Simulation Education in Nursing

Podcast Transcript

[00:00:00] Carol Pehotsky: Our topic today is simulation and its use in nursing and frankly in healthcare. And when we hear the word simulation and simulation use in education, our brains often go right to the mannequin that blinks, the high tech fully equipped lab with all the beeps and whistles and things that we would use in a patient care area, the virtual reality headset that puts us into another place where we can get as close to real as possible.

[00:00:31] But simulation is so much more than that, and it really is giving our nurses and our healthcare colleagues an experience from which they can learn. I'm joined today by Dr. Nicole Brown, senior Simulation education specialist for Cleveland Clinic.

[00:00:48] Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care to advancing your career, to navigating tough on the job issues. We're so glad you're here. I'm your host Carol Pehotsky Associate Chief Nursing Officer of Surgical Services Nursing.

[00:01:08] All right, everyone. Welcome back. Today we're gonna talk about simulation and its applications in nursing. And those of us who learned to be nurses in the stone age, it wasn't really a thing. We had nursing labs and, and I still very fondly remember my nursing lab instructor who, who was a military trained nurse and made sure we absolutely knew what we were doing before we left that lab.

[00:01:31] But another core memory is the struggle of trying to get a a TED hose on a mannequin's leg and thinking I'm gonna be a terrible nurse 'cause I can't even put a stocking on this patient. And other things that there wasn't the technology or the resources to make it even a little bit realistic.

[00:01:48] And all of the very first clinical day I also remember that it was scary as all get out. But that weird realization that, oh, it's actually easier to do this on a human being than on the resources we had at the time.

[00:02:02] Thankfully, life has improved, training materials have improved. Technology has really opened the doors for pre-licensure nurses and really everyone in healthcare to have a much more realistic safer opportunity to practice in, in a space that isn't with a live patient.

[00:02:20] So to that end, I'm so excited to welcome Dr. Nicole Brown to the show today. Nicole is a senior simulation education specialist at Cleveland Clinic, a fantastic nurse, a colleague I've known for several years. I'm so glad to have you on the show.

[00:02:32] Nicole, welcome.

[00:02:33] Dr. Nicole Brown: Thank you. Thank you for having me.

[00:02:34] Carol Pehotsky: Of course. So if you wouldn't mind getting us started with talking a little bit about your nursing career thus far and, and how you found your way to simulation.

[00:02:42] Dr. Nicole Brown: Yeah, I, as you're recounting your experience, I found that I had a similar experience because I too, I'm gonna assume you, you and I both went to nursing school in the 19 hundreds, right?

[00:02:55] Yes. I love to say that to my kids. I graduated high school before Google was invented.

[00:03:00] Carol Pehotsky: Oh, yeah.

[00:03:00] Dr. Nicole Brown: And so a lot of my experiences in nursing school. We used each other. [Mm-hmm.] And at the time when simulation came around here, say, at Cleveland Clinic, it was mannequins. And so therefore, if you're not doing something with mannequins, you are not simulating.

[00:03:16] However, having dove into this simulation world, I realized simulation is just simulating anything you would experience. It's not necessarily the technology. And so we really were doing simulation back in the 19 hundreds.

[00:03:32] Carol Pehotsky: Fair. That's right. Yeah. Yeah. Okay.

[00:03:34] Dr. Nicole Brown: And I'm sure each and every one of the nurses that may be listening can recount using an orange or using each other.

[00:03:42] Carol Pehotsky: The gel pad.

[00:03:43] Dr. Nicole Brown: Yes, the gel pad. Oh God. I love the gel pad. But that doesn't answer your question. How did I get into nursing and what are some of my backgrounds? I am the first person in my family to graduate from college with a bachelor's degree.

[00:03:58] Carol Pehotsky: Wow.

[00:03:58] Dr. Nicole Brown: And my interest in healthcare was, I had a dad that was very sick when I was young. He had cancer. We won't get into that. He's here today, he's great.

