innovative moulage techniques that replicate real wounds, the center provides a comprehensive and immersive learning environment.

Distinctive in South Texas

While spooky tales of manikins coming to life after hours may circulate, it's important to remember that behind the fun tales lies a serious mission: preparing the next generation of nurses with the skills and confidence to provide exceptional patient care.

In the fall of 2023, the Center for Simulation Innovation earned accreditation from the Society for Simulation in Healthcare for excellence in teaching and education. The recognition places it among the top simulation centers statewide and highlights its role in preparing nursing and inter-professional teams for clinical practice. The accreditation process took two years and validates the center's high standards in delivering simulation-based education.

"Our goal is to ensure that when our students graduate, they are practice-ready and confident in their abilities," said Click. "The technology we have allows them to experience situations they might not encounter in their clinical rotations - they'll be ready for anything."

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