1. INFUSING ETHICS THROUGHOUT THE CURRICULM THROUGH THE USE OF SIMULATION Dawn Ferry, APRN, CNP, CHSE Director for the Center of Simulation & Computerized Testing Norma Brown, MSN, RN, CHSE Coordinator, Simulation and Clinical Learning Resource Center

2. There is no conflict of interest for either DAWN FERRY OR NORMA BROWN

3. OBJECTIVES To discuss ethical decisions as they might be presented in a simulated environment To apply an End-of Life scenario as an example of an ethical dilemmas

4. SIMULATION You are participating as the observers

5. Debriefing What are your thoughts?

6. Debriefing What could have been done differently?

7. Debriefing What other issues does this simulation help you reflect on?

8. Why ethics?

9. DEFINITIONS ETHICS---moral principles that govern a person’s or groups' behavior Ethics identify what should be done to live with one another in a civil society.

10. Ethical Principles AUTONOMY- self determination BENEFICENCE - doing good NONMALEFICENCE - do no harm VERACITY - telling the truth FIDELITY – faithfulness JUSTICE – fairness, equity

11. Ethics--didactic versus bedside reality

12. Ethical Simulation SENIORS- End of Life Course (Widener University) ▫AIDS patient

13. SOPHOMORE YEAR (The College of NJ) FIRST CLINICAL COURSE ▫ SKILLS!!!!! ▫ CRITICAL THINKING!!!!!! ▫ CARING!!!!!! ▫ PLUS ETHICS—OH MY!!!!!!!!! Starting the Ethical Process

14. Ethical Process Continues SENIORS (Both schools) ▫END OF LIFE—Hospice

15. Final Ethical Encounter SENIORS- End of Life Elective Course ▫AIDS patient ▫Putting it all together

16. Uniform Questions in Debriefing How did you feel? Did you have the knowledge and skills to work through the ethical dilemma? What would you do differently? What was the ethical dilemma?

17. Benefits to programs Students are put into an ethical dilemma and then have to figure out what to do Critical thinking ENHANCED Places ethics in a practical bedside setting within the safety of the simulation environment

18. Outcomes Students enjoyed it—student satisfaction Comments- ▫“patient was DNR and I found myself conflicted because I desperately wanted to do something to help the patient but respecting the patient’s last wish was more important” Sophomore TCNJ ▫“after this class...caring for those who have recently lost a loved one might be one of the hardest things I will ever have to do” sophomore TCNJ ▫“this was so real---we need to learn like this more---I felt like I was really telling the family that their grandmother had died and that the one family member did not understand DNR— WOW—that is really a skill to learn!” sophomore TCNJ

19. Outcomes continued Students were able to talk about their feelings and how they felt about the ethical issue.

20. Improvements Include junior students Firm up simulations and use across both curriculums Include ethics in a variety of simulation experiences Provide pre-simulation readings that foster discussion regarding ethical issues Include inter-professional groups Better capturing of outcomes

21. Lessons learned Sophomore students can see the ethical issue but are just overwhelmed by the skills and death frightens them This type of debriefing requires time and focused questions

22. References Clark, Sarah; McLamb, K. One Small Step for a Student Nurse, One Giant Leap to a Registered Nurse: Using Simulation to Assist the Transitioning Nurse Clinical Simulation In Nursing, Vol. 8, Issue 8, e400 Fink, Margaret; Linnard-Palmer, L; Ganley, B; Catolico, O; Phillips, W. Evaluating the Use of Standardized Patients in Teaching Spiritual Care at the End of Li Clinical Simulation In Nursing, Vol. 10, Issue 11, p559–566 Jeffers, S., Ferry, D. (2014). Nursing care at the end of life: A service learning course for undergraduate nursing students. Nurse educator, 39(6), 307-310 Sharpnack, Patricia; Goliat, L; Baker, J; Rogers, K; Shockey, P. Thinking Like a nurse: Using Video Simulation to Rehearse for Professional Practice Clinical Simulation In Nursing, Vol. 9, Issue 12, e571–e577 Wiseman, Allison; Haynes, C; Hodge, S. Implementing Professional Integrity and Simulation-Based Learning in Health and Social Care: An Ethical and Legal Maze or a Professional Requirement for High-Quality Simulated Practice Learning? Clinical Simulation In Nursing, Vol. 9, Issue 10, e437–e443