[00:04:08] But I saw how people took care of him in the hospital and I said, I'd really be interested in trying that. [Yeah.] But full disclosure, I had really no idea what nurses did and what that really meant other than you work in a hospital. [Mm-hmm.]

[00:04:23] Which I realize is also not the only places nurses work. But I started my career down at Akron City Hospital. I worked in the CCU coronary care unit before moving on to the emergency department. Went to some other different hospitals in the [mm-hmm] uh, Northeast Ohio area, but really focused on ED. [Okay.] Was more of my specialty.

[00:04:43] Tried my hand at management for a little bit, thinking I was going to love that.

[00:04:47] Carol Pehotsky: And?

[00:04:48] Dr. Nicole Brown: No.

[00:04:48] Carol Pehotsky: Okay.

[00:04:49] Dr. Nicole Brown: Mm-hmm. No. Nope. Did not care for that path. And ended up getting into education. [Mm-hmm.] I was here for about a year at Cleveland Clinic and they told me You're gonna do simulation now.

[00:05:01] Carol Pehotsky: Oh, okay. Well, that's one way to get into it.

[00:05:03] Dr. Nicole Brown: Absolutely. And as you already heard I didn't do [right] what I thought was simulation [yeah] anytime before. So I didn't know what it was and really just went to a training on how to work a mannequin and [Okay] and went from there. And that was in 2011. So it's been a good long time.

[00:05:23] Carol Pehotsky: Yeah, we'll start there. There wasn't a lot around. How did you educate yourself? Everything from the definition is more than what you and I thought back in the day. [Yeah.] To how to use all this technology and how to make it meaningful.

[00:05:38] Dr. Nicole Brown: That is a wonderful question. The age old question. How is simulation different?

[00:05:44] So simulation really finds its roots in experiential learning theory. There are many ways to have an experience, working a clinical shift is an experience.

[00:05:55] Carol Pehotsky: Very much so.

[00:05:55] Dr. Nicole Brown: But simulation is really supported in the debriefing aspect. So when you think about how to do simulation and how did I do it, there's the facilitation side as well as the debriefing side. Then there's also scenario creation and all the things in between.

[00:06:13] And so my first training was on just go do it and.

[00:06:19] Carol Pehotsky: Jump into the pool. Here we go.

[00:06:20] Dr. Nicole Brown: Yeah. And you just ask people these three questions. What went well? What would you wanna do differently? And what are your takeaways?

[00:06:27] And I never was able to really understand and draw the connections on how does this activity create meaningful learning?

[00:06:36] Carol Pehotsky: Mm. Okay.

[00:06:38] Dr. Nicole Brown: So one of our pillars is to educate those who serve. [Yes.] And therefore wonderful organization to provide me some training. And just really started to look at what is simulation? What is this?

[00:06:51] There's a society for simulation in healthcare that has been around since the two thousands. [Okay.] Which arguably is not that long. So this is a continued growing, developing, evolving field. There's also the International Clinical Simulation and Learning group. We call it a INESL 'cause that's a lot easier to say.

[00:07:10] They created the standards of best practice [Oh] that have grown and developed over the last 10 years. And through those different organizations, I really have been able to grow and develop. [Nice.] I also had a really meaningful debriefing education at a very well known group that does debriefing. [Mm-hmm.]

[00:07:32] And more experience, more reflection, and just living out what simulation is in my own life has really helped as well.

[00:07:40] Carol Pehotsky: Fantastic. Tell us a little bit more about, we're so fortunate here to have such a developed simulation. Yes. Not just curriculum, but also facility. Can you tell our listeners a little bit more about it?

[00:07:51] Dr. Nicole Brown: We are truly blessed with resources. [Mm-hmm.]

[00:07:53] Simulation, as I mentioned, is really just simulating an experience that might happen or, or something that is in real life. It is not about the technology, it is really not even about the location. And so because of that, we have numerous different types of simulation, modalities, locations where we can achieve whatever it is that we need. [Mm-hmm.] What our learning object are, it all comes back to the learning objectives.

