To Die or Not to Die?
That is the Question!
Eric Bauman, PhD, RN, Paramedic
Kim Leighton, PhD, RN, CNE
“. . . 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
How you handle these
situations will always be
(Walsh & Hogan, 2003, p. 890)
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
Examine perceptions of simulated
Explore faculty concerns related to
teaching students about death and
Identify the benefits of integrating
simulated patient death experiences
into clinical curricula
What is the Problem?
Should the simulator die?
Beneficial or harmful?
What should be considered when
deciding whether to allow the
simulator to die?
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
Might affect students’ feelings about
learning with simulation
Won’t like coming to simulation lab
Feel like they killed the simulator
Might think they didn’t provide
Educator not comfortable talking
Might hurt students psychologically,
bring out buried feelings
Acute Respiratory Distress Syndrome
(ARDS), Herniation Syndrome
Result of Action or Inaction
Blood Transfusion, ACS, Medication
Error, Failure to act - provide treatment
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, &
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)
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)
Medical Education Literature
In a study of Internal Medicine Residents(8)
49.3% