Continuum

A new state-of-the-art building brings nursing students into the 21st century.

~In 1863, when Florence Nightingale journeyed to the Crimea to nurse injured British soldiers fighting the war there, she was appalled at the deplorable conditions in which her patients languished. “The hospitals were dark, the windows were wet and dark—it was really a breeding ground for infection,” explains University of Utah nursing student Ryan Harvey. “She went in and opened up the windows and the doors, let in the light and fresh air, and made it a much better place for healing.”

The first time Harvey stepped into the newly renovated College of Nursing’s Annette Poulson Cumming Building, he says, “I thought about this new building and how it opens up to let in so much light, and it reminded me of her.”

For four decades, nursing students have mastered the art of healing in the University of Utah’s familiar College of Nursing building. But in August 2010, after two years of taking classes in temporary locations during the building’s renovation, nursing students reentered an utterly new home. The transformation from that dark, brick building with its maze of dim hallways into a structure of glass, light, and open space would have dazzled even Nurse Nightingale.

“The opportunity to renovate this building,” says Maureen Keefe, Louis H. Peery Endowed Chair and dean of the College of Nursing, “was to say, ‘Let’s dream about what the future of nursing education should look like,’ and then design that into the building.”

That dream comprised three main objectives. One was “to create more faculty and staff workspace that was appealing and inviting,” says Keefe. With people stacked three and four to an office, cramped research space, and little natural light, the building—though considered stately in its day—no longer served to entice top-notch faculty to the college. “We have a faculty shortage nationwide,” Keefe explains. “We really need to attract other top talent from around the country to keep our faculty strong.”

The second objective led to stripping the building down to the studs. “The infrastructure was so outdated that we had to replace everything,” says Keefe. “Not only did we have to structurally reinforce the building [for seismic stability], but the wiring was so old—and the heating and cooling system and the ductwork—that they had to take out all the infrastructure and put all new in.”

Left: Adjacent to the student services department and a computer lab is the student lounge, which offers comfortable couches and café tables for individual or group study. Middle: Internationally renowned Utah artist and color theorist Anna Campbell Bliss custom designed paint shades to create a sunrise effect in the building's stairwell. Right: A glass balcony on the building's fifth floor gives a sense of connection between research and administrative teams.

Thanks to a generous $5 million lead gift from U of U supporter Ian Cumming (see sidebar) to name the building for his wife, Annette Poulson Cumming BSN’68 MBA’83—along with a donation from partner Intermountain Healthcare, and State funding—the renovation began in December 2008. Because of the onset of a recession and the resulting downturn in construction, dollars stretched farther than originally expected, allowing the design to incorporate additional hoped-for features. Keefe says, “It gave us a chance to look at how we could create a sustainable, open, light, energy-efficient building as we put it back together.” Originally planned to meet silver LEED certification, Keefe says the enhanced design may qualify for the gold certification level.

As important as the infrastructure and faculty work space are, they weren’t the renovation’s primary objective. “The first goal was creating a better learning environment for the students,” says Keefe.

Because the nearby Health Sciences Building provides adequate classroom space, “We could repurpose and redesign the function and flow of this building,” Keefe explains. That meant more room for research areas, as well as open, collaborative work spaces for professors and students.

It also meant there would be room for the building’s centerpiece: the new Intermountain Healthcare Simulation Learning Center, a 12,600-square-foot simulated hospital environment occupying the entire first floor.

“When I was educated as a nurse, we’d go into the skills lab and practice with a syringe injecting an orange, but nursing education has evolved since then,” says Keefe. “A nurse has to know a lot more about sophisticated technology and computers, such as the digital monitoring that’s there by the patient and the bedside computer. So how do you balance all this technology in health care delivery with the human touch, with the person in the bed?”

The building's auditorium was reconfigured, adding glass panels that allow more natural light to flood the space. The five-story facility now features large areas of glass throughout the facade.

