Three different simulation spaces at the Betty Irene Moore School of Nursing provide a plethora of real-life scenarios for nursing students to prepare and apply their clinical knowledge

By BRANDON NGUYEN — science@theaggie.org 

From tears and grief to newfound intimacies and growth, students at UC Davis’ Betty Irene Moore School of Nursing are placed into authentic, complex simulations to apply clinical practices learned in the classroom. As part of the nursing school’s curriculum, these dynamic simulations are created by faculty — sometimes even involving them as actors — to create potential real-life scenarios that nurses may encounter. 

Terri Harvath, a professor at the Betty Irene Moore School of Nursing and a nurse educator for over 20 years, is the mastermind behind developing simulations for the nursing students and has guided countless nursing students toward applicable real-life practices. 

“Clinical practice of tasks has always been a part of nursing education, but I would say in the last 20 years, we’ve really been looking at how to introduce simulation, and we’ve gotten more and more sophisticated over time with how those simulations can emulate real life situations,” Harvath said. “What we know about the research that’s been done in simulation as a part of nursing education is that the more authentic the experiences are, the more students learn and the more they grow in both their psychomotor and their interpersonal skills.” 

To reproduce real-life experiences, faculty have focused on creating an environmental atmosphere in which nurses would most commonly find themselves. In Moore Hall on the UC Davis Sacramento campus, there are three different simulation spaces. The first involves a setup similar to that of the inpatient hospital unit that looks like an eight-bed hospital ward. The second simulation space comprises a 15-room primary clinical care space that patients typically enter to see their primary care providers. Unique to the UC Davis campus, the last space has been deliberately set in a one-bedroom apartment that emulates the home environment as health care shifts more into the community to tend to elderly patients, according to Harvath. 

Megan Hansen, a communications and marketing specialist supporting several departments at UC Davis Health including the UC Davis Health Center for Simulation and Enhancement, has played the role of the partner of a dying patient in a simulation and reflects on the powerful experiences that simulations offer for both the students and herself.

“End-of-life care and death can be such a taboo topic in American culture, so I’ve been impressed by how this training session handles those discussions while imparting valuable knowledge and information to the students,” Hansen said via email. “I was so impressed with the students’ reactions. They were so soothing and kind, one even asked if she could hold my hand. I felt cared for and their sincere care and concern was so evident to me.”

How the nursing students handled the simulations impressed Hansen, and she emphasized the importance of empathy in the health field.

“This [simulation] exemplified for me the types of warm, sensitive, caring and incredibly capable students we have at the nursing school,” Hansen said via email. “These are just the types of people we want out in the real world caring for our loved ones and us.”

The simulation Hansen volunteered to partake in involved a two-part end-of-life care situation that two nursing students immersed themselves in as the other students watched. The first part involved a woman in the hospital who decided to end treatment for cancer and go on hospice care. She was supported by her partner, which was the role that Hansen played. During this training, the two women discussed next steps with the care team. 

In the second part of the simulation, which was held in the one-bedroom apartment environment, a woman who was ill was in her final moments and died while the nurses were visiting. It was up to the nurses to tell the partner that she had died.

Emily Boone, a second-year graduate nursing student, was one of the nursing students in this same simulation who had to deliver the news of the recently passed patient to Hansen. 

“I had a lot of nerves going in, and I wanted to be someone who could provide a therapeutic space for a person going through a difficult time,” Boone said. “I went all in and was completely immersed. There’s a reason I want to be a nurse, but after this experience, I’m more sure of my purpose. I know how to be present and helpful, without being overwhelmed by emotion. I feel much better prepared when that moment inevitably comes.”

After simulations, students are led by faculty in intimate group debrief sessions to discuss their experiences and learn from each other. 

“The debrief sessions are where the magic really happens,” Hansen said. “These take place after the simulations are done and we discuss what worked and what didn’t work and how to make improvements. This is where faculty, staff and students share their experiences and knowledge, and in this session everyone was so willing to be vulnerable, to cry, to discuss those difficult topics in a safe, nonjudgmental environment.”

With countless scenarios instrumental to students’ growth as nurses, Harvath has high hopes for the impact simulations can have on students not only in the nursing field but also various medical fields.

“My hope is that we expand the use of simulations, and what we know from the research is that students can actually use 50 to 75% of their clinical learning and simulation and they do just as well or better than students who are in traditional clinical experiences,” Harvath said. “And again, it’s because these are such potent and well-designed learning experiences. The pandemic is especially helping us understand that we need to be able to engage students in clinical learning outside of the clinical setting, and I think simulation really allows us to give that potent clinical learning experience, so my hope is that we use more of it because it’s a very intentional approach to curriculum and clinical design.”

Written by: Brandon Nguyen — science@theaggie.org 

Stigma surrounding drug overdose is a serious issue, and the pandemic has only led to further relapse due to inaccessible health care 

By BRANDON NGUYEN — science@theaggie.org

Over 100,000 deaths were attributed to drug overdoses, largely due to the opioid epidemic, during a yearlong period that ended in April 2021, according to the Center for Disease Control and Prevention (CDC). This was a 28.5% increase in deaths compared to the year prior during the same time frame. 

Dr. Aimee Moulin, a professor of emergency medicine and the director of behavioral health at the UC Davis Medical Center, described what it means to be a victim of substance abuse. 

“Usually people with addiction experience a lot of barriers in terms of getting addiction treatment: long intakes, long waits, paperwork and insurance,” Moulin said. “So we need to treat addiction as an emergency.”

