The true art of simulation is in bringing the illusory to life. Mannequins that can change heart rates and even give birth. An apartment with a mock refrigerator and sink. All of this is meant to make the fake seem as real as possible.
When students enter that staged apartment, however, the person sitting on the couch is quite real.
“I can tell early on that some students are a little more nervous to see me than others,” says Steve Nigh, a College of Nursing simulation actor.
While many simulations can be done with mannequins, some require face-to-face human contact to practice communication skills. For those, the college brings in patient actors: people who act the part of an old woman about to be discharged from the hospital or a veteran with PTSD. The practice nursing students get with these actors makes them better prepared to handle similar situations in health care environments.
Clinical Instructor Alicia Davis says actors are a crucial part of designing these types of simulations. Their commitment to the role determines how well the experience will prepare nursing students for real life.
“Communication is the biggest part of any health care professional’s job. If you can’t communicate with your patients, it just stops everything,” Davis says. “You won’t be able to figure out their needs and build a rapport with them without communicating. Patient actors need to understand the role in a way that helps make it realistic for everyone.”
This training is especially important in preparing nurses to respond to unpredictable situations. One simulation calls for an actress to play a pregnant woman coming to the hospital for what students think is a routine appointment. However, the actress tells the students midway through the appointment that her blood sugar levels are abnormally high: a potential sign of gestational diabetes. Students then must recommend the appropriate course of action.
Susie Duecker, a local actress, plays the pregnant woman along with several other simulated roles. Before students arrive, she receives a card outlining the basic details of her role, but her conversations with students are improvised.
“All you’re really thinking about is what the circumstances of your character are and what objectives they have,” Duecker says. “Once you’re able to get your head around what matters to them, the conversation flows from there.”
Those conversations are not always easy. One of Duecker’s characters is a patient suffering from schizophrenia; another is an older woman battling dementia. As part of her performance, Duecker will exhibit intentionally off-putting behavior, such as repeating the same question multiple times or raising her voice to talk over the students. This forces students to keep practicing good communication skills even under stress.
Nigh, who has been a patient actor for the past three years, says he tries to match his more challenging performances with the appropriate students.
“I tend to challenge the ones who are more confident and try to throw a few more things at them to see how well-versed they are,” Nigh says. “If others are not so sure about what they should do, I back off because I want to ensure this stays a positive experience for them.”
“The situations where you’re dealing with human emotions are always hard to portray in simulation; good actors help give our students experience with those,” Davis says.
Life experiences often help prepare the actors for their roles. Duecker once witnessed a friend having a manic episode, a memory she draws upon to portray the patient with schizophrenia with both respect and realism.
“The more I’m committed, the more students are able to drop into their role and treat me as a patient, not an actor,” Duecker says.
Through these simulations, students learn how to interact with patients with empathy. The sight of a young woman in a wig pretending to be elderly might elicit laughter as a reflexive reaction, just as the dementia patient asking repeatedly if the student would like a cup of coffee might provoke irritation. Recognizing those emotions and replacing them with compassion is an essential nursing skill, one that cannot be taught with a mannequin.
“Health care comes down to whether or not you feel judged as a patient and whether you feel like the nurse is there with you, looking at you from a position of respect,” Duecker says.
