Students in the Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences have plenty of high-tech opportunities to practice patient care. The college’s Clinical Simulation Center allows students to practice caring for patients on realistic manikins made from plastic and latex and powered by a Windows server. The pretend patients can breathe, blink, vomit, bleed, cry and cough up sputum. They can even suffer a runny nose.
Behind the glass walls of the center’s control room, instructors orchestrate immersive nursing training experiences for students: collapsing the manikin’s lungs, engineering heart attacks, causing hemorrhages and even simulating childbirth – “in every way you could imagine a childbirth happening,” says simulation operations manager Tim Russom – so that students will be prepared to attend live births in the maternity ward. With no patients harmed, the only consequences for these simulated calamities are lessons learned.
“The first time we take the masks off, you can hear the gasps in the room.”
And one unique simulation in the department travels to the classroom: instructors trained in Mask-Ed™ pedagogy arrive in nursing classes, disguised as older adults, wearing silicone masks and clothing suitable for seniors.
Russom and assistant professor of nursing Judy Scott suit up in these prosthetic masks – plus tweed slacks, knit sweaters and the occasional walker or cane – to portray two older adults, eighty-year-old neighbors Mack Roy and Doris Belmont, who both have a keen interest in helping UCCS nursing students learn how to care for older patients.
“The first time we take the masks off, you can hear the gasps in the room,” Russom says.
Russom and assistant professor of nursing Judy Scott routinely suit up in the prosthetics – plus tweed slacks, knit sweaters and the occasional walker or cane – to portray two older adult patients, eighty-year-old neighbors Mack and Doris.
Scott and assistant professor of nursing Lynn Phillips are conducting research on changes in knowledge, skills, and attitudes about caring for older adults before and after the Mask-Ed™ interventions, planned with sophomore nursing instructors during the school year.
“Being a leader in the simulation world, why do we need masked education?” asks Judy Scott, assistant professor of nursing. “A manikin cannot do what Doris and Mack can do. Mack and Doris are even more immersive. It’s almost a step above working in the sim lab.”
The silicone masks are startlingly realistic in real life. They feature full heads of real human hair – including ear, nose and chest hair for Mack – and soft, age-spotted skin that extends to the mid-chest. Scott and Russom shop at Goodwill for orthopedic shoes, hats and reading glasses, and spend time writing expansive biographies and medical histories for their characters. Each condition is carefully tailored to a lesson plan designed to teach UCCS students about the nuance of geriatric care.
According to Russom, “The hardest thing about Mack and Doris – and it’s not wearing the mask and pretending to be someone else – it was creating their life story. You have to have a life story so that when our students meet these people, they are people.”
They tailor their portrayals of the characters with a level of detail meant to not only simulate geriatric adults’ medical conditions, but also to educate students about older adults’ social and socioeconomic concerns.
Scott, depicting Doris, wraps her legs with bubble wrap and wears two pairs of tights to mimic edema and swelling in her ankles before stepping into class. She brings up not just her medical concerns, but also the fact that the dementia medications for Doris’s husband are so expensive that Doris can’t always afford her own. Russom, portraying Mack – a retired Korean War medic with combat-induced deafness – likes to talk about the difficulty of acquiring hearing aids from the Veterans Affairs system.
The interactive simulations test students’ technical competencies, as well as their ability to communicate empathetically with older adults.
Russom says that when students interact with one of the simulation lab’s manikins, “I consider it a win when I can get a student to pat the manikin’s shoulder.” Using Doris and Mack for a classroom simulation means that Scott and Russom can give students an opportunity for even more realistic and empathetic patient care – from speaking up to compensate for Mack’s hearing loss to being careful with Doris’s fragile skin while taking a pulse.
“The hardest thing about Mack and Doris was creating their life story. You have to have a life story so that when our students meet these people, they are people.”
“We can guide our students through different scenarios that we’re interested in them learning about,” Scott says, “all based on our lesson plans.”
Scott learned about masked education in 2017, when she saw a TED Talk on YouTube by Australian academic Kerry Reid‐Searl, who patented the technique. To create geriatric patient characters for Australian nursing students, Searl commissioned silicone masks from the Hollywood costume company that created Robin Williams’ prosthetic masks for “Mrs. Doubtfire.”
“When I saw the video, I thought, ‘Ah-hah!’” Scott says. “’We could take this into our classrooms.’”
Scott’s interest was sparked by awareness of the growth of the aging American population and her exploration of surrounding research. In general, nursing of older adults is not as attractive to students as the emergency room or the ICU, and research findings indicate that ageism is prevalent across health care settings. Scott, Russom and Phillips hope that this unique simulation will help students be better prepared to engage with older adults and have more interest and compassion in this growing area of need.
Using grant money from the CU Diversity and Excellence program and the nursing department, Scott pulled together enough funds to purchase silicone masks for the Doris and Mack characters and bring the simulation into the classroom.
Since debuting the program in 2018, Scott and Russom have gathered data to determine whether or not Doris and Mack are having an impact on UCCS students.
According to Scott, “We wanted to know: do Doris and Mack make a difference in terms of attitudes about taking care of older people, intent to work with older people after graduation, and concepts of ageism?”
In early analyses of survey instruments, Scott has already seen improvement in UCCS health science students’ attitudes towards older adults.
“We’re certainly improving knowledge and skills, and some attitudes,” she says. “Whether or not we’re influencing intent to practice is what I’ll be interested to see.”
Scott and Russom see endless possibilities for Doris and Mack to visit different classes on campus, from courses on nutrition and mental health to classes in the William J. Hybl Sports Medicine and Performance Center’s new health promotion major. They want students to understand that life doesn’t stop after age 65 – and that older adults can continue to be healthy and active, especially when they have competent and compassionate care.
According to Scott, “This simulation strategy has a very, very important impact on our future healthcare providers.”
Russom stresses the versatility of the education that Doris and Mack bring to future healthcare providers.
“This is not high-tech,” he says. “This is old-school compared to the other things I do. But it is an exceptionally well-suited method of education.”
He continues, “At some point, this is where we’re all headed. For our students to learn about [geriatric care] and be comfortable with it from the beginning of their education, that’s going to help all of society, all the way down the line.”