Pa. Providers Learn About Bipolar Patients
Nov. 19--The emergency room patient is clearly manic.
"You think you can control my life? No way -- I'm going to give you two minutes. If you don't take care of me and let me leave this hospital, then I've going to march right out of here, and don't think you can bring in some security and tie me up, because that's not happening.
"Because I am Andrea, and no one deals with Andrea except with respect, and understanding, because I am a talented artist and this world has yet to see what I can accomplish and just you wait, because I'm coming out in just a few weeks and this whole art world will not have a word to say, because they're going to be so overwhelmed by the quality of my work."
"Andrea" in this case is a simulated patient dubbed Andrea Warhol, and she is used by nursing instructor Ann Fallon at The College of New Jersey to help her students learn how to deal with a bipolar patient who has been brought into a hospital and is insisting on being released.
Ms. Fallon, who is also a psychoanalyst, said she is not quite sure why she chose to play off the name of artist Andy Warhol for her character, and didn't remember until just before she came to Pittsburgh for the recent annual meeting of the American Psychiatric Nurses Association that the artist had grown up here.
There is no evidence that Mr. Warhol had bipolar disorder, although some have speculated that his aloofness and fixation on pop culture objects suggest he might have had Asperger's syndrome, a high-functioning form of autism.
Other than using his picture and some of his famous soup cans on her poster last week, Ms. Fallon doesn't base any of her simulation on events from the artist's life.
She does know artists who have bipolar illness, though, and "they are sometimes in a manic phase where a lot of them don't believe that is what's happening to them. So in this simulation, we get to talk about the fine line between insanity and creativity. That's where this came from."
For the simulation, Ms. Fallon wanted to give her students a vivid experience of what it is like to deal with a patient who is talking nonstop, has grandiose ideas about herself and her importance to the world, and resists treatment.
During the simulation, students stand next to a bed with a mannequin wearing a Warhol wig. Ms. Fallon delivers the audio from an adjoining control booth.
By the time they do the exercise, she said, the students have been taught about responding gently but firmly, listening carefully and going through a checklist on whether the patient is in danger of harming herself or others, or is abusing drugs or alcohol.
"If they're effective in their communication with me," she said during a poster presentation at the David L. Lawrence Convention Center two weeks ago, "I start to tone it down. If they're not effective, I escalate," even to the point where she lets out a blood-curdling scream.
The Andrea exercise is part of a growing trend in nursing schools of using simulations to expose students to real-life situations, sometimes using audio from an instructor and sometimes using actors to portray different kinds of patients.
Gail Katz, a nursing professor at the University of Colorado, said schools are increasingly using medical mannequins, which can range in price from $30,000 to $250,000, to teach students practical skills, especially in areas where it is hard to find enough training slots in hospitals.
Originally borrowed from the airline industry, simulations are designed to give students a chance to fail, if need be, in a safe environment.
"So if we do something wrong, we don't kill a patient, but we kill the mannequin," said Ms. Katz, who was the lead author on a recent paper on medical simulations.
The goal of the training, she said, is that "when you're faced with a crisis, you've already managed it in a real-life situation. You've hard-drived people's brains, is what I like to say, so when they come up against a situation, that part of the brain will kick in and people will say 'I know how to do this.' "
Psychiatric simulations have been some of the most difficult to create, she said, because even the high-end mannequins can't simulate facial expressions.
But even though the Andrea simulation relies on Ms. Fallon's voice, one nursing student said it was effective enough that "at some points the situation and the patient seemed unmanageable, but afterward during the reflection, we discussed ways that we could better handle a patient like that in the future."
Ms. Fallon said students are sometimes stressed out by the exercise, and to relieve the tension, she will have Andrea belt out a version of "Somewhere Over the Rainbow" when they leave the room.
She also has another student portray Andrea's sister, who sometimes is helpful, and sometimes is testy and will say things like, "I can't stand her anymore; take her off my hands."
Ms. Fallon believes her Andrea simulation has worked well in exposing her students to a typical kind of psychiatric patient.
There's only one problem. Her charges are so young today that many of them don't know who Andy Warhol is.
"So when I do it the next time," she said, "I'm thinking I might name the character Charlene Sheen."
Mark Roth: mroth@post-gazette.com or 412-263-1130.
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