Ethical Reasoning Development through Disaster Simulation: SoTL in a Simulation Laboratory.

Transcription

1 Georgia Southern University Digital Southern SoTL Commons Conference SoTL Commons Conference Mar 29th, 3:00 PM - 3:45 PM Ethical Reasoning Development through Disaster Simulation: SoTL in a Simulation Laboratory. Erika Metzler Sawin PhD, RN James Madison University, sawinem@jmu.edu Follow this and additional works at: Part of the Curriculum and Instruction Commons, Educational Assessment, Evaluation, and Research Commons, Educational Methods Commons, Higher Education Commons, and the Social and Philosophical Foundations of Education Commons Recommended Citation Metzler Sawin, Erika PhD, RN, "Ethical Reasoning Development through Disaster Simulation: SoTL in a Simulation Laboratory." (2017). SoTL Commons Conference This presentation (open access) is brought to you for free and open access by the Conferences & Events at Digital Commons@Georgia Southern. It has been accepted for inclusion in SoTL Commons Conference by an authorized administrator of Digital Commons@Georgia Southern. For more information, please contact digitalcommons@georgiasouthern.edu.

2 Ethical Reasoning Development through Disaster Simulation: SoTL in a Simulation Laboratory Erika Metzler Sawin PhD, RN Sara Greco BSN, RN, Julie Sanford DNP, Erica Lewis PhD, RN & Alison Ames, PhD First iteration funded by James Madison University Madison Collaborative

3 By the end of this presentation, you should be able to: Describe the use of a disaster simulation for teaching undergraduate nursing students disaster nursing concepts Describe the use of a disaster simulation for teaching undergraduate nursing students disaster ethical reasoning Discuss application of SoTL practice in the simulation laboratory setting Discuss incorporation of university-wide objectives into a SoTL research project Examine student role in SoTL research initiatives

4 SoTL PROJECT BACKGROUND Foundational elements for SoTL project: Shared faculty/ student interest in disaster nursing Opportunity: International Network of Universities Disaster Nursing Workshop in Hiroshima Japan BSN Student: Senior Honors Capstone project Engaged Teacher Scholar Program Center for Faculty Innovation Faculty willingness to pilot

5 BACKGROUND: DISASTERS and SIMULATION The nature of disasters are unpredictable but inevitable. Yet, disaster preparedness education is scarce in nursing curriculums. Dichotomy of routine and disaster nursing is a cause for ethical dilemmas and moral distress. Simulations are a powerful learning tool, but little research has been done on the outcome of simulations on nursing students attitudes towards ethical reasoning. Fletcher, Justice, & Rohrig, 2015; Schmidt et al., 2011; Veenema et al., 2016

6 Nursing Role and Disasters: Nurses have an important role in disaster preparedness and preparation. Individual patient/ family care coordination Can be part of a multidisciplinary response team Triage - individual and population levels Epidemiology and rapid surveillance Community needs assessment Disaster communication response ethics Sheltering of individuals and families (Stanley, Farra, & Hassmiller, 2016)

7 BACKGROUND: CURRICULUM OVERVIEW BSN students Community Health Course Prerequisites: Adult Health (2 sem.) Gerontology content Psychiatric/Mental Health Women s Health Pediatrics - coreq

8 STUDY AIM To investigate how a disaster nursing simulation affected nursing students perceived ethical reasoning confidence. Utilize a structured debriefing session that utilized the Madison Collaborative s Eight Key Questions as a framework for ethical reasoning. Explore the effect of the intervention on students perceived importance of ethical reasoning and students perceptions of the Eight Key Question Ethical Reasoning Framework. Participants attitudes towards ethical reasoning were measured before and after the exercise.

9 Research Questions 1. How do disaster nursing simulations affect nursing students perceived ethical reasoning confidence? 1. How do disaster nursing simulations affect nursing students perceived importance of ethical reasoning? 1. How does application of the Eight Key Questions to ethical dilemmas faced in the disaster scenario affect nursing students outlook on The Eight Key Questions Ethical Reasoning Framework?

10 SIMULATION in NURSING: QUICK ORIENTATION Pre-class: Readings Pre-briefing Simulation lasted 15 minutes Developed using INACSL standards Debriefing

11 Methods: The Design, Sample, and Instrument Design: Pre/post survey Sample: Total of 90 students. 16 third-semester BSN students Fall 2015; 74 Spring 2016 Instrument: Survey of Ethical Reasoning Debriefing: JMU Eight Key Questions Approved by James Madison University Institutional Review Board

12 Methods: Simulation Design A train derailment has caused a toxic chemical spill in the neighborhood of Harrisonburg, VA. A group of nursing students on their way to clinical are the first to witness and respond to the disaster. 9 victims of the crash who are experiencing varying degrees of injury. Biochemical waste being carried on the train is no longer contained and poses a threat to individual and environmental health. Available resources are limited to the basic assessment and first aid supplies students have on hand for their day of clinical. It is expected to be approximately 30 minutes before additional help can arrive.

