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Byline: Susan Abram, Staff Writer

VAN NUYS - Nurse Silvia Jourdan calms her desperate patient as best as she can, by telling her to breathe.

"Noelle, are you having any pain?" Jourdan asks.

Through a frozen, wide-eyed, locked-jaw expression, Noelle gives the young Jourdan an unexpected earful.

"AHHHH! ... This is the worst pain ever!"

Noelle may be plastic, but she's no dummy. Giving birth is no picnic, even for a mannequin.

"Noelle breathes, she pushes, she grabs you," says Jennifer Astasio, a nurse education manager at Valley Presbyterian Hospital, where Noelle is a "patient."

"She's wonderful for the nurse student to sharpen her critical skills."

Noelle is one of five high-fidelity human patient simulators recently acquired by the hospital for its new nursing skills simulation lab. Short of sweating or having bad breath, the mannequins can do anything they are told to do from a wireless laptop. Commands include everything from "convulsions" to "urinate."

They also are the latest tool in nursing education, to help new graduates transition from a classroom setting to a real hospital floor.

"In here, the nurse can have a post-real experience in a sophisticated environment," said Ali Tayyeb, education manager at Valley Presbyterian.

"This is much easier, without placing the patient at risk. You're allowed to make mistakes in here."

Valley Presbyterian is one of a handful of community hospitals that has been able to have the mannequins. Students enrolled in nursing programs from Los Angeles Valley College and California State University, Northridge, will be able to use them.

Nurse educators say the mannequins can test new graduates in various scenarios intended to sharpen skills and also boost confidence, while raising legal, ethical and critical issues at the same time.

Noelle, for example, is pregnant. She can have an easy birth or a complicated one, her movements, breathing and speech controlled by the tester.

With her feet up in stirrups, nurses prepare and comfort Noelle as she begins to have contractions. As she exhales, her rubber cervix opens and the crown of the baby's head begins to show.

But just when they think they may have a smooth birth, nurses are sent on a roller coaster of medical issues. Noelle's blood pressure may dip, or she may hemorrhage, or the baby could be tangled in the umbilical cord, its vitals abnormal.

Noelle's baby, also a high-fidelity mannequin, is cared for as part of the test, so that nurses understand the beginning and end of the birthing process.

Nurses also can get tested with Hal, a male mannequin with chest pains, who moans in agony. His rubber wrists throb as his pulse races, his pupils dilate as a bright light shines in his eyes. They must determine if he is going into cardiac arrest or if he has overdosed on cocaine.

The lab, complete with examination bays, beds, monitors and the

mannequins was built with a grant from the UniHealth Foundation. The lab also will be visited by elementary school children to encourage nursing as a profession at a young age, Tayyeb said.

High-fidelity mannequins are still considered a new tool. But they are proving effective in retaining new nurses, said Jana Berryman, president of the International Nursing Association for Clinical Simulation and Learning. The organization is a collaboration among nursing educators who share information about the simulation exercises on a national and international level.

"Nurses leave the profession because they don't feel comfortable in practice," Berryman said. "This is an education tool that helps retain nursing" and maybe cure the nursing shortage.

Barryman, based at the Colorado Center for Nursing Excellence, said that five years ago, only a handful of schools in her state owned the mannequins. Now, 90 percent of all nursing schools have them.

"The demand is there," she said. "They are pricey, but they are cheaper than taking a patient's life."

But challenges remain. Nurse educators are having to learn how to use the technology, and it's not always easy, Barryman said.

"The technology doesn't come with all this pre-written information," she said.

Back at Valley Presbyterian, seasoned nurses also will have a chance to care for Noelle. The hospital plans to use mannequins in emergency simulations.

Jourdan, the young nurse who participated in a recent simulation, said she learned by being thrust into a hospital setting right out of school. All those uneasy moments as a new nurse could have been better, she said, if she had the opportunity to be in a simulated hospital right after school.

"I wish I had this when I first started," Jourdan said. "It really makes a difference for the time when you first work with patients."



3 photos


(1 -- color) Silvia Jourdan works with a mannequin that simulates a woman giving birth in a training lab at Valley Presbyterian.

(2 -- color) Pupils contract or dilate in response to light on the high-tech mannequins used for training at Valley Presbyterian Hospital in Van Nuys.

(3) Educator Sonya Kaldjian, left, and education manager Leslie Jaeger examine the back of a mannequin for injuries typical of bedridden seniors.

Evan Yee/Staff Photographer
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Title Annotation:L.A. Life
Publication:Daily News (Los Angeles, CA)
Date:Apr 2, 2009
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