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'Are you o.k., Mrs. Johnson'

DATE: Wednesday, October 19, 2016

Simulation set-up mimics home visit

Esther Russell of Springfield talks to "Mrs. Johnson" during a simulated home visit.

Among her many ailments, Mrs. Johnson suffers from cirrhosis and hypothermia. She uses a nasal cannula connected to an oxygen tank to help her breathe. Yet, she still likes to smoke Newports and drink Keystone Light and nips of Jack Daniel's Fireball. 

Mrs. Johnson is not very tidy. Her small studio apartment is a mess. Garbage overflows the trashcan. Dirty dishes, chip bags, empty beer cans and liquor bottles crowd the kitchen sink. Newspapers cover the floor, from one end of the room to the other.   

Mrs. Johnson has lots of problems. That's why Esther Russell is here.  "Mrs. Johnson, what's this?" Russell politely asks, pointing to the white powdery substance on the table.  

"I crush up my pills, Mrs. Johnson says. "It's easier for me to swallow them."  

Mrs. Johnson blinks frequently, and she talks without moving her lips.  

"Are you feeling all right today?" Russell asks.  "I guess," says Mrs. Johnson.  

Frankly, Mrs. Johnson looks a little stiff. She never budges from her chair nor moves her hands, even though she's holding a cigarette between the fingers of her right hand. Her immobility, however, is not one of her medical conditions.  

"Mrs. Johnson" is a SIM, a computerized medical simulation mannequin used at Holyoke Community College to train students for work in health care fields. Her vitals, including pulse and breath rate, are controlled by a simulation technician who sits in a darkened control room behind a two-way mirror. Her voice is his as well, coursened and piped in through a microphone. 

Russell, who is from Springfield, is a student in HCC's Community Health Worker program. Mrs. Johnson's apartment scene was staged to mimic the conditions a community health worker might find during a home visit.  

"Community health workers need to know how to work with individuals who may have multiple health conditions and be able to help them get the assistance they need to improve their health," said Janet Grant, coordinator of HCC's Community Health Worker program. "They are often hired by organizations to make home visits to help patients follow their treatment plans."  

Earlier this year, HCC became the first area institution to unveil a Community Health Worker certificate program. Last week, students enrolled in Health 104: "Core Competencies for the Community Health Worker" had their first chance to practice in the simulation lab at HCC's Center for Health Education.

"The community health worker program is fairly new in Massachusetts and to our college, and the use of simulation in our Community Health Worker program is cutting edge," said HCC SIM lab coordinator Michelle Sherlin. "Nobody in the country is using it much outside of nursing and medical education, so to use it for a Community Health Worker outreach experience for students is very innovative."  

Working in pairs, students took turns visiting Mrs. Johnson, knocking on her door and entering only after she gave them permission. In a nearby conference room, their classmates and instructor watched the interactions on a large-screen monitor.  

"In our class, we can role play some of this as a way to practice the needed skill sets, but doing it in a simulation lab is much more realistic," said Grant. "The SIM staff set the room up with items that would trigger the kinds of conversations community health workers need to have with clients when doing this work, conversations about safety, nutrition, medication, oxygen therapy, smoking cessation, alcohol abuse, support systems and a lot more."  

After each visit, students discussed what they had done well and where they might improve and listened to feedback from Grant and guest Wendy Coco, a program manager at Commonwealth Care Alliance who supervises the agency's community health workers.  

"It was great to have Wendy there to field questions and talk about what this looks like in the 'real world,'" said Grant. 

STORY and PHOTOS by CHRIS YURKO: Esther Russell of Springfield talks to "Mrs. Johnson" during a simulated home visit.