13 SIMULATION SPECIFICS S.T.A.R.T. Triage System Victim profiles 2 Fatalities (Mannequins) 1 Critical Care Pediatric Patient (Sim Baby) 1 Stable but Pregnant (Term) Mother 5 Standardized Patients (SPs) with varying degrees of injuries (Actors) One of the SPs will not speak English Multiple age groups represented

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18 We are grateful to: Lauren Mullen (Sim Lab Director), Brandi Burkhart (Sim Lab Manager), Rebecca Beam (SP Coordinator), and Nathan Spencer (Lab Tech), as well as the Standardized Patients

19 Results: SER Part 1 Ranking of Skills Table 1. Nursing Students Rank of Ethical Reasoning Importance Pre and Post Simulation Pre-Simulation Median Rank Post Simulation Median Rank Wilcoxon signedrank test (Z) Significance (P) < 0.001

20 Results: SER Part 2A Confidence and Importance Table 2. Nursing Students Mean Confidence and Importance Subscale Scores Pre and Post Simulation Pre-Simulation Mean Score Post Simulation Mean Score T-Test Significance (p) Importance Confidence <0.001 *N =90

21 Results: SER Part 2B Self - Reported Abilities to use the Eight Key Questions Table 3. Self-Reported Abilities to Use the Eight Key Questions (8KQ) Wilcoxon signed Significance rank (Z) (p) I can state from memory the 8KQ of ethical reasoning <0.001 When faced with an ethical situation, I can correctly identify the most relevant KQ I can weigh and balance the relevant KQ to make an informed decision I can apply the 8KQ ethical reasoning framework to aspects of my personal life I can apply the 8KQ ethical reasoning framework to aspects of my professional life I can apply the 8KQ ethical reasoning framework to aspects of my civic life < < < < <0.001

22 The Eight Key Questions Fairness : How can I act equitably and balance all interests? Outcomes: What are the short-term and long-term outcomes of possible actions? Rights: What innate, legal, and social rights apply? Character: What actions will help me become my ideal self? Liberty : What principles of freedom and personal autonomy apply? Empathy: How would I respond if I cared deeply about those involved? Authority: What do legitimate authorities expect of me? Responsibilities: What duties and obligations apply?

23 Methods: Debriefing Design Personal Reflection: Each student identifies an ethical dilemma from the simulation Group Reflection: Students share the ethical dilemmas they experienced Application of Eight Key Questions: Students collectively choose one of the ethical decisions they made, and discuss how the 8 Key Questions could have informed your decision. Practice/role playing: Discuss how the Eight Key Questions can be used to guide ethical decisions in the future Discuss application to professional and personal lives

24 Conclusions Discussion Increased ethical reasoning confidence and perceived importance of ethical reasoning show in one or more sections of SER Positive reception of Eight Key Question Ethical Reasoning Framework Limitations Non-random selection Uncertainty of lasting benefit Students prior exposure to 8KQ Recommendations Interdisciplinary simulation with other healthcare majors Compare to other ethical construct surveys Measure change over time Incorporate moral distress component to the study Consider a conflict resolution component to alleviate moral distress?

25 DISCUSSION - Increased evidence for simulation as a tool for development of ethical reasoning development - Incorporation/ application of ethical reasoning into their future patient care - Concern: Will students experience moral distress without skills to implement their ethically based decisions? - Faculty facilitated and role played hypothetical conversations - Students described conversations necessary for implementation of decision - Described clear communication strategies

26 SoTL/ Project Challenges Integrating with Simulation Lab schedules Conforming to student academic schedule Sustainability Community Health Instructor considerations Disaster education preparation Debriefing skills

27 ACKNOWLEDGEMENTS Madison Collaborative The Center of Assessment and Research Development JMU School of Nursing Simulation Director and staff International Network of Universities 2015 Workshop on Global Health and Nursing

28 PLEASE FEEL FREE to CONTACT ME: Erika Metzler Sawin PhD, RN Associate Professor James Madison University School of Nursing Faculty Fellow: Engaged Teacher-Scholar Program

