When he woke, he was active and then became increasingly distressed. He thrashed violently in his bed followed by becoming completely unresponsive. I checked for a pulse and found none. I immediately called a code and began chest compressions.
That is the situation Ashley Van Der Zee found herself in as she finished one of her very first shifts as a new nurse. She had only recently graduated from Washington State University College of Nursing.
Ashley’s efforts continued for 30 minutes and ultimately saved the patient. Her story exemplifies howsimulation-based training can prepare someone to turn the seemingly impossible into an “I’m possible.”
Ashley’s was working at a level 1 trauma center in Seattle. Her first job as a new nurse. One of her patients that evening was an elderly male. He had been brought there for a wound VAC (vacuum-assisted closure) following injuries that had left him with severe orthopedic trauma, a collapsed lung, and a crushed pelvis. He had just emerged from surgery and had begun regaining consciousness from anesthesia when he started showing signs of a pulmonary embolism (PE).
Ashley was the first to recognize that the patient was suffering from a PE. When she found that he had no pulse, she immediately took the lead. She quickly assembled a team of available staff, assigned roles, and began directing Cardiopulmonary Resuscitation (CPR). “I had an identical simulation at WSU where the patient had a PE. I was very surprised by my ability to remain calm and level-headed, but I could…because I had done it before,” Ashley said.
For nearly 30 minutes, Ashley and her team performed CPR. The attending physicians and anesthesiologist, who had left after the surgery, returned and began managing the code. After repeated rounds of compressions and team members rotating through using high performance CPR protocols, the patient finally returned to spontaneous circulation. He was going to live.
In the hours that followed, Ashley’s fellow nurses recognized her for seizing the initiative. “They were blown away; I went from new nurse to nurse running the code. When they asked me how I knew what was happening, I shared my experience with the similar simulation. I thought during my first code I would be so uncomfortable. But, in that instant, I have never been more calm and collected,” Ashley said.
Ashley的故事说明了今天如何在医疗保健中使用模拟。从历史上看，提供者被治疗真正的患者局限于学习。国家护理国民理事会（NCSBN）现在建议使用模拟可用于替换最多50％所需的临床时间。跨医疗保健，现在正在使用模拟，不仅要教授临床技能，而是教授批判性思维，领导和团队合作技能。“看到一个，做一个”是“制作”两次“模拟”，行动一次。“
我们要感谢ASHLEY和WSU的模拟人员对零可预防危害的互补贡献。它是因为他们的奉献精神和努力 - 学生和教育工作者一样 - 阿什利的第一个代码不是她的第一个代码。如果它不适用于Ashley的模拟经验，她可能无法像她一样果断和大胆地行事。You are examples to all of us in the simulation and patient safety community of what it means to say “I’m possible.”
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