The Simulation Learning Center, under the direction of clinical instructor Carolyn Scheese MS’07, with curriculum managed by Assistant Professor Allen Hanberg, is a state-of-the-art teaching environment that tackles that very question.

Stepping into the Basic Preparation Studio, which occupies the western half of the Simulation Center, is like entering a typical surgical ward, complete with a nurses’ station, 20 high-tech hospital beds (which resemble regular beds in the way the space shuttle resembles a go-kart), bedside computers, digital monitors, and wheeled cabinets of equipment and supplies.

In the Advanced Preparation Studio on the eastern side of the floor, nursing students use the technology and equipment in six intensive care rooms to handle critical-care scenarios. Two rooms open to form a pediatric/obstetric room, with a birthing bed and an infant Isolette.

Completing the realistic picture, every one of the beds in both studios is occupied by a life-size computerized mannequin.

“We try to make this as real as possible,” says Sue Chase-Cantarini MS’95, assistant clinical professor and faculty facilitator in the Simulation Learning Center. The mannequins, she notes, “can cry, cough, sweat, and have drainage from their ear, nose, or mouth. They have pulses in seven places. Vomit doesn’t come out, but they make the retching noise. [The mannequin] can have liver failure, diarrhea, pain, seizures, bleeding wounds, or we can make it react physiologically to any intervention. It can urinate on command, or dribble. It has heart sounds, lung sounds, and bowel sounds.” The mannequins come in various shapes, sizes, ethnicities, and ages, including child- and infant-size.

One of the mannequins even gives birth to a baby mannequin.

No one, especially not the professors, expects the Simulation Learning Center to replace the reality of working with actual patients in a live hospital setting. The Learning Center can’t supplant clinical experience. What it can do is focus learning in controlled scenarios, so nursing students experience diverse situations that may not happen when shadowing a nurse in a real hospital. As first-year nursing student Allie Zimmerman explains, “The hospital setting will always be different. It’s really fast-paced, and you don’t have time to go to the debriefing room to talk about what you didn’t understand.” The Simulation Learning Center complements the clinical experience, because it “makes you think more about the pathophysiology of the patient,” says Zimmerman. “It really challenges your learning. The mannequin asks questions, making you think about what you need to know and what you need to tell this patient. I think sometimes that gets missed in the clinical setting because you’re just trying to keep up.” Zimmerman appreciates the professors’ approach, too, when they say, “Go in there and try it. And if you make a mistake, that’s great. Next time you’ll go in and do it differently.”

Such cutting-edge, high-tech/high-touch training is attracting more than just nursing students to the new building. Intermountain Healthcare donated funding to create the Simulation Learning Center not just to train future nurses, but also because the healthcare giant believes the training center can help working professionals. “They want to send their teams of nurses and physicians here to experience better team training,” says Keefe. She sees the center becoming a resource for professionals from University Hospital, Intermountain Healthcare, the Veterans Affairs Medical Center, and all of the College of Nursing’s partners, both on campus and in the community, for team training, recertification, and continuing skills training.

Bliss envisioned the building's main floor as an Italian galleria, with smaller rooms flanking a spacious atrium. Installations representing the four elements adorn the walls outside the classrooms.

Just inside the Basic Preparation Studio hang two paintings, “Man” and “Woman,” created by artist Anna C. Bliss, who provided several striking paintings and design features for the building’s renovation. The two canvases depict figures wrought in geometric lines, resembling the wireframe used to model figures in computer animation. But these representations have energy and movement that grant the figures life. According to Katie Schrier BA’98, manager of public affairs for the College of Nursing, Bliss “wants to remind students that as technology continues to give them newer and better ways of doing things, they can never lose touch with human compassion and the human element.”

Echoing that message, the college’s beloved sculpture of Florence Nightingale, created by noted sculptor Avard Fairbanks in 1979, now stands in her place of honor in the open area between the Basic Studio and the Advanced Studio. With her marble lamp held high, she is poised to welcome a new generation of nursing students into the healing light of the new Annette Poulson Cumming Building.

