Timo comes to class: ‘These simulation classes are exactly where we make a difference, as applied university education’

This morning we are in Deventer. Whoever walks from the lift round the corner towards the restaurant on the ground floor of the Saxion building, may inadvertently cast their gaze through the large windows of the simulation class of the nursing study programme. It is not the tables and chairs but rather the hospital bed with life-size plastic dummy that catches the eye of almost every passer-by. Executive Board member Timo Kos also regularly looks intriguingly inside, he says, after limping into the classroom this morning on crutches. An ironic coincidence: luckily nothing too serious, but a tricky break in his foot now set in plaster and requiring a couple of months of patience. Nonetheless he is here, and looking forward to being present during the practical lesson given by Femke Dijkstra and Arjan Christenhusz to fifteen first year students in applied university nursing.

Monday morning

The students are also now trickling in on this Monday morning. They started their applied university nursing study programme in September, after completing HAVO, VWO or MBO. A few of them already have some healthcare experience from previous education. However, for the majority this morning’s practical class is brand new. “Exciting, getting to work with a dummy,” is audible in the chit-chat. Timo is also curious. He introduces himself to the group (“I’m not the actor today, the crutches are purely coincidence,”) and takes his place among the students. First, time for the introduction. What is this lesson about? Lecturers Femke and Arjan explain. “This is an active lesson. We want to get you to do as much as possible at the patient’s bed,” says Arjan. This simulation lesson combines all the subjects that students have had since starting in September, he continues his explanation: “You have learned how you should communicate and you can practise that here. And if you’ve learned the theory about blood pressure monitors then you can try that out here during this case study. It’s all theory that you can put into practice during these practical classes.”

Breathing, blood pressure, temperature

In the meantime, Lecturer Femke Dijkstra, who once worked as Accident & Emergency Doctor, walks around handing out pocket cards. These contain a compact but complete explanation of the ABCDE method, that students will be using. The abbreviation refers to the different steps that they need to practise in an acute, simulated healthcare situation: Airway, Breathing, Circulation, Disability and Exposure & Environment. Put succinctly: Is it safe here, what can you hear, see and feel of the patient’s breathing? Is the patient conscious? After the initial checks, the following steps focus on whether the patient has possible neck injuries, blood pressure and blood loss, pupil size, the degree of consciousness and blood sugar level. Taking the temperature and doing the pain score are also components of the ABCDE method.

Substantiating decisions

Then it is time to go to the real simulation room. While we are moving to the next classroom, Timo says that the ABCDE method reminds him of a job he once had at Schiphol during his student days. “I was a high risk flight agent: a security officer who asked people a fixed set of questions before they were permitted to board a flight to a high-risk destination. That was aimed at preventing incidents. This concerns a medical list. Back then it was about security. In both cases you have to make a rapid assessment of a certain situation following a fixed protocol. Your information is never complete, but you still have to make a well substantiated decision.” It is similar to what the nursing students are practising today, agree lecturers Femke and Arjan.

The patient's pulse

By now, we have reached the hospital classroom and are standing round the bed with the dummy lying under the sheets. Femke is standing at the back of the room. She can use her remote control to make the dummy cough, and open and close its eyes. She can also alter the heartbeat. Arjan: “How can you check the patient’s pulse properly? At what other places can you feel the heartbeat? At the jugular vein. Does anyone know its name? The carotid artery.” Next, the students take a step forward and touch the simulation dummy for the first time. How should you grip the wrist? What do you do with your hands? “You can even detect the heartbeat on the back of the foot between the big toe and the second toe,” says Arjan.

Ms Pietersen

While Arjan is discussing the ABCDE pocket cards with half of the group, Femke goes with the rest of the students into the second simulation room. This one can’t be seen from the corridor. Suddenly, we are standing in an old lady’s living room. There are coffee cups on the table beside a vase of flowers. A fishbowl is on the sideboard. The lady, represented by another simulation dummy, is lying in bed. We now find ourselves in a home or nursing home situation. Femke gets out the pocket card and discusses the setting with her group of students. She asks her students: “What would you do if you arrive at this fictional Ms Pieterson’s home to bandage her legs?” “You are surprised to find her in bed. What is the first thing you notice?” The students look at their pocket cards again to go through the different steps. Is there a smell of gas? In what position is the person lying? Is there any shortness of breath? And: perhaps surprisingly... is a dog present? Femke: “That can cause an unsafe situation. Imagine that you have to help someone get up from the floor or turn them over, or perhaps even resuscitate them. A dog can get frightened or become aggressive. Try to make sure that the pet goes into another room.” Arjan and Femke take the students in the hospital room and the living room step-by-step through the ABCDE method. Timo watches with interest. It is now time to give the trainee nurses all the space they need to practise their actions hands-on. In peace and quiet, without an outsider watching them. Therefore, it’s time to say a brief ‘Goodbye’ to lecturers and students.

After leaving the classroom, we chat briefly with Timo about this special practical lesson. What was his impression of the past hour? “I enjoyed it very much. It is their first simulation class in their first year, when they can actually get practice after almost three months of theory. It was also valuable to meet Arjan and Femke beforehand to hear about their preparations. What qualities do you need to do your work successfully? You are lecturer, actor, facilitator and there’s also the technical operation of the simulation dummy. You can see that they are able to draw on their wide experience from their own professional practice and provide students with all manner of situations.” Timo noticed that Femke and Arjan also seemed to apply the ABCDE method to the students in their class. He remarked: “After about half an hour, Femke could see from their eyes and body language that some students were beginning to lose interest in the bedside instruction session.” She intervened immediately: ‘Arjan, do something, the students are falling asleep!’ I thought that Arjan handled this cleverly by asking the students who had a tough weekend. It was their first lesson on a Monday morning. Quite a few put their hands up! This showed how you, as lecturer, can apply communication and observation techniques in practice. You live and breathe the knowledge you want to convey. I really enjoyed watching the interaction between Femke, Arjan and the students.”

Passionate

“I can see how passionate they are about teaching,” concludes Timo. “Femke told me that standing with her students around a bed is the high point of teaching for her. Arjan talked in class about the wide scope of work where these students will eventually pursue their careers: the GP emergency post, the nursing home or a care home for people with mental health issues. There is plenty of choice. Students are here to learn the basics which they can apply in so many ways, in combination with the specific knowledge they will gain at a variety of places. These simulation classes are exactly where we make a difference as applied university education. Now you have plenty of time to ask questions and learn. Soon, you will be standing at a real bed and the situation may be critical.”