[00:08:19] So here at Cleveland Clinic we do have a surgical lab where we work with human tissue and are really able to hone procedural skills, surgical skills. We also, in that line, we have a virtual reality lab where we work on task trainers. [Okay.]

[00:08:37] You might have heard of the Da Vinci robot.

[00:08:39] Carol Pehotsky: Oh, well, in my world, yes. Very much so.

[00:08:42] Dr. Nicole Brown: Exactly. I thought so. We have a simulator where you can work on simulated patients, but still hone in the nuances of working with that device as well as other different task trainers. I will say I do not, nor have I ever worked in a surgical setting.

[00:09:00] I had the opportunity to do surgery on a. Make sure you get the a not real patient. [Yes.] It was a virtual patient. We're all patient.

[00:09:08] Carol Pehotsky: We're gonna highlight that in the audio.

[00:09:09] Dr. Nicole Brown: Yes. Ex- exactly. And I was performing surgery. [Wow.] Again, never done it. Unfortunately, I did not have good outcomes. We just,

[00:09:18] Carol Pehotsky: I can imagine.

[00:09:18] Dr. Nicole Brown: We'll leave it at that. But it was an opportunity to see what it was like. [Yeah.] But then we have mannequins ranging from neonatal all the way up to adults and everything in between. And then we even have other different procedures. I mentioned virtual reality, but we also then have virtual reality for teaming and for full scenarios.

[00:09:38] Carol Pehotsky: Oh Okay.

[00:09:39] Dr. Nicole Brown: And it really meets whatever we want. [Mm-hmm. Mm-hmm.] And I know I mentioned that we have all of this in Ohio. We have numerous simulation facilities across our entire enterprise. [Okay.] So full simulation labs in Abu Dhabi, and we have several different ones down in Florida and London, and we're all over.

[00:09:58] Carol Pehotsky: Fantastic. Well, and about this time that you and I met, I was stepping into the periop leadership role in education and yeah, we still have it, we call it the mock OR, it is not. It's, there's a mannequin staring at you, but it's really about giving that safe space where nurses and tests can learn the scrubbing skills and practice that in the environment that doesn't actually have a patient or a surgeon.

[00:10:20] And it's been such a great partnership with you and your team. We, we've been able to get into the higher tech OR. The first time you see a mannequin blink, it's like, wait, what just happened? And once you get past that, then you can really start co-creating.

[00:10:34] Now that we have this facility around us, whether it is high tech or not, like you said, what's the objectives? What are we trying to gain here?

[00:10:42] Let's talk a little bit about applications in nursing. So what are some ways that simulation-based learning helps strengthen some of our nursing skills? The things we're looking for in nurses of any vintage?

[00:10:54] Dr. Nicole Brown: Yeah. I could recount all the different courses that we support nurses along the continuum with. [Mm-hmm.] But speaking just more generally, I love how you said all types of nurses.

[00:11:10] Simulation can be accomplished no matter where you're at. [Okay.] And it is being accomplished no matter your experience level. We do in onboarding. The first day that you set foot on a Cleveland Clinic facility, you're working in simulation, you are having some experiences with the equipment that you're going to be touching. [Sure.]

[00:11:31] The concepts of CPR and how we firmly believe in saving a patient's life. [Mm-hmm.] Lots of different concepts there. We then have, in our residency program, our residencies are those nurses with less than one year of experience. [Yep.] They're in specialized tracks and they are working with scenarios specific to the area in which they work.

[00:11:56] [Mm-hmm.] And concepts include providing a report to a provider. [Ah] We do know that nurses are taught sbar in school, but it doesn't mean all those letters come out and it takes experience and practice and feedback. [Sure. Mm-hmm.] So we support that ongoing growth and development. We then work within the experienced continuum to work with caregivers that are actively working on the bedside.

