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Death of a Simulator Kim Leighton, PhD, RN, CNE BryanLGH College of Health Sciences, Lincoln, NE

“ . . . nurses are privileged to have the unique and special opportunity to be present at the most remembered events during one’s life—both birth and death. How you handle these situations will always be remembered.” (Walsh & Hogan, 2003, p. 890)

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

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

Faculty Concerns When Simulator Dies
Won’t see correct outcome of SCE
Takes too long to restart simulator
Don’t have enough time to re-run SCE
Might affect students’ feelings about learning with simulation
Won’t like coming to simulation lab

Additional Concerns
Feel like they killed the simulator
Might think they didn’t provide correct care
Educator not comfortable talking about death
Might hurt students psychologically, bring out buried feelings

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)

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)

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 < 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

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

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

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.”

Questions? Kim Leighton, PhD, RN, CNE Dean of Instructional Technology BryanLGH College of Health Sciences Lincoln, NE [email_address] 402-481-8713

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.
REFERENCES

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.

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