FOR IMMEDIATE RELEASE                                                                             August 5, 2008


The Ketterman Nursing Skills Lab on the Enid campus of Northwestern Oklahoma State University is the site for a pilot study aimed at finding ways to improve nursing students’ abilities to assess clinical situations with patients.

The study is being conducted by Kim Bruce, coordinator of the Ketterman Lab, Dr. Carole McKenzie, chair of Northwestern’s Nursing Division, and Dr. James Bowen, dean of Northwestern’s School of Professional Studies.  It utilizes the SimMan® Manikin in the lab to test a theory for improving patient care without jeopardizing live patients. 

The theory speculates that nursing students’ abilities to appropriately evaluate a clinical situation with a patient will be enhanced if they will “pro-actively” reflect on the situation prior to engaging in a solution and then reflect  again once they have seen the outcome of their applied solution.  Similar studies in the past have shown that nursing students report having had “epiphanies” about their role as a nurse as a result of reflecting on their practice.  Initial results in the Ketterman Lab study have been similar to the earlier studies with possibly some enhancement from the “proactive reflection” component.

When the researchers first formulated their hypothesis they were concerned how to clinically test it, since ethically they could not risk a human patient’s health to do so.  The life-like manikins in the new Ketterman Nursing Skills Lab provided a possible solution.  The manikins can be programmed to exhibit symptoms and react to treatment just as a live patient would.

            The Ketterman Clinical Skills Lab is a simulated four-bed hospital ward with a labor and delivery suite and a multipurpose ER/ICU room. The lab was made possible through a generous donation from Paul Ketterman and the collaborative efforts of the

Northwest Area Health Education Center (NWAHEC), two local hospitals (St. Mary’s Regional Medical Center and Integris Bass Medical Center), and two Higher Education Institutions (Northwestern Oklahoma State University and Northern Oklahoma College).

            In addition to providing clinical experiences for nursing students from Northwestern and Northern, the lab also is being used for staff development for area health care facilities.

            A report of the pilot study recently was submitted and accepted at two international conferences - the Sigma Theta Tau International Research Conference in Singapore and the IEEE International Conference on Advanced Learning Technologies in Santender, Spain.  No one from the group was able to go to Singapore to make the presentation; however, Bowen did travel to Spain to make the presentation there.

            For the purpose of the study, the SimMan® Manikin was programmed to be a 57-year-old male, 100 kg (220 pounds) and 72 inches in height.  The “patient” was post-operative with an abdominal incision.  His vital signs were initially normal, however, during the simulation the “patient” began hemorrhaging, became agitated, complained of pain, and his blood pressure dropped. 

            From the “proactive reflection” to the post-occurrence reflection the students tended to change in the following ways: (1) first expressing uncertainty they moved to a sense of being more certain of what to do; (2) from initial confidence that the “patient” would be ok they moved to a lack of confidence when his condition deteriorated and then moved to an awareness of their deficits as a nurse once they reflected on the situation; (3) from an apparent unawareness of their knowledge needs they moved to a greater awareness of their need; (4) from being incognizant of their role in patient care to more certainty of the role; and (5) from a sense of “all is well” to being caught off guard by the “patient’s” complications.

            In addition to observing the nursing students’ changes in behavior, researchers also looked at personality type, age, years of college, extent of clinical experience and level of thinking skills as factors that might influence the students’ reactions.

The researchers plan to continue their study by monitoring the students from the pilot study through their clinical experiences in the remainder of their program to

determine the effect of ProActive/Post-Occurrence Reflection exercise.  They also will calculate correlations between demographic data and higher level thinking skills and between personality type and higher level thinking skills.

For more information on the study or Northwestern’s nursing program, contact Bowen at (580) 327-8455 or


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