[00:12:24] [Mm-hmm.] It's not just coming and doing mock codes. We do many other quality related events process. Are the processes that we are working in, do they make sense? Where are our deficits? Where are our gaps? [Ah] Where can we improve? What are those latent safety threats that, if not caught, could impact a patient?

[00:12:44] So, yeah, the whole continuum, and I would be remiss if I didn't mention what we're doing with our students. [Okay.] While they don't necessarily work for Cleveland Clinic, we are still working with that next generation nurse in launchpad programs. In fact, today one is happening and there's mannequins on the floor, and they're working on what does CPR look like?

[00:13:06] [Yeah.] Again, what more equipment and what does it mean to be a nurse? And really to help support the profession before they even get started.

[00:13:14] Carol Pehotsky: And if you all missed the episode on Launchpad to Nursing, you can listen to the episode that's already live with Linda Gardner. Thanks for that cross-promotion, Nicole.

[00:13:21] Dr. Nicole Brown: You're welcome.

[00:13:22] Carol Pehotsky: So I'm gonna go back to something you said, 'cause I don't know that I've ever thought about it this way. We use simulation to try out processes as well as educate reinforce. [Yes.] Do you have an example of a situation where somebody came and said, we wanna try this new process? Can we simulate to see if it works?

[00:13:42] Dr. Nicole Brown: Yes. We could do an entire podcast on process simulation, but some large projects that most listeners would have heard of is opening a new facility.

[00:13:56] Carol Pehotsky: Sure.

[00:13:56] Dr. Nicole Brown: So that's a, a pretty obvious [mm-hmm] thing. You're opening a brand new hospital. Most recently we opened Mentor Hospital. [Mm-hmm. Okay.] Does everything work?

[00:14:06] You know, all the individual systems are tested. Epic is tested before the phones are tested [mm-hmm] before, however, do all of those systems test together? [Mm-hmm.] And that tends to be a really big question.

[00:14:20] And we did some mock operations. [Mm-hmm.] And it was discovered that before any patients were there, no patients were harmed the

[00:14:31] code alarms [mm-hmm] when you push the button rang not to Mentor Hospital, but they rang at Medina Hospital.

[00:14:40] Carol Pehotsky: Oh no. Now, yes. That's a great catch.

[00:14:42] Dr. Nicole Brown: Yeah. That's an m and a hospital. Yeah, but the distance is, [oh my gosh] about an hour and a half.

[00:14:48] Carol Pehotsky: At least.

[00:14:48] Dr. Nicole Brown: Yeah, I think. [Mm-hmm] and I don't think your response teams would have good times if that was how it was, and so we were able to reroute that ahead of time.

[00:14:56] Carol Pehotsky: Yeah. Wow.

[00:14:57] Dr. Nicole Brown: There's also a group that is looking at sepsis response. [Okay. Mm-hmm.] So not a mock code. Right? And so we're in a different variety of what does this look like? We have provide training, and now we're looking at is that training working? Does our process at this hospital make sense?

[00:15:18] And what we found is while we've been training nurses to collect blood cultures [mm-hmm] it's actually lab doing it. So is lab doing what they're supposed to? [Mm sure.] And we then found a process with our metrics. Antibiotics cannot be given until blood cultures have been drawn. Right. But when you look at lab process, they bundle care, which is common practice.

[00:15:46] Carol Pehotsky: Sure, yes, of course.

[00:15:47] Dr. Nicole Brown: Meaning they get blood cultures from two sites, but they do the first site that you know, they [mm-hmm] clean, they collect. They move to the other side, they clean, they collect, they now need to scan in both of those. [Mm-hmm] However, nurse at the bedside, blood cultures are done yes, visually they are done, they're collected. [Sure.]

[00:16:08] However, nurse then goes, scan, hang, antibiotics are up. But the blood cultures were never scanned and therefore it appears, oh, they're done out of order. So it's not that we weren't compliant in our process,

[00:16:22] Carol Pehotsky: Sure we follow our process, we just didn't have the documentation to support it.

[00:16:25] Dr. Nicole Brown: Correct.

