High-tech mannequin known as “Julia” enables nursing students to practise end-of-life-talks with patients.


It’s the conversation no one wants to have, but talking to patients and their families about death is an inevitable aspect of healthcare professional jobs. To address this shortfall in the training of nurses, the University of Houston College of Nursing is now using a high-fidelity mannequin to simulate the challenging interactions which take place at the end of their patients’ lives.

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Funded by the Texas Higher Education Coordinating Board’s Nursing Innovation Grant Program, this specialized training is believed to be the first-of-its-kind innovation to be used by collegiate nursing programs.

According to Cheryl Brohard, assistant professor and project director, “Nurses will tell you that they don’t feel confident or competent with this subject matter. This is a real issue for the nurses.” Brohard, who has completed the ‘End-of-Life Education Consortium’ training, spent 30 years as an oncology nurse and the last decade of her career working with hospices and other seriously ill patients. Her aim with the addition of the simulation lab is to make the nurses as comfortable as possible when facing these emotionally challenging situations. The latest research shows that 28 percent of all patients who died in the United States in 2015, died in hospitals with nurses at their bedside. Brohard says it is imperative that hospital-based nurses who provide direct care to these dying patients on a 24/7 basis, are competent in palliative and end-of-life care.

The simulation lab is designed to replicate a home-like setting, with the goal of building students’ knowledge, communication skills and confidence when they are with dying patients. The female mannequin used in this controlled environment, nicknamed “Julia,” is programmed to breathe, blink and even to simulate various medical conditions. In a nearby room equipped with a video and audio-feed of the simulation lab, a faculty member plays the role of the patient, with students hearing the voice through a speaker near the mannequin. Sometimes, ‘her husband’, played by a College of Nursing staff member, is by her side too to further replicate a real scenario.

This simulated interaction teaches students to respond appropriately when, for example, the patient turns blue due to lack of oxygen or becomes panicked while experiencing shortness of breath. The rest of the class watches via a projection screen in the classroom.

In a situation where students are told that “Julia” has terminal lung cancer, they will be exposed to three end-of-life scenarios during their last two semesters of training. In the first scenario, students sit face-to-face with the patient, who is coming to terms with her recent diagnosis. They are expected to discuss advanced care-planning, including healthcare wishes and whatever decisions there are to be made. Next, the patient’s health will begin to deteriorate as the cancer progresses. Students will need to manage the patient’s symptoms and dispense medication appropriately. Finally, the students will be with “Julia” and “her husband” when she dies.

It is being well-received by students. “This is great experience for real life, because when you walk through a patient’s door, you never fully know what to expect,” says nursing student Aashaqali Momin. “I’d rather be anxious here than be anxious out in the field. This is a valuable learning opportunity.”

“You can read a book 10,000 times and you’ll know what to do, but real life doesn’t always work like the books. Unpredictable things happen,” said nursing student Vy Pham. “The more times we can experience these scenarios, the calmer we feel.”

Kathryn Tart, Dean of the College of Nursing is as receptive to the idea: “This is the area that physicians and healthcare providers really have a difficult time with. How do we start the end-of- life conversation? It’s one of the most needed requests from our hospital partners,” she said. “This research will not only educate our students, but it has far-reaching implications for the entire health care system.”

This work was supported in part by a grant from the Texas Higher Education Coordinating Board (THECB). The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policy of the THECB.

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