BOZEMAN – Five-year-old Hal looks at the upheld finger of a nursing student who is talking to him and follows it with his eyes. When the student nurse asks him what hurts, his eyes well up with tears and the pain is evident in his facial expression.

But Hal isn’t a real 5-year-old: He’s a high-fidelity manikin, one of over a dozen high-tech simulators recently purchased by the Montana State University Mark and Robyn Jones College of Nursing. Hal’s job, along with those of Susie (an adult female manikin), Tory (a baby manikin) and even Victoria (a birthing simulator) is to make sure MSU’s nursing students have a chance to gain experience in a real, tactile way, while also ensuring they know how to effectively handle common clinical challenges and the rare medical emergencies that a student may not encounter during their two years of nursing education.

The manikins are part of a new simulation curriculum in the nursing college. While simulation has been a part of the curriculum for many years, the content was previously determined by individual faculty members who included it in an existing course. With the new format, each semester’s simulations dovetail with what students are learning in their other courses. Whether they are learning basic patient safety, how to manage acute childhood asthma attacks, or dealing with a crisis such as a postpartum hemorrhage, the manikins can effectively simulate real-life patient care situations.

“When we send our students into a clinical learning experience, they focus on the needs of the patients they happen to see that day. But there are situations they may never get to see,” said Amanda Mauws, who teaches the simulation course at the MSU Mark and Robyn Jones College of Nursing Great Falls campus. “Simulation gives us the ability to be intentional with our teaching, including the scenarios and learning outcomes we want all our Bobcat nursing students to master.”

Each of MSU’s five nursing campuses in Bozeman, Billings, Great Falls, Kalispell and Missoula has at least three manikins, which can cost up to $100,000 apiece. For Joe Poole, co-coordinator of MSU’s simulation program and one of the curriculum’s designers, the manikins also came at an ideal time for nursing students.

“When COVID initially happened, all our students were shut out of their clinical sites. Every hospital, every nursing home, every medical clinic was closed to students,” said Poole. “We had to pivot toward simulation and virtual simulation. There’s solid research to show that there are great learning outcomes through simulation. It’s much more emotionally connected than if we were to sit around a table and read a case study or do a PowerPoint or watch a video.”

In addition to the hands-on skills that students practice in simulation, the realistic nature of the manikins allows them to practice their bedside manner and patient interactions as well. In simulation, student nurses must practice everything as if they’re in a real clinic, from communicating with other team members to introducing themselves to the patient to explaining treatments in a way that is understandable. That’s especially important when patients are children, which makes Hal an ideal practice resource.

“He is incredibly lifelike,” said Mauws. “You can put him in an idle mode and while you’re talking, he’ll turn his head and his eyes will track. It’s like he’s really listening to your conversation, which is good practice for remembering that when you’re talking, even to a team member, you have someone listening, especially when it is a child.”

The manikins have an enormous range of technical capabilities and are built to engage students’ critical thinking. They have pulses in multiple locations as well as breath, heart and lung sounds that can be heard with a stethoscope. Students can fit them with IVs, catheters or ventilators. Their vital signs will display on a heart rate monitor, and they can even withstand the electrical shock that comes from a defibrillator.

But as impressive as the manikins are, the human side of simulation is just as important, says Poole. That takes the form of a debriefing after each practice, something for which the simulation faculty members receive formal training. Poole says a standard post-simulation debriefing often takes two or three times as long as the simulation itself.

“Debriefing allows us to get to the core learning objectives and really address not just actions and behaviors, but the thinking that was behind those actions and behaviors,” he said. “We have to create a space where the student feels safe to learn, safe to make mistakes and safe to ask even the simplest questions. If we don’t do that, then the outcome isn’t going to be nearly as good.”

Current and future nursing students will now take a simulation course during every semester of their two years in the Mark and Robyn Jones College of Nursing. Each course will build on the one before until students have developed fluency in both technical practice and the communication skills necessary to become effective nurses. For Mauws, watching that development happen is one of the best parts of her job.

“You get to see those lightbulbs start to go on as they think back to the simulation,” she said. “In a clinical, we can’t always be with them at every moment to try and help them gain this understanding. In simulation, we can have those one-on-one interactions to create a knowledge base where they can build their practice. I think it’s exciting, and it’s exciting to see them get excited about this immersive learning experience.”

Founded in 1937, Montana State University’s Mark and Robyn Jones College of Nursing offers bachelor’s, accelerated bachelor’s, master’s and doctoral-level nursing education to produce nurses, nurse leaders, nurse educators and nurse practitioners for Montana. The college of nursing has campus locations in Bozeman, Billings, Great Falls, Kalispell and Missoula. Montana State University is the largest producer of registered nurses in Montana and is the sole provider of doctoral nurse practitioner education in the state. More information is available at

 - by Reagan Colyer, MSU News Service -

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