Tyler Coates says it’s harder than you might think, as he works in tandem with two other Hardin-Simmons University physical therapy students, to move a patient from a wheelchair to a hospital bed. The groaning sounds coming from the intensive care patient add to the sense of alarm the students feel when they practice the transfer for the first time.
Coates, a graduate from Tarleton State University, along with Bryan Blare and Boone Dugan, both HSU graduates earning their Doctor of Physical Therapy degree, are practicing with one of the simulation mannequins in the lab of the Patty Hanks Shelton School of Nursing. Meanwhile, simulation lab coordinator, Phil Howell, adds another layer of reality as he controls the groans and other sounds being made by this realistic mannequin.
“Patients do better sooner when they get out of bed and start moving around,” said Coates. “That’s one of the roles of the physical therapist. What’s interesting about being at the nursing school is that here we get to experience what nurses do every day. We learn how to keep all the tubing together that ICU patients depend on.”
Physical therapy is critical to helping patients get well, contends Dr. Marsha Rutland, HSU associate professor of physical therapy, as she helps the students transfer the patient from the wheelchair to the bed. “Gaining range of motion will prevent muscles from deteriorating. Getting a patient upright and moving also aids in cardiovascular and gastrointestinal functions. Even though someone may be tied to a ventilator, they will do so much better when they are able to get out of bed and move around.”
Howell said the simulated people are so sophisticated that they come equipped with a pulse. “The mannequins appear to breathe and some even have pupils that dilate and constrict, and their lips turn blue when deprived of oxygen.” Howell said the sounds the mannequins make are important to learning. “Students begin to recognize and correctly identify heart and respiratory audio clues. We’ve installed pan, tilt, and zoom cameras with regional microphones in the lab so we can record and play back. Students also learn by watching themselves and others perform.”
Lisa Van Cleave, assistant professor of nursing, said the course is part of a new interdisciplinary program to acquaint PT students with handling patients confined by ventilators and other common hospital equipment.
“This week we have been talking about critical care and some of the issues associated with patients tied to equipment,” said Dr. Dennis O’Connell, professor of physical therapy at HSU. “Students have gone through lectures, but in this second phase, students learn how to feel comfortable when dealing with medically complex patients.”
“I think this really helps the physical therapy students to know what to expect when working with patients in ICU,” said Van Cleave. “It is a lot harder to deal with equipment and tubes than many of the students realize.”
The idea for the cross-over of disciplines, using the nursing school facilities and instructors to help physical therapy students’ deal with critical care patients, came when O’Connell and Van Cleave were visiting prior to a board meeting. O’Connell said, “I mentioned that PT students have a lot of fear and concern about working with ICU patients. We need a real-life way to build a students’ confidence regarding the lines and tubes that provide patient support.”
“Physical mobility is one of the earliest goals for a patient. If a patient is not moving, even a patient with multiple traumas, he or she will lose strength and cardiovascular fitness the very first day. This really is a great learning experience for all of us to interact like this,” said O’Connell.
Rutland and O’Connell emphasize the importance of PT students learning to be team players. “Learning how to work with nurses and respiratory therapist is crucial to their training,” said Rutland.
“A patient belongs to the nurse; the nurse is charged with keeping the patient alive,” said O’Connell. “As physical therapists we may only see the patient 60 to 90 minutes per day.”
Next week, Rutland says the PT students will work with the simulated patients with no instruction from the nursing or PT professors. Class members will be able to watch and critique from a monitor in a hallway just outside of the lab. Last year was the first time PT students participated in the interdisciplinary program. “We are seeing the results of last year’s training in our students today as they become confident in working in a hospital setting,” said Rutland.