[00:16:25] Carol Pehotsky: Got it. Okay.

[00:16:26] Dr. Nicole Brown: And by doing it in simulation we were able to see that. And so this is like a hot off the presses. They are identifying that. That was just identified and so now protocols can be written in a way that does support the true process and to ensure that we are doing the right things for the right reasons and giving the explanations.

[00:16:45] Carol Pehotsky: That's fantastic. I love that so much. Talk to me a little bit more about VR training and nursing. Where are we using that in our nursing profession?

[00:16:54] Dr. Nicole Brown: Yeah, absolutely. VR first started in 2022 here at Cleveland Clinic. [Okay.] We, before COVID, I had an interest in bringing this type of simulation. [Mm-hmm.] But with the COVID Pandemic, we did have some delays in getting started.

[00:17:11] So virtual reality, just from a definition stake, is fully immersive, wearing headsets, practicing in a fully virtual environment. And the power of VR is you do not have to be in the same place at the same time. And therefore you can practice with anyone across our system [oh] at any time. [Okay.] That works really well when you are an organization like Cleveland Clinic, when you do standardize your practice across all facilities.

[00:17:43] Carol Pehotsky: Ah, yeah.

[00:17:44] Dr. Nicole Brown: Now with that being said, what are we using it for in nursing? [Mm-hmm] That was the, the real question. And we're seeing it a lot in our residency programs. [Okay.] Because it is a way to simulate in the most immersive way. [Okay mm-hmm.] And so they have buy-in because they are in.

[00:18:03] Carol Pehotsky: It's there. Yeah.

[00:18:03] Dr. Nicole Brown: They, they're there and they're in, and so our pediatric residencies are using it. Our ED critical care residency group down in Florida, they have adopted it to look at trauma sims. [Oh.] Their sim centers are not as big and they don't have as many resources. [Sure.] And so from a moulage standpoint that make up of it, to make it look more real, we can push a button.

[00:18:30] Carol Pehotsky: Ah, there you go.

[00:18:31] Dr. Nicole Brown: And they are in an immersive situation [wow] where the patient they're working on could be squirting blood and talking all confused. [Yeah.] And it brings about those emotional responses of, oh no, I'm terrified. [Yeah.] Rather than, oh, this is a piece of plastic. And so it's enhancing it in the content, but also that emotional connection.

[00:18:53] We're also using it to create that pipeline. Abu Dhabi has headsets and they are using it to showcase what nursing is. [Ah, okay cool]. And what nursing can be. So there's a lot of different ways VR is being used across our enterprise.

[00:19:10] Carol Pehotsky: All right. And as somebody who gets super motion sick and tried it for about five seconds, I'm grateful for other opportunities to learn that are not VR based.

[00:19:19] Dr. Nicole Brown: Exactly. And that comes back to not one modality. [Yeah.] Is what you need in simulation.

[00:19:25] Carol Pehotsky: Yep. You mentioned with VR, and I imagine it happens in in a variety of modalities for simulation as well, that emotional connection, it creates that core memory, stealing it from Inside Out, the movie, we've created that core memory, we're going to remember it.

[00:19:39] I imagine though, you get some people who have some pretty strong emotions. Mm-hmm. And so how do you respond in whatever modality, make sure that they understand it's a safe space, and really help them process through that?

[00:19:50] Dr. Nicole Brown: Love this question. Again could be an entire podcast. There is a theoretical concept that talks about the value of stress in learning.

[00:20:02] [Yeah.] And one of the reasons experiential learning is so powerful is when learners are stressed, their brain is activated, and therefore they engage more with the content.

[00:20:18] Carol Pehotsky: Makes sense.

[00:20:19] Dr. Nicole Brown: Now, there is also a continuum where you can be too stressed and you're paralyzed, so you have to find that right balance.

[00:20:26] But simulation allows for stress to then connect it to the learning outcomes. And that's why I personally find it to be a superior way of learning. [Mm-hmm.] Not discounting all the others, but that's my bias.

