To give students a feel for what older patients are like, University of Texas Permian Basin recently acquired a sim person that is aged from top to bottom.
Received in April 2022, the mannequin can be a man or woman, any ethnicity, and be 65 and up. Simulation Specialist Cynthia Gomez said the students see geriatric patients throughout their clinical rotations, except in obstetrics, pediatrics and the neonatal intensive care unit.
“… She’s got freckles on her body just to show different landmarks that a patient might have. Her chest rises and falls. We we can do any lung sound … We can simulate that she was a smoker and do wheezing. We can intubate her if she ever needed to be on a ventilator,” Gomez said.
The mannequin can also blink rapidly, speak and scream. She is known as Mary Green, or Miss Mary. The students are drilled on the different sounds patients make to the point where they can recognize abnormalities relatively easily.
There are 140 students in the bachelor of science nursing program. First-semester students were caring for her on a recent Wednesday so they were given relatively simple simulations.
Gomez said it’s really beneficial to have this mannequin.
“… A lot of students don’t realize aged skin is a little bit different to insert an IV or to do a Foley catheter because it’s not as tight and your veins tend to roll a little bit more. Geriatric patients have more profound veins and they tend to roll, so we have to show them how to anchor down and then go in rather than just go in. … There’s a little bit of excessive skin you have to lift a little bit more and go a little bit deeper. so she’s been beneficial for that. Also, geriatric patients are just a little bit more brittle … You can’t just transport the patient. You’ve got to be more cautious of everything that you do. …,” Gomez said. “Showing them the gray hair, the aged skin, they become more conscious of that.”
Gomez also put a yellow “fall risk” bracelet on the mannequin so students know to watch for that. She weighs about 60 pounds, so a lot of times they transport her by wheelchair. It also gives the students practice on how to transfer her from bed to wheelchair.
“We will bring her out with every semester. We have four different semesters — freshman, sophomore, junior, senior. We’ll bring her out in three out of four because our OB, peds unit we won’t bring her out at all,” Gomez said.
She observes the students as they work with Miss Mary and offers them annotated notes and they have access to the video so they can go back and watch it.
“… They come into the room by themselves. … They close the door. They communicate with the mannequin. … If I need to speak back through her I have a headset, where I can do just that. I can hear them and talk back through it, or speak through the intercom. They come in; they’ll ask the patient (their) name, date of birth, and I can talk back through them and we’ll leave them notes so that they know exactly what they’re doing,” Gomez said.
The students can see the feedback as soon as one of the clinical instructors grades them, giving students a chance to correct themselves. They can watch the videos with a single sign in that’s integrated into their UTPB login.
Students have to educate the patient on everything they do and the drugs they might get.
“Let’s talk to our patients as if they have a middle school education to simplify all the terminology,” Gomez said.
Because there are several nursing schools in the area, the hospitals will only release a certain amount of slots so UTPB has to share with Odessa College and Midland College. Students have to be sent to different areas so they can get mental health practice, rural practice and home health.
They have a home health room where nursing students work with social worker students. Students have to figure out how to check a patient’s glucose level and secure the area to make sure it’s a safe environment.
“You have to report anything to Adult Protective Services. How do we take care of this patient the best in their home,” Gomez said.
The social workers help determine if the environment is safe, take their own notes and make their own evaluations.
“They’re a lot more the mental health aspect of it,” she said.
“Ours is more physical” and determining whether the patient can take care of themselves at home and keep up with monitoring cholesterol and taking insulin, for example.
Gomez has been at UTPB for two years, but has doing simulation for eight years. She was previously at University of Texas at El Paso where they had about 25 mannequins.
A new mannequin is about to debut at UTPB that tracks you with his eys and has non-verbal cues. He can cry and he can speak.
“And we’ll have one here in West Texas …,” Gomez said.
Students Madison Owen, Radhika Patel, Aminat Oyeniyi all say the mannequin is beneficial.
Owen said the mannequin makes it person without it being personal.
Patel said the mannequin can make different sounds like wheezing so they can differentiate between the sounds when they are in clinical settings.
Kai Siphanthabut, Nayeli Marquez and Abigail Marquez are all in their first year.
“I was scared of it at first,” Siphanthabut said. “But when you actually get into it, they’re nice.”
Rene Fierro, clinical teaching specialist, said Miss Mary has been a great asset to the team because they didn’t have anything geriatric specific before.
“She’s a great resource for our students because they really get to see the realism of her whit the aging skin and when they’re doing assessments she has skin folds and things like that. Part of assessments is you have to do a full body skin check and that includes checking under skin folds in other areas for any types of wounds or skin breakdown. Our other mannequins, they’re all flat-skinned. There’s no need to move anything around and it’s a very important aspect with geriatric populations. The other thing is having her at the level she is as far as what’s called the fidelity … we can run higher-level scenarios with her. With the geriatric population, we add in more of the cognitive changes so we have our Alzheimer’s/dementia and also we can go into more specifics as far as with urinary tract infections and what the cognitive effects of those are, specifically in our geriatric populations. A lot of times in the older populations, our first indication of a urinary tract infection is cognitive behavioral changes vs a urine test,” Fierro said.
The first signs of infection in younger patients may be a fever, body aches and chills.
“With her, we’ll be able to add in a lot more … so they start doing more thorough assessments with that mindset for the geriatric. We get to do a lot of cool things with her. Our students really love interacting with her,” Fierro said.
Fierro has been at UTPB for almost a year and is a graduate. He has worked at Midland Memorial Hospital, but has primarily worked in home health serving communities throughout the Permian Basin.
“I love it. I’m from Odessa and to be part of this program within my community, especially for a job in the healthcare industry that is so needed … I know it’s needed across the board, but our area is in high need. I like to be a part of my community providing this education for our nurses that are going to be caring for my community, my people, my family members. To have that effect in that way … means a lot to me as a nurse and as a local of Odessa,” Fierro said.
“It brings me a lot of pride also because I see a lot of young people that are from here also. A lot of them are first-generation and come from similar backgrounds. It’s really nice to see that kind of continuation and … growth with them as well,” Fierro said.