29 References 1. Alger JR, Sternberger L, Goldstein B. The Madison Collaborative: Ethical Reasoning in Action. Quality enhancement plan for the Southern Association of Colleges and Schools Commission on Colleges. Harrisonburg, VA: James Madison University; Association of Women s Health, Obstetric & Neonatal Nursing. The role of the nurse in emergency preparedness. Nurs Womens Health. 2012;16(2): p. doi: /j x x. 3. Austin E, Hannafin N, Nelson H. Pediatric disaster simulation in graduate and undergraduate nursing education. J Pediatr Nurs. 2013;28(4): p. doi: /j.pedn Beam B. START triage basics. [Video]. Omaha, NE: University of Nebraska Medical Center; Available from: Accessed April 10, Best L. Ethically speaking. Nursing not as usual: Hazard preparedness in the workplace. Minn Nurs Accent. 2009;81(3): p. 6. Bremner M, Aduddell K, Amason J. Evidence-based practices related to the human patient simulator and first year baccalaureate nursing students' anxiety. Online J Nurs Inform. 2008;12(1):10p-10p 1p. Accessed April 10, Callister L, Luthy K, Thompson P, Memmott R. Ethical reasoning in baccalaureate nursing students. Nurs Ethics. 2009;16(4): p. doi: / Dreifuerst K. The essentials of debriefing in simulation learning: a concept analysis. Nurs Educ Perspect. 2009;30(2): p. Accessed April 10, Fairchild R. Practical ethical theory for nurses responding to complexity in care. Nurs Ethics. 2010;17(3): p. doi: /

30 10. Federal Emergency Management Agency. Preparedness. Published in Accessed April 10, Fletcher L, Justice S, Rohrig L. Designing a disaster. J Trauma Nurs. 2015;22(1): p. doi: /jtn Forneris S. Enhancing clinical reasoning through simulation debriefing: A multisite study. Nurs Educ Perspect. 2015;36(5): p. doi: / Friberg EE, Turner EP, Weepie, AKW. Public health nursing and the disaster management cycle. In: Stanhope M and Lancaster J, eds. Public Health Nursing: Population-centered Health Care in the Community. 8ed. Maryland Heights, MO: Elsevier Mosby; Grimaldi M. Ethical decisions in times of disaster: Choices healthcare workers must make. J Trauma Nurs. 2007;14(3): p. doi: /01.JTN b. 15. The Madison Collaborative. The eight key questions handbook. James Madison University Website. Published Accessed April 10, Hooper C. Ethics virtual patients: A new pedagogical tool for educators? J Med Ethics. 2015; 41(7): p. doi: /medethics Iacobucci T, Daly B, Lindell D, Griffin M. Professional values, self-esteem, and ethical confidence of baccalaureate nursing students. Nurs Ethics. 2013;20(4): p. doi: / IBM Corp. Released IBM SPSS Statistics for Windows, Version Armonk, NY: IBM Corp. 19. Johnstone M, Turale S. Nurses' experiences of ethical preparedness for public health emergencies and healthcare disasters: A systematic review of qualitative evidence. Nurs Health Sci. March 2014;16(1): p. doi: /nhs

31 References 20. Kaplan B, Connor A, Ferranti E, Holmes L, Spencer L. Use of an emergency preparedness disaster simulation with undergraduate nursing students. Public Health Nurs. 2012;29(1): p. doi: /j x. 21. Kimhi E, Reishtein J, Cohen M, Friger M, Hurvitz N, Avraham R. Impact of simulation and clinical experience on self-efficacy in nursing students: Intervention study. Nurse Educ. 2016;41(1):E1-E4 4p. doi: /NNE Lavoie P, Pepin J, Boyer L. Reflective debriefing to promote novice nurses' clinical judgment after high-fidelity clinical simulation: a pilot test. Dynamics. 2013;24(4): p. Accessed April 10, McLeod-Sordjan R. Evaluating moral reasoning in nursing education. Nurs Ethics. 2014;21(4): p. doi: / Priest C. Catastrophic conditions, tough decisions: The roles and responsibilities of nurse leaders in disaster settings. Nurse Lead. 2009;7: p. doi: /j.mnl Robinson E, Lee S, Zollfrank A, Jurchak M, Frost D, Grace P. Enhancing moral agency: Clinical ethics residency for nurses. Hastings Cent Rep. 2014;44(5): p. doi: /hasr Smith KL, Bashkov BM, Fulcher KH. Assessing attitudes toward ethical reasoning: Examining the factor structure of the survey of ethical reasoning. Harrisonburg, VA: James Madison University; Smith KV, Witt J, Klaassen J, Zimmerman C, Cheng AL. High-fidelity simulation and legal/ethical concepts: A transformational learning experience. Nurs Ethics. 2012;19(3): p. doi: / Smith SJ, Roehrs CJ. High-fidelity simulation: Factors correlated with nursing student satisfaction and self-confidence. Nurs Educ Perspect. 2009;30(2): p. doi: / University Hospitals EMS Training & Disaster Preparedness Institute. S.T.A.R.T. simple triage and rapid assessment. Published Accessed April 10, 2016.Weiner E, Irwin M, Trangenstein P, 30. Gordon J. Emergency preparedness curriculum in nursing schools in the United States. Nurs Educ Perspect. 2005;26(6): p. Accessed April 10, 2016.