[00:20:40] So in order to make learning safe, all simulations should have a pre-brief. [Okay.] And the pre-brief should be more than, Hey, we're going to do a sim.

[00:20:50] Carol Pehotsky: Here we go.

[00:20:50] Dr. Nicole Brown: Yep. You ready? Great. But what are the objectives? What are your expectations? What do you want the learners to do or not do? What is considered in scope? What is not in scope? Mm. And the point is you don't wanna surprise your learners.

[00:21:06] I know one of the biggest learnings for me when I was developing as a simulationist was, do I tell a learner that they are going to go into a simulation where the patient has a cardiac arrest?

[00:21:19] And as a baby simulationist, I thought to myself, absolutely not. You do not want to tell them because

[00:21:26] Carol Pehotsky: it won't, they won't be told in real life. Exactly. Yeah, yeah, yeah.

[00:21:29] Dr. Nicole Brown: However, what I have found, I had a mentor in simulation question me on that and say, why wouldn't you tell them what's happening? Simulation is not the real thing. It's just like the real thing. [Okay.] I was like, okay, fine. We'll try this out.

[00:21:48] And I told people, this patient is going to code, and the learners were like, oh, okay. And then they still missed a ton of things.

[00:22:00] Carol Pehotsky: Oh, they still didn't, so they didn't get the answers to the test in advance?

[00:22:04] Dr. Nicole Brown: No, because when you're still at the end of the day just because you know what's gonna happen to your patient doesn't mean you know what to do, when to do it, how to do it, and why to do it. And so it removed the stress of what was happening or not.

[00:22:18] Carol Pehotsky: The aha moment.

[00:22:19] Dr. Nicole Brown: Yes. And it doesn't feel like you're being caught. [Mm.] You're not being tricked. [Yeah.] It, this is what is happening now do what you're supposed to do. [Ah.] But then on the flip side, most all of our simulations are not coding patients. [Right.] They are working through routine procedures, routine situations that they may encounter in real life.

[00:22:43] So telling a learner, this patient is not going to code. You do not need to do life saving interventions. It gives them this good. Yeah. But what's interesting is I think a lot of nursing schools still do a lot of coding types in it.

[00:23:03] Carol Pehotsky: Oh, sure. They come with their own [yes] mindset of what they think simulation is.

[00:23:07] Dr. Nicole Brown: Exactly. And so they still don't trust you.

[00:23:11] Carol Pehotsky: You're trying to trick me. I know you are. Yes. Oh boy.

[00:23:13] Dr. Nicole Brown: So a lot of it is in your pre-brief, whatever you say, you better do.

[00:23:17] Carol Pehotsky: Yeah, for sure.

[00:23:18] Dr. Nicole Brown: Because you need to build trust and rapport of we're not trying to trick people. [Mm-hmm.] And I think that's true in simulation, but that's also true in any real life situation [absolutely] when you're working with preceptors, et cetera, it's not any major concept.

[00:23:31] Carol Pehotsky: Yes. So, pre-briefing, very important. And you've mentioned it earlier in the, in the episode, I definitely wanna come back here and linger here. The debrief. Yes. Really where the learning happens. I imagine that's also where some of the processing of the motion happens, whether there's a trick or not.

[00:23:46] Yeah. Tell us more about that and, and the techniques that you use. Also another podcast episode, I realize.

[00:23:53] Dr. Nicole Brown: No, yeah. I actually was not gonna say it this time. Debriefing is the foundation of experiential learning because once you have an experience, you need to reflect on that experience.

[00:24:04] [Mm-hmm.] And if you don't have a robust debrief, or you don't even allow time for a debrief. In theory, your experience may have been wasted. If no one reflects on it, they're not learning. [Yeah.]

[00:24:17] So a debriefing is designed to take the experience that happened, understand the why the actions happened, and then potentially build off, reframe, strengthen what was done.

