Exam Room: Simulation Training — Just Like the Real Thing
Because veterinary nurses often explain the diagnostic plan for companion animals (and even perform some), they need to understand the diagnostic procedure being performed, as well as the normal diagnostic values and reference ranges that pertain to the procedure. While this can create anxiety, simulation training can help veterinary nurses develop the skills and confidence to explain and perform certain clinical procedures.
Even after graduation, however, veterinary nurses can practice their skills via simulation in the veterinary practice. Simulation is not just for the new graduate—it also benefits seasoned veterinary nurses, who must continually hone their skills. These simulations can also be useful in training staff members. You may already be using simulations in your practice now. For example, your clinic may require monthly crash drills or scavenger hunts for important items. But how do you incorporate simulation into your clinic when you need to gain more dexterity in such procedures as obtaining intraocular pressure (IOP) or cystocentesis? We’ll get to that, but first, let’s discuss what is meant by simulation.
Through simulation, conditions are created or replicated to resemble real-life situations.1 It is a learning modality in which the practitioner or student practices a procedure on a mannequin. Some mannequins can be purchased, but you can also create your own. High-fidelity simulations use computerized mannequins,2 whereas low-fidelity simulations use role-play, noncomputerized mannequins, or task trainers.2 You can create your own mannequin using everyday craft items and stuffed animals.
SIMULATED PRACTICE: OBTAINING IOP
To practice obtaining IOP via simulation requires nothing more than a stuffed animal, grapes, and the regular supplies necessary for this procedure, such as a tonometer and anesthetic eye drops (FIGURE 1).
To create your mannequin, replace the eyes on the stuffed animal with grapes (FIGURE 2). Once this is done, anyone can begin practicing the procedure.
High-fidelity simulations use computerized mannequins,2 whereas low-fidelity simulations use role-play, noncomputerized mannequins, or task trainers.2
Step by Step
Calibrate the tonometer according to the manufacturer’s directions. Always use a sterile tip cover for each patient.3
- Mimic applying a topical anesthetic to the eye (grape).3
- Using very light taps, make contact with the cornea (grape).3
- Record the average reading. Depending on the model used, you may have to record the average of 3 readings.3 Newer models do this automatically.
All veterinary nurses should be familiar with the normal IOP range for cats and dogs: 10 to 25 mm Hg.4
SIMULATED PRACTICE: OBTAINING URINE VIA CYSTOCENTESIS
Another type of simulation entails using a stuffed animal to teach the proper protocol for obtaining urine via cystocentesis. Cystocentesis is frequently used to obtain a sterile urine sample from the patient’s bladder. The veterinary nurse uses his or her palpation skills to isolate the bladder.
All that’s needed for this exercise is a stuffed animal, alcohol, a water balloon, and the appropriate-size syringe and needle for the patient and bladder size (for the exercise shown in FIGURE 3, we are using a 3-mL syringe and a 22- to 25-gauge needle).5,6 The needle should be 0.75 to 1.5 inches long, depending on the size of the patient and bladder.5,6
To create the mannequin, replace the stuffing with a water balloon (FIGURE 3). You’re now ready to start practicing the procedure.
A follow-up simulation may include a mock conversation between the veterinary nurse and facilitator (who acts as the client).
Step by Step
- Restrain the “patient” in dorsal recumbency. We are using a cat mannequin in this scenario; restraint in lateral recumbency is also acceptable.
- Palpate the urinary bladder (water balloon).5
- Swab the area over the caudal abdomen with alcohol.5
- Isolate the urinary bladder (water balloon) between the fingers of the nondominant hand.4
- Insert the needle at a 45-degree angle without applying negative pressure.5
- Withdraw urine (water) from the bladder.4,5 You can add a drop of yellow food coloring to the water to mimic the look of a urine sample.
- Release the plunger and withdraw the needle.5
All veterinary nurses should be familiar with the complications that can occur during this procedure, including urine leak resulting in a uroabdomen, bowel puncture or laceration, and puncture or laceration of the vena cava.6 This is yet another reason that creating these simulations is a valuable teaching tool: It allows new veterinary nurses to get comfortable in these situations before working with live patients.
A debriefing should follow any simulated training with a mannequin. This debriefing should be led by a facilitator who guides and supports participants toward understanding and achieving objectives.1,2 The facilitator can be a veterinarian or a veterinary nurse who is well trained in the procedure being practiced.
A follow-up simulation may include a mock conversation between the veterinary nurse and facilitator (who acts as the client). For the IOP procedure, the veterinary nurse should be able to educate the client regarding the procedure itself, normal ranges, the importance of follow-up visits, and medication with which the patient may be discharged. For cystocentesis, the veterinary nurse should be able to explain the importance of obtaining a sterile urine sample. Such simulated conversations teach veterinary nurses the appropriate communication required for a successful client education experience and reinforce their skill set, education, and abilities.
- INACSL Standards Committee. INACSL standards of best practice: simulation glossary. Clin Simulat Nurs 2016;12(S):S39-S47.
- Aebersold M, Tschannen D. Simulation in nursing practice: the impact on patient care. Online J Issues Nurs 2013;18. Manuscript 6.
- Herring N. Proper intraocular pressure measurement. Clinicians Brief 2017;Jan/Feb:3, 7-9.
- Collins BK. 6 eye errors you’re probably overlooking. DVM360. March 13, 2017. veterinarymedicine.dvm360.com/6-eye-errors-you-re-probably-overlooking. Last accessed December 8, 2018.
- Rizzi TE. Urinalysis in companion animals part 1: collection, sample handling, & initial evaluation. Todays Vet Pract 2014;Mar/Apr:64-68.
- Poulin RV. Using cystocentesis to obtain sterile urine samples. Clinicians Brief 2017;Nov/Dec:52-55.