Starting treatment as early as possible will help with recovery  and will reduce the high overdose rates from fentanyl and opioid use disorder. With the Substance Use Navigator Program under the Department of Emergency Medicine at UC Davis Health, patients with addiction are quickly identified and are offered support and treatment 24/7 from both clinicians and counselors. 

Patients are placed on medications such as buprenorphine, morphine or methadone, which are effective at reducing withdrawal symptoms. Then, they are connected with patient navigators, who are certified drug and alcohol counselors who help connect patients with rehabilitation programs and can customize treatment plans.

Tommie Trevino, a former patient and now a patient navigator at UC Davis Health for over five years since the program’s establishment, described how his experiences resonate with the patients and how his motivational counseling has helped many of his patients turn their lives around. 

“Learning recovery takes time and does not happen in a day,” Trevino said. “When I talk to people now, it’s like, ‘Hey, you’re not going to get straight today; you’re not going to stop using drugs today.’ You’ve developed a lot of bad habits; addiction is like a disease. It’s like a trigger bag, because once you have it, it’s with you for the rest of your life so you have to learn how to manage it, and I‘ve had great success teaching not only patients how to manage it, but also the families and everyone around them.”

Both Moulin and Trevino recognize addiction as a “disease” and emergency that needs to be normalized and emphasize the need to eliminate the stigma associated with substance abuse.

“Substance abuse is a treatable medical illness, and it’s life-threatening,” Moulin said. “So we just need to kind of normalize treatments so that people can feel safe to come in and disclose that they’re suffering, and we can offer help. There’s this myth that it’s a moral failing, which is demonstrably not true, and there’s this bias that we have in our society, and then compounded on that is the fact that it’s really the only medical disease that is also a crime.” 

In efforts to spread and normalize addiction as a medical illness, UC Davis Medical Center is collaborating with CA Bridge, a nonprofit organization with operations built around the Substance Use Navigation Program to provide support and treatment to all substance abuse patients. 

“Most medical providers do not view addiction treatment as part of their job, so people who use drugs are often stigmatized, sometimes treated for other conditions and sent on their way with a list of often inaccessible specialty addiction clinics,” according to the CA Bridge website. “Our goal is to transform addiction treatment by ensuring that every hospital in California provides 24/7 access to evidence-based care.”

Written by: Brandon Nguyen — science@theaggie.org 

Editor’s Note: An earlier version of this article contained language to describe addiction that is not in accordance with Aggie standards. The article has been updated, and we apologize for any harm caused. Writers and editors are trained in our sensitivity standards and will be reminded — if you have any questions, concerns or comments, please do not hesitate to reach out to managing@theaggie.org and editor@theaggie.org.

Through macrophages and bone cancer cells, researchers hope that the new 3D model will help them better understand osteosarcoma growth 

By MONICA MANMADKAR — science@theaggie.org

UC Davis researchers employ tissue engineering to study the interaction of macrophages, a special type of immune cell involved in the detection of foreign bacteria and tumors. There have been many studies that linked macrophages to osteosarcoma progression. In this study, researchers delved into how studying these macrophages could be a potential opportunity to develop immunotherapies. 

Given this understanding, the Leach Laboratory at the UC Davis Department of Orthopaedic Surgery created an artificial bone marrow model that could help them better understand osteosarcoma, a common type of bone cancer in children.  

Osteosarcoma begins to develop in the bone marrow but can spread to other bones around the body, especially around the knees and upper parts of the arms. With its treatment barely making progress, less than 25% of people with this cancer survive five years post-diagnosis. This cancer grows in a complex bone marrow environment, making it harder to study. Current models do not account for its key features and 3D structure. Hence, the researchers at the Leach Lab created an engineered bone marrow (eBM) to mirror the native bone marrow and study the tumor’s progression. 

“The eBM provides a 3D environment as opposed to 2D, which can greatly affect cell behavior, and since it can be maintained in vitro, it gives us a culturable way to control microenvironmental factors like oxygen tension,” Katherine Griffin, a dual doctoral of veterinary medicine and immunology candidate and a researcher at the Leach Lab, said. “There aren’t many models out there that are capable of this. It’s very novel to approach a cancer immunology question with a tissue engineering approach.”

The lab will use the eBM to study osteosarcoma cells with and without macrophages added. Macrophages are extremely important in creating the tumor’s environment and their addition can be related to disease development. Using dyes, the researchers will record the movement of the cells over time. 

“We are combining immune cells which would be commonly interacting with the tissues and adding macrophages that have different characteristics,” Dr. Kent Leach, a professor of orthopedic surgery and biomedical engineering at UC Davis, said. “Adding these different types of immune cells may be contributing to tumor growth, which is a new area in the fight against cancer.”

Leach hopes to create a combination of cancer biology, tissue engineering, immunology and patient care through his laboratory’s research and future work. 

Bringing immunology knowledge to the table, Griffin works as the main graduate student on the project although this is a combined effort between the faculty collaborators, Dr. Kent Leach, Dr. Steven Thorpe, Dr. Lor Randall and Dr. William Culp. 

Osteosarcoma is rare enough that clinical trials and other more common methods for cancer research are less effective at efficiently figuring out its biology. 

“The current model is only for mouse cancer cells hence [we] would like the eBM to translate to human and canine samples so we can really capture those natural populations and better understand patterns in osteosarcoma tumor progression,” Griffin said about their future research goals. 

Written by: Monica Manmadkar — science@theaggie.org