Hpsn 2009 To Die Or Not To Die


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Presentation on using High Fidelity mannikin based simulation for curricula addressing death and dying in the health sciences. Presented at HPSN 2009 3/2009 in Tampa FL.

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Hpsn 2009 To Die Or Not To Die

  1. 1. To Die or Not to Die? That is the Question! Eric Bauman, PhD, RN, Paramedic Kim Leighton, PhD, RN, CNE
  2. 2. “. . . 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)
  3. 3. Disclosure  Eric is an education consultant for the Town of Madison Fire Department, Vernon Memorial Healthcare, and a Pfizer stockholder  Kim is adjunct faculty for METI, receiving honorarium for training and consultation
  4. 4. Objectives  Examine perceptions of simulated death experiences  Explore faculty concerns related to teaching students about death and dying  Identify the benefits of integrating simulated patient death experiences into clinical curricula
  5. 5. What is the Problem?  Should the simulator die?  Very controversial  Beneficial or harmful?  What should be considered when deciding whether to allow the simulator to die?
  6. 6. What Are YOUR Thoughts?
  7. 7. What Others Have Said. . .  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
  8. 8. 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
  9. 9. Simulated Death Experiences  Expected  End-of-Life  Unexpected  Acute Respiratory Distress Syndrome (ARDS), Herniation Syndrome  Result of Action or Inaction  Blood Transfusion, ACS, Medication Error, Failure to act - provide treatment
  10. 10. We Need TWO Volunteers!
  11. 11. 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 (Beck, 1997; Van Rooyen, Laing, & Kotzk, 2005)  Preconceived ideas/not prepared for reality, self- doubt leading to fear and anxiety, feel could have done more/did something wrong leading to guilt (Van Rooyen, Laing, & Kotzk, 2005)  Anxiety R/T shock over physical deterioration, feeling inadequate, not knowing how to communicate, making mistakes; Sudden death more distressing than expected (Cooper & Barnett, 2005)
  12. 12. 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 (Mooney, 2002)  Survey 352 nurses, 66% rated knowledge of EOL care fair or poor (Meraviglia, McGuire, & Chesley, 2003)  Survey 2300 oncology and generalist nurses, 62% rated EOL education as inadequate (Ferrell, Virani, Grant, Coyne, & Uman, 2000)
  13. 13. Medical Education Literature In a study of Internal Medicine Residents(8)  49.3% felt inadequately trained to lead a cardiac arrest  50.3% felt that standard ACLS training did not provide necessary team leadership skills related to resuscitation  40% indicated they received no additional training related to resuscitation beyond a standard ACLS course  52.15 felt prepared to lead a cardiac resuscitation - 55.3 worried they made errors  Residents felt unsupervised - No backup  Post event debriefing/feedback was lacking (Hayes, Rhee, Detsky, LeBlanc, & Wax, 2007)
  14. 14. How Do We Prepare Them?  2% of nursing textbook content related to EOL care (Ferrell, Virani, & Grant, 1999)  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% (Rabow, McPhee, Fair, & Hardie, 1999)  In the UK, average 12.2 hours of EOL education in degree programs and 7.8 in diploma programs (Lloyd-Williams & Field, 2002)  Clinical experiences  Medical Students lack educational experience related to delivering death notification and legal aspects of death investigation
  15. 15. How Do YOU Think Simulation Can Help?
  16. 16. 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 “Bad Pathology is Bad Pathology”  Opportunity to talk about current or suppressed feelings (Squire, 2006; Gee 2003)
  17. 17. Psychological Safety  Debriefing is vital: support, reassurance, guidance, knowledge (Allchin, 2006; Walsh & Hogan, 2003; Thiagarajan, 1992)  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 (Allchin, 2006)  Chaplain/Religious practitioner  Psychiatric nurse practitioner  Backup for the instructor  Counseling opportunities
  18. 18. Psychological Safety:Take Home Message Have a psychological safety plan in place prior to death and dying training
  19. 19. More Volunteers Please!!
  20. 20. NOW What Do You Think?  Should the simulator die?  What are the benefits?  How do we prevent potential harm?  What will YOU do?
  21. 21. 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.”  “We need to know if we can handle patients dying before our first day taking call”  “Gaining experience with death and dying earlier in medical school might have influenced my choices related to residency training”
  22. 22. Questions? Dr. Eric Bauman, Faculty Associate Department of Anesthesiology University of Wisconsin School of Medicine and Public Health Madison, WI ebauman@wisc.edu 608-263-5911 Dr. Kim Leighton, Dean of Educational Technology BryanLGH College of Health Sciences Lincoln, NE kim.leighton@bryanlgh.org 402-481-8713
  23. 23. REFERENCES Allchin, L. (2006). Caring for the dying: Nursing student perspectives. Journal of Hospice and Palliative Nursing, 8(2), 112-117. Beck, C. T. (1997). Nursing students’ experiences caring for dying patients. Journal of Nursing Education, 36(9), 408-415. 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. Ferrell, B., Virani, R., & Grant, M. (1999). Analysis of end-of-life content in nursing textbooks. Oncology Nursing Forum, 26(5), 869-876. 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. Gee, J. P. (2003). What video games have to teach us about learning literacy. New York: Palgrave MacMillian. Hayes, H.W., Rhee, A., Detsky, E., LeBlanc, V.R., and Wax, R.S. (2007). Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: A survey of internal medicine residents. Critical Care Medicine 35(7), 1668-1672. Lloyd-Williams, M., & Field, D. (2002). Are undergraduate nurses taught palliative care during their training? Nursing Education Today, 22(7), 589-592.
  24. 24. REFERENCES (cont) 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. 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. 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. Squire, K. (2006). From content to context: Videogames as designed experience. Educational Researcher. 35(8), 19-29. Thiagarajan, S. (1992). Using games for debriefing. Simulation and Gaming, 23(2), 161-173. Van Rooyen, D., Laing, R., & Kotzk, W. J. (2005). Accompaniment needs of nursing students related to the dying patient. Curationis, 28(4), 31-39. 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.