—Kelley J.P. Lindberg BS’84, a freelance writer based in Layton, Utah, is a frequent contributor to Continuum.

A Nurse’s Gift

As Annette Poulson Cumming’s 60th birthday approached, her husband, Ian Cumming, faced a common husband’s dilemma: What kind of present to get your wife that is truly unique?

Ian, chair of the board and former CEO of Leucadia National Corp., had the means to do something extraordinary, so he did,  choosing to give her a legacy—a gift to the next generation of nurses, and, at the same time, one to the community. At a birthday dinner party for Annette, surrounded by family and friends, Ian announced a $5 million gift to the University of Utah’s College of Nursing for the renovation of the building that now bears her name.

Annette Poulson Cumming and her granddaughter Quinn with a mannequin used in the Simulation Learning Center.

In 1968, Annette graduated with a nursing degree from the U, just months before the College of Nursing moved into its now-familiar campus building. “I never attended classes in the old building, but I did go to meetings and other things there, so I knew it well. It was a dark and foreboding environment—that was the style at that time,” she says of the structure that nurtured four decades of nursing students. “What’s incredible is that they’ve learned so much about architecture since then, and now this building can be one of the jewels on the whole campus.”

Annette’s nursing career and her interest in the business aspects of nursing propelled her to hospital leadership positions, an MBA, and positions on boards and foundations dedicated to improving the health and lives of people, especially women, around the world. In 2000, Annette and Ian established the Annette Poulson Cumming Presidential Endowed Chair in Women’s and Reproductive Health; they have also endowed a chair in dermatology and donated a patient room at University Hospital. Active on the College of Nursing’s fundraising board for two decades, Annette was instrumental in helping the college become one of the first with a community outreach board. Ian, in turn, was a founding member of the John A. Moran Eye Center’s Advisory Board and served as campaign chair for the C. Roland Christensen Center at the David Eccles School of Business (and remains a member of its advisory board).

Annette’s commitment to nurses and their education remains unwavering. “It’s very often a thankless job,” she says of nursing, and yet, “a lot of what I think are my attributes now are things I learned as a nurse.” In 2001, the University of Utah awarded her an Honorary Doctorate of Humane Letters.

Thanks to Annette and her husband’s generosity, future nurses will be able to build on those attributes, ensuring a healthier future for our communities.

Web Extra

As a faculty facilitator for the Simulation Learning Center, Sue Chase-Cantarini MS’95 gets to play the Wizard of Oz. From a hidden control room, she monitors students as they navigate through pre-determined scenarios. Using computers, she manipulates the mannequins, changing their blood pressure, giving them heart arrhythmias, or triggering any number of other conditions. Via a voice-changing microphone, she speaks through the mannequins, responding to students’ actions and questions. Sometimes actors join the scenarios, playing worried family members as the students juggle physical tasks like inserting a catheter or administering medication, along with the psychological tasks of calming the patient and relatives.

Afterwards, Chase-Cantarini meets with her students in a debriefing room, reviewing videos and discussing successes, challenges, and performance gaps, and reflecting on their experience in each scenario.

One of the Simulation Center’s goals, says Chase-Cantarini, “is to make it a very safe environment for students to make mistakes, discover new skills and techniques, and learn from watching each other. We make it safe for the patient and safe for the student. They’re learning that they can feel safe to speak up and share new learning strategies in a nonjudgmental way.”

Harvey, in his second year in the College of Nursing, agrees: “There can be a level of fear and anxiety when you walk into a hospital for the first time, not knowing where things are and how they’re laid out. There are sights, sounds, smells, and other things you don’t normally experience in everyday life. When you throw in the human element and you don’t know what to expect, it can be extremely overwhelming the first time. The Simulation Learning Center, with its actors and mannequins and technology, helps students get over that. It lets them practice in an environment where they can make mistakes and not have the consequences. Everybody makes mistakes when they’re new. To make those mistakes in a safe environment is invaluable.”