[00:24:33] There's a concept of frames in simulation and frames in simulation. That's like the why. [Okay.] It's the why people do what they do, but we don't see their why. We see their actions. [Uhhuh. Yeah.] We see what they do. [Mm-hmm.] And the results of those actions, but we only infer the why.

[00:24:53] And so a good debriefing uses objective data, things that happened in the sim and explore the why this happened.

[00:25:04] [Sure.] There's ways within a concept called debriefing with good judgment where you are using your own opinion to walk a ladder of inference. We won't really spend too much time there, but the bottom line is debriefing is not meant to be, okay I'm now gonna lecture you on this content. Thank you for participating.

[00:25:25] Yeah. But it's really. Hey, you did this. I'm thinking this is where you were going, but what was going on for you at the time? [Mm-hmm.] Because if I think somebody did an action because they don't have knowledge, and I then sit and teach them.

[00:25:43] But the real reason they didn't do something is because they maybe didn't have all the information and they didn't collect all the information. They missed some pieces. And so it wasn't a knowledge issue. It was maybe an assessment issue. [Mm sure.] Does my teaching make a hill of beans a difference?

[00:25:59] Carol Pehotsky: No, probably not.

[00:26:00] Dr. Nicole Brown: Mm. No. So we have to meet them where they're at. [Yeah.] And it is also true. We find that debriefing is often deficit specific. [Sure.] You did this wrong, let's fix it.

[00:26:11] However, the statement, a broken clock is right twice a day. Right? [Yeah.] Just because someone did something right does not mean they did it right for the right reasons. [Ah.] So it's important to reflect on all aspects of the debrief. Anything that was good or bad, so then we can understand and make sure their rationales are accurate.

[00:26:34] It almost comes back to care plans. What's the rationale? [Yes.] So care plans actually have meaning?

[00:26:39] Carol Pehotsky: Uh, yes. Yes. Nursing students, we promise they have meaning. They do. Well, it's a perfect, perfectly good close to a lot of this conversation. I do wanna ask you one more simulation type question.

[00:26:51] We have listeners from [Yes] all over the globe, thankfully. And thank you for listening everyone. I know you've inspired a lot of listeners today, and some of them are saying, I wish I could, but I don't have funding, we don't have mannequins, I don't have a space. How do they get started?

[00:27:08] Dr. Nicole Brown: Love, love, love this question. And I do think it comes back to what is the definition of simulation? [Yeah.] And so often simulation is defined by the equipment that you have. The highest technology mannequin means we have more simulation, but at the core, simulation is rooted in an experience. [Mm-hmm.] And you need very, very little money to have an experience.

[00:27:37] I remember precepting nurses when I worked in the ED on IV starts. [Mm-hmm.] And I grabbed a blue glove and some IV tubing and some tape, and I cut a chunk out of the IV tubing, I put it inside the glove and I taped it down and said, start an IV. [Yep.] And that was a very powerful [Yeah] cheap task trainer. [Mm-hmm.] Yeah.

[00:28:05] However, concepts like teams, teaming, teamwork, communication, some of my most favorite ways to simulate that, [mm-hmm] is with gamification. [Sure.] There is some wonderful literature on serious games and or gamification. At the core, it's using games to teach a topic. [Okay.] Period, that's easiest way to look at it.

[00:28:29] I had to do some interprofessional training that had been live, but then had to go online. [Mm.] How am I going to play a game with people? And I made them do a Sudoku puzzle. Ah, super simple. Yeah. You can just google some Sudoku puzzles. [Mm-hmm.] And there you go. But it's about how they work together as a team. [Yeah.] How do you communicate? Who do you assume as a lead? All of those things can still happen.

[00:28:57] So if you're not sure where to start, the first thing I would say is, what are you trying to teach? What are your learning objectives? [Mm-hmm.] And how might you be able to do it? There are many articles talking about low resource sim centers. [Oh, okay.] Low resource ideas. Lots of different ways to look through that, but how can you gamify it or use the equipment that you've got?

