School on wheels brings lessons to nurses working in prisons

Simulation supervisor Cindy Letavec, RN, right, runs the scenario for Corrigan-Radgowski Correctional Institution nurses Karen Guity, left, and Melissa Brown as they train on a "high fidelity" mannequin simulator Tuesday on board the University of Connecticut Mobile Simulation Laboratory parked outside the prison.

Montville - When they entered the prison cell Tuesday afternoon, nurses Melissa Brown and Karen Guity found "inmate" Carl Raffone sprawled face down on the floor near a small pool of blood, the back of his head still bleeding.

"Can you hear me?" asked Brown, a registered nurse at Corrigan-Radgowski Correctional Center, where she and 24 other nurses care for about 1,500 inmates. "Did you fall on your head?"

Raffone, actually a computerized mannequin that produces simulated breath, pulse and bowel sounds and can talk, responded like the dazed, confused patient he was supposed to be.

"I feel really nauseous. I feel weak. Are you a doctor? I feel nauseous," it said, as Guity and Brown fixed a cervical collar around his neck, called 911, cleaned his wound and tried to turn the 6-foot patient simulator onto its back.

As the two nurses concluded they were dealing with a diabetic episode and ultimately administered glucose gel to boost low blood sugar, a captive audience watched. Cindy Letavec, correctional hospital nursing supervisor, and Karen Zelvin, registered nurse and trainer, watched through a window from the next room. Janine Leitkowski, registered nurse at Corrigan, and Denise Panosky, assistant clinical professor at the University of Connecticut's School of Nursing, observed via a television monitor in a third room.

"It was a totally humiliating experience to be watched by everyone," Brown said after the nine-minute exercise.

"That was a scary simulation," Guity added.

This hands-on lesson took place inside a 40-foot van customized with three rooms - one set up like a prison cell, one with simulation computers and monitors and a third with a screen for observers - parked just beyond the barbed-wire fence that surrounds Corrigan. The van, purchased, equipped and staffed with a $1.1 million federal grant, is the first of its kind in the country, according to Panosky.

Called the Mobile Simulation Laboratory, it's meant to be a school on wheels for prison nurses, giving them a chance to practice both frequently and infrequently needed skills and acquire new ones.

"One of the biggest difficulties for prison nurses is that they can't just pick up and leave for the day for training," said Constance Weiskopf, director of nursing for correctional managed care. "Having the education come to them and having it be state of the art keeps their skills and competencies fresh. It has generated a lot of excitement."

The van is the result of a partnership between UConn School of Nursing, the UConn Health Center and the state Department of Correction. Since it was purchased in August, it has traveled to seven of the state's prisons, Panosky said, spending two weeks at each to train nurses in groups of four.

Statewide, there are 400 nurses caring for 18,000 inmates and residents of halfway houses.

"We expect to go to each facility at least twice a year," she said.

Levatec said typical training scenarios include chest pains and needing CPR, hypoglycemic or neurological reactions and going through detoxification due to drug or alcohol addiction. About 90 percent of all the medical care inmates need is provided by in-house prison nurses and doctors, she said.

After the exercise, the nurses and observers analyze how it went. During the analysis, the nurses discuss what they did and why, while the observers ask questions, brainstorm alternate responses and offer feedback.

"It's in the debriefing where the education takes place," said Desiree Diaz, assistant clinical professor of nursing instruction at UConn.

Karen Guity, a nurse from Corrigan-Radgowski Correctional Institution, checks the blood pressure on a mannequin used in a simulation aboard the Mobile Simulation Laboratory.
Karen Guity, a nurse from Corrigan-Radgowski Correctional Institution, checks the blood pressure on a mannequin used in a simulation aboard the Mobile Simulation Laboratory.


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