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The keyword is collaboration. At the beginning of the 2022-23 school year, a new educational partnership between 91�ֿ� and Geauga County’s Berkshire Local School District took shape with the opening of the new pre-K-12th-grade Berkshire school building on the 91�ֿ� Geauga Campus in Burton. Effectively creating shared resources and enhanced learning opportunities for all students along life’s timeline, PRIME (Partners in Rural Innovative Models of Education) is the guiding principle behind the innovative K‐16 approach toward education in Geauga County.   

As the first semester under PRIME drew to a close, the concept was put to the test by turning an otherwise routine nursing simulation exercise for 91�ֿ� Geauga nursing students into a dramatic experience for both the nursing students and also for some Berkshire High School theater students. 

First, we must set the scene. Nursing simulations are course requirements that have been incorporated into the 91�ֿ� College of Nursing curriculum for many years. They place nursing students in lifelike simulated situations where feedback can be given in real time, usually using a Sim-Man, which is a  computerized manikin (not to be confused with a ) possessing lifelike features. The Sim-Man is preprogrammed with certain physical ailments that nursing students must ‘diagnose’ and ‘treat’ using concepts they have learned in the classroom. 

However, one day in November 2022, junior nursing students in the Medical-Surgical (Adults) course of Lecturer Jessica Larubina MSN, CMSRN were challenged to interact with real people, not manikins. Theater students from Berkshire High School were tasked with improvising certain end-of-life scenarios so the nursing students could test their clinical skills and know-how under pressure. The goal of the experience was to meet course objectives through live interactions, with the actors playing off of each other as if in a real clinical situation.  

Nursing students were expected to… 

• Recognize signs and symptoms of imminent death in a dying patient 

• Identify the differences between hospice and palliative care 

• Perform appropriate end-of-life care with a dying patient 

• Apply therapeutic communication techniques when caring for a dying patient and their family 

Wayne Nieh is a third-year BSN student at 91�ֿ� Geauga who underwent this live simulation to gain more hands-on clinical experience, practice therapeutic communication strategies, and apply critical thinking skills while working with a classmate as a team.  

Calling this live simulation “very unique,”  he says that this experience helped him and his partner to better understand and connect with patients receiving end-of-life nursing care, including symptom management, therapeutic communication, and family-centered care. 

Surprised by the emotions stirred up by the human interaction, Wayne says, “I felt saddened, uncomfortable and afraid to say the wrong thing throughout the simulation. However, this experience allowed me to carefully choose words and confront my own intense emotions when providing comfort care to the patient. The most important lesson that I learned was to honor the patient’s wishes (Advance Directive) and to deliver high-quality nursing care with empathy and charity.” 

Void Spanos is a junior at Berkshire High School who learned about this acting opportunity through the director of Berkshire’s fall play. Void has acted in several plays and musicals, most recently portraying Abram van Helsing in “Dracula” on stage.  

Void explains, “This simulation was less about treating a patient, and more about dealing with people who are stressed, angry, or upset. I was especially interested in it as a way to practice more improv and interactive things, which I haven't done as much of. We were given some suggestions of questions to ask and personalities for our characters, but it was mostly unstructured.” 

Overall, Void says, “I think it was a good learning experience for both me and the nursing students. I would definitely do it again if I had the opportunity. It gave me more perspective on all the stuff that medical professionals have to deal with.” 

Wayne agrees: “I truly appreciate the high school actors, and they performed very well. I believe a live simulation experience is an effective method for simulation protocols in some instances instead of using a manikin. While our manikin is wonderful for simulation experiences that require changes in a patient’s clinical condition, for this specific type of experience, the students needed to use therapeutic communication techniques that are often hard to deal with. Exposing them to these experiences now can assist them in handling them in real-life clinical situations.”  

Lecturer Larubina adds, “The students did a great job with guidance and coaching. This was the first time we utilized high school theater students, therefore some adjustments may be made for future simulation experiences, but we would love to collaborate further with Berkshire.” 

This collaborative project between the College of Nursing at 91�ֿ� Geauga and Berkshire was facilitated by BSN coordinator Melissa Owen, MSN, RN, BSN. She reached out to the principal and staff at Berkshire to seek and identify willing student volunteer actors, then met with the students to provide guidance for the simulation. 

Ultimately, all involved express that this learning experience was enlightening and beneficial to students at both Berkshire and 91�ֿ� Geauga. This collaborative simulation brought the educational community together to enhance deeper understanding and mutual respect among students at different levels of education and areas of interest. It was a prime example of potential realized by PRIME. And it’s just the beginning.