With her experience in the field as a nurse, Amy Cowperthwait knew that when the nurses she worked with at the University of Delaware entered the workforce, they were going to be faced with challenges — particularly in communicating with people.

“By just having them utilize plastic mannequins, we really weren’t preparing them to enter the clinical arena very well,” she said. “It was really a desire to get them not just focusing on the skills and tasks that they need to do, but also on the communication and the empathy and what we call ‘the art of nursing.’”

That desire pushed Cowperthwait to reach out to the university’s theater department to see if a few actors might be able to act as patients and family members.

Allan Carlsen, a professor of theater, got four students together for an independent study program to test the idea.

“After we did our first semester simulation, which was two weeks in the middle of the fall semester of 2009, he looked at me as we were leaving and I was so happy. It just was exactly what I was looking for,” Cowperthwait recalled. “And he said, ‘This is going to become a boiling pot that you’re going to have a hard time putting the lid on.’ And at the time, it was definitely foreshadowing, because it’s taken off like a rocket.”

“It” is Healthcare Theatre, an interdisciplinary project at the University of Delaware that combines acting and health sciences.

Following its debut nearly a decade ago, the program now works with UD programs — like the schools of nursing, psychology, nutrition and EMS — and outside companies like Nemours, A.I. DuPont, Christiana Care Health System, New Jersey Academy of Family Physicians, Beebe Medical Center and more.

The course, which consists of three hour classes that combine film, text, observation, improvisation and experiential learning, prepares students to act in simulated health care settings and allows for the assessment of medical and communication skills of other in-training health care providers.

The actors are selected through an audition process. Classes have approximately 20 to 25 students, in which students put in about 32 hours of acting time. During each class, the actors portray patients and interact with nursing students and outside health care professionals.

“Theater is a collaborative art form, and it’s made up of a lot of human beings who are all working toward one purpose: basically, to put on the show, to convey a message,” Carlsen said.

When Kathy Matt, dean of the College of Health Sciences, came to the university in 2009, she heard of a presentation that would demonstrate what Healthcare Theatre endeavored to do. She decided to see what it was all about.

“You could just see how powerful it was and how important it is to have people practice this — not only the skills of being able to do blood pressure or how to work with the patient and get them out of bed, but then how do you do this when you work with patients and some are happy to do it and some are not?”

In the decade since, Matt said she has been a huge proponent of the program.

“I think it is a great way for our health care professionals to actually learn how to work together as a team, but also sort of hone their skills in communicating with patients and family members, and all of that is sort of critical for us to really get to good health outcomes,” she said.

Carlsen noted that Healthcare Theatre was born during a time where these person-to-person skills didn’t seem like they were important in health care.

“With just better communication skills between the provider and the patient, you’re going to have better outcomes and more successful outcomes,” he said.

Matt, whose background is as an neuroendocrinologist, said that they have done studies on the effectiveness of this program.

“You look at this and sort of think it’s all theater, and it’s all simulation,” she said. “For the people involved in it, when they come into this scenario, it becomes very real.”

Looking at stress hormones, Matt said it is clear the students take it seriously. Studying cortisol levels also helps determine when is best for the students to be debriefed on how they did in the session.

“There’s a lot of science that goes into thinking about how do we do this and do it in the most effective way,” she said.

Healthcare Theatre also gave way to Avkin, a business that specializes in wearable technology to curate patient-centered simulations. That collaboration included the School of Engineering to create the products.

“If you think of like a patient with a tracheostomy, I can’t cut holes in my students’ necks and have them be a tracheostomy patient, but we began creating products to put on top of them, so that they could portray a patient and act like a patient,” Cowperthwait said.

An overlay, which is placed on the actor, is designed to give a very realistic experience for the students.

“It’s so real, it just freaks everybody out,” Carlsen said. “But guess what? It’s safe.”

Since the success of the program has taken off, representatives travel throughout the country and into Canada to talk about Healthcare Theatre and give advice on how other universities can start their own programs.

“We’re not the only program that wasn’t happy with a mannequin. Other people had a problem,” Cowperthwait said, noting that about five institutions are starting a Healthcare Theatre program this year. “Our program is so unique, because not only is it something where they’re academically learning, but we’re seeing this huge side benefit of them applying what they’re learning as far as their communication skills. Their confidence is growing because they’re taking this course.”

Matt added that health care leaders looking at transforming primary care practices throughout the state worked with Healthcare Theatre.

The students created a scenario that depicted a patient’s difficulties getting aid.

“What happened was, everybody sat and watched this scenario play out, and they could all agree this is not what should happen,” she said.

When they moved into the discussion portion, Matt said that each health care representative was more open to fixing the problems presented.

“As we were discussing it, they could refer to the scenario that they saw, they could all identify with it and they could actually identify with the people having all these challenges,” she said. “It gets to a different place. It sort of makes everybody open to change. Nobody had to defend their own offices.”

Carlsen called the program life-changing. He noted that in his acting classes, he always tells the students that, of course, they’ll learn about theater, but they’ll also learn about themselves, about public speaking and how to be a better communicator.

“That’s not just in school, or at your job, or your job interview, but with your children, your parents and your loved ones, significant others. If the whole world were better communicators, we’d all be better off,” he said. “Healthcare Theatre is the poster child for inter-professional education and interactive education. People that go through this and come out the other side always say it was just transformative.”

Cowperthwait said that, at first, she thought that the program would only benefit her nursing students’ professional education.

“In the end, it actually was something that was so much more powerful,” she said. “The true definition of inter-professional education is that you’re learning from, with and about each other. And really what is happening with this Healthcare Theatre program. It’s the ‘from, with and about’ that really hits home.”

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