Death of a Simulator

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Death of a Simulator

• Kim Leighton, PhD, RN, CNE
• BryanLGH College of Health Sciences, Lincoln, NE

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. . . nurses are privileged to have the unique
and special opportunity to be present at the most
remembered events during ones lifeboth birth
and death. How you handle these situations will
always be remembered.
(Walsh Hogan, 2003, p. 890)
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Objectives

• Describe the three most common types of simulated
  death experiences
• Discuss issues and benefits related to simulated
  death
• Discuss the importance of proactive planning for
  the psychological safety of participants when
  there is expected or potential for simulator
  death

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Simulated Death Experiences

• Expected
• End-of-Life
• Unexpected
• Acute Respiratory Distress Syndrome (ARDS),
  Herniation Syndrome
• Result of Action or Inaction
• Blood Transfusion, ACS

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Faculty Concerns When Simulator Dies

• Wont see correct outcome of SCE
• Takes too long to restart simulator
• Dont have enough time to re-run SCE
• Might affect students feelings about learning
  with simulation
• Wont like coming to simulation lab

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Additional Concerns

• Feel like they killed the simulator
• Might think they didnt provide correct care
• Educator not comfortable talking about death
• Might hurt students psychologically, bring out
  buried feelings

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What Does the Research Say About Student Nurses
and Patient Death?

• Anxiety stems from feelings of personal
  inadequacy and limited clinical experience caring
  for dying patients (1, 2)
• Preconceived ideas/not prepared for reality,
  self-doubt leading to fear and anxiety, feel
  could have done more/did something wrong leading
  to guilt (2)
• Anxiety R/T shock over physical deterioration,
  feeling inadequate, not knowing how to
  communicate, making mistakes Sudden death more
  distressing than expected (3)

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What Do Practicing Nurses Say About Their EOL
Education?

• 75 of Australian nurses received neither
  adequate nor appropriate training to enable them
  to deal with death and dying (4)
• Survey 352 nurses, 66 rated knowledge of EOL
  care fair or poor (5)
• Survey 2300 oncology and generalist nurses, 62
  rated EOL education as inadequate (6)

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How Do We Prepare Them?

• 2 of nursing textbook content related to EOL
  care (7)
• Review of 50 top medical, surgical, psychiatry
  texts for 13 EOL content areas found helpful EOL
  info in lt 25, minimal coverage in 20, and no
  content in over 50 (8)
• In the UK, average 12.2 hours of EOL education in
  degree programs and 7.8 in diploma programs (9)
• Clinical experiences

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How Can Simulation Help?

• Experience death in a safe environment
• Pattern recognition for expected or adverse
  outcomes
• See consequences of actions or inactions
• Improve communication skills
• Increase comfort in caring for patient at EOL
• Do everything right sometimes patients still die
• Opportunity to talk about current or suppressed
  feelings

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Psychological Safety

• Debriefing is vital support, reassurance,
  guidance, knowledge (10)
• Qualitative study found personal reflections of
  loss, death, dying, and grief helped students
  deal with patient death and helped them deal with
  their own losses (10)
• Chaplain/Religious practitioner
• Psychiatric nurse practitioner
• Backup for the instructor
• Counseling opportunities

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Responses to End-of-Life Simulated Clinical
Experience

• I learned valuable ways of caring for dying
  patients.
• Students need more exposure to these
  situations.
• Made me realize I need more time to practice
  providing cares to the dying and their families.
• More realistic than just talking about it (and
  role playing).
• Demonstrated a real life-like event and the
  emotions and feelings that one might experience.

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Questions?

• Kim Leighton, PhD, RN, CNE
• Dean of Instructional Technology
• BryanLGH College of Health Sciences
• Lincoln, NE
• kim.leighton_at_bryanlgh.org
• 402-481-8713

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REFERENCES

• Beck, C. T. (1997). Nursing students experiences
  caring for dying patients. Journal of Nursing
  Education, 36(9), 408-415.
• Van Rooyen, D., Laing, R., Kotzk, W. J. (2005).
  Accompaniment needs of nursing students related
  to the dying patient. Curationis, 28(4), 31-39.
• Cooper, J., Barnett, M. (2005). Aspects of
  caring for dying patients which cause anxiety to
  first year student nurses. International Journal
  of Palliative Nursing, 11(8), 423-430.
• Mooney, D. C. (2002). Nurses and post-mortem
  care A study of stress and the ways of coping
  doctoral dissertation. Griffith University,
  Southport, Queensland, AU.
• Meraviglia, M. G., McGuire, C., Chesley, D. A.
  (2003). Nurses needs for education on cancer and
  end-of-life care. Journal of Continuing Education
  in Nursing, 34(3), 122-127.
• Ferrell, B., Virani, R., Grant, M., Coyne, P.,
  Uman, G. (2000). Beyond the supreme court
  decision Nursing perspectives on end-of-life
  care. Oncology Nursing Forum, 27(3), 445-455.

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REFERENCES (cont)

• 7. Ferrell, B., Virani, R., Grant, M. (1999).
  Analysis of end-of-life content in nursing
  textbooks. Oncology Nursing Forum, 26(5),
  869-876.
• 8. Rabow, M. W., McPhee, S. J., Fair, J. M.,
  Hardie, G. E. (1999). A failing grade for
  end-of-life content in textbooks What is to be
  done. Journal of Palliative Medicine, 2(2),
  153-156.
• 9. Lloyd-Williams, M., Field, D. (2002). Are
  undergraduate nurses taught palliative care
  during their training? Nursing Education Today,
  22(7), 589-592.
• Allchin, L. (2006). Caring for the dying Nursing
  student perspectives. Journal of Hospice and
  Palliative Nursing, 8(2), 112-117.
• Walsh, S., Hogan, N. (2003). Oncology nursing
  education Nursing students commitment of
  presence with the dying patient and the family.
  Nursing Education Perspectives, 2A, 866-890.