[00:29:22] Carol Pehotsky: I love it. You've shared so much with us today, and I'm so very grateful. I'm hoping you'll stay humor me and answer a couple more fun questions. [Okay.] So our audience get to know you as an amazing human being, as well as a, an absolute social matter ex- expert.

[00:29:35] Dr. Nicole Brown: All right. I'm here for it.

[00:29:36] Carol Pehotsky: So you're here for it.

[00:29:37] Alright. Let's see. What is something you wish you knew as a brand new nurse?

[00:29:41] Dr. Nicole Brown: Mm-hmm. As I said, I was the first college graduate as well as the first nurse in my family. [Okay.] I think two things that I would want people to know, or what I wish I knew is when you get the title of you're a nurse, everyone assumes you know everything about everything.

[00:30:00] [Yep.] Yeah, and I started in the coronary care unit. Countless people would ask me about their cuts and booboos and my responses were, I'm not sure, but your heart's fine. Because That's right. You're not sure.

[00:30:14] So I think in, in some ways it's be okay to say, I don't know something. [Mm-hmm.] Because you will not know everything. And once you do get into wherever you work, you are gonna become more specialized and yeah, you're gonna build your own knowledge, but then it doesn't mean you're gonna know the nuances of things. [Right.]

[00:30:33] And then the other one I think is more personal and has evolved. [Okay]. I know I was guilty of this. Is that I treated everything that I was doing within two patients, as, you know, tasks I needed to complete. Ah, it was all about, frankly, it was all about me. It's my schedule. I need to do this at this time because this is what I want to do.

[00:30:56] But then having the wonderful opportunity ha ha to be a patient myself, [ah, yeah] you realize that after all, you're still a human and you still have needs and desires and hopes and wishes and pain points and things like that, and that as a nurse thinking that it's all about you, you completely miss

[00:31:21] why you are doing it in the first place. [Mm-hmm.]

[00:31:23] Now, I'm not here to say that every patient is a bed of roses, but at the same time, understanding that when a patient is upset or hurting or something to that effect, they're not trying to inconvenience you. That's my therapy for the moment.

[00:31:38] Carol Pehotsky: Thank you. And, and it's led well into my final question. We've spent a lot of time this year as an organization talking about the power of purpose, so I'm hoping as your closing answer, you'll share with us what's your why.

[00:31:50] Dr. Nicole Brown: Yeah. My why comes from a lens of why am I in education and simulation. [Okay.] And it really is just that I see this profession very easily slipping into technology and reliance on technology.

[00:32:10] I have a son, he's 14 now, but when he was little, he's Mom, you wanna play doctor? Sure, let's play doctor. I go lay on the couch thinking he's gonna come over and start pretending to assess me. [Mm-hmm.] What he actually did was he flipped over a laundry basket and sat down with his hands on it as if he was doing a keyboard. And he says, why you here? And pretends to type.

[00:32:32] Carol Pehotsky: Type, type, type.

[00:32:33] Dr. Nicole Brown: Yes. And that has been a story that I have shared for the last 10 years because it was so profound to me. We rely so much on technology that we lose that human element. [Mm-hmm.] And so for me, my why is to continue to help caregivers of all experience and all specialty to understand that we are still here for humans.

[00:32:57] [Mm-hmm.]

[00:32:58] We are here to help and care and provide for humans because at the end of the day, that is what matters. Yes, you need to put things in the chart. Yes, you need to be good at your IV starts, all of those things. [Mm-hmm.] But the real true why is because we want our patients, our humans to be Okay.

[00:33:21] Carol Pehotsky: Wonderful. Thank you so much for joining me today.

[00:33:24] Dr. Nicole Brown: It was my pleasure. Thank you

[00:33:28] Carol Pehotsky: As always. Thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at Nurse Essentials at ccf.org. To learn more about nursing at Cleveland Clinic, please check us out @clevelandclinic.org slash nursing.

[00:33:55] Until next time, take care of yourselves and take care of each other.

[00:34:03] The information in this podcast is for educational and entertainment purposes only, and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.