The Bethel nursing department’s end-of-life simulations are designed to give students experience with the death of patients in a realistic setting.

By Hannah Toutge

As spring encroaches on the chill of winter and campus begins to stir with life, seniors in Bethel’s nursing department prepare themselves to deal with the reality of death.

The department’s End-of-Life Simulation takes place during spring semester and causes nursing students to feel a mixed rush of emotions.

“Some people love SIM and others dread it,” Peyton Witzke, a senior nursing major, said. “I’m somewhere in the middle.”

The End-of-Life Simulation (EOLS) is a realistic experience designed to teach nursing students how to deliver comfort care to a dying patient under intense pressure.

“It’s different from other SIMs because you know that this patient will not ‘go home’ after your care, and he/she will not get better,” Witzke said. “Hospice nursing is very different from normal nursing and this simulation teaches that very clearly.”

During the EOLS, students are entrusted with the care of a mannequin lovingly referred to as SIM-Man, which is connected to real IVs and vitals machines. The SIM-Man displays most of the same bodily functions as a live human including a pulse and breath sounds, which can be changed according to the scenario.

“We are definitely super blessed to go to a school that can afford SIM-Man!” Witzke said.

Students’ simulation performances are observed by their professors and other staff (who control SIM-Man) from behind a mirrored wall, and their peers who watch from another room via video camera.

“That’s a lot of eyes and ears trying to figure out if you have the slightest idea what to do in an unknown situation,” Witzke said.

Witzke shares that this year’s simulation was especially difficult for her personally because the patient was dying of cancer, and Witzke lost her own father to cancer when she was younger.

Dr. David Cheesebrow, associate professor of nursing and EOLS instructor, confirms that the realness of the simulation is a stumbling block for many students.

“It’s an extremely real situation and that can sometimes bring up memories from people’s personal lives,” Cheesebrow said. “But that’s not unusual from what would happen in a real situation.”

Cheesebrow hopes nursing students would learn “how to continue [their] professional work despite the fact that [they] might be affected.”

Theatre students also play an important role in the EOLS each year, acting as the family of the dying patient during the simulation; although willing actors are usually difficult to come by.

Despite the role being a paid opportunity (theatre students earn $9/hour if they agree to act in the simulation), theatre students are often unwilling to participate due to the anxiety that surrounds EOLS.

“It’s the general fear of pain, suffering, and death that people are very afraid of,” says Cheesebrow. “I think theatre students deal with these things in plays all the time, but [the EOLS] seems more real to them.”

This will be senior Emma Martin’s third year acting in the EOLS. As a theatre arts major, she values the opportunity to hone her acting skills and help nursing students navigate the challenges of administering end-of-life care to patients in high-stress situations. Martin is provided with a script, but she’s not expected to recite lines word-for-word. The script serves as more of an outline for how Martin is to lead the nursing students to make the scene go in a certain direction.

She also wears an earpiece so Cheesebrow and other staff can feed her lines if necessary. Martin dons a costume, wig, and makeup to add to the effect of her character in the simulation.

When asked how she feels during an EOLS, Martin said, “Exhilarated, because when you play off of other people’s responses, you never know where you’re going to go. It’s interesting to see how each nurse reacts differently. Depending on how they react, I might have to switch my direction. It’s a fun journey.”

The EOLS causes students to feel heightened amounts of pressure and anxiety, but that isn’t because of the potential for a bad grade (students’ performances are graded S/U). Many students are intimidated by End-of-Life because they find that they have a personal connection to the situation, and it’s difficult to act under that emotional stress. However, encouragement and support comes from all sides.

“Don’t be afraid of [EOLS],” Cheesebrow said. “This is a challenge…but it’s a safe environment.

If you don’t do everything absolutely right, this is the place for that to happen. This is the place to develop those skills.”

Witzke also encourages future EOLS participants by saying, “It actually is such a blessing to be present with people when they are straddling the space between Heaven and earth, and to be able to be a comfort to them.”

“It has absolutely nothing to do with [us]. God has called us to be uncomfortable and spread the light, even during death.” – Peyton Witzke, Senior, nursing major.

Despite the importance of a nurse in an end-of-life situation, Witzke focuses on what God’s control means to her.

“It has absolutely nothing to do with [us]. God has called us to be uncomfortable and spread the light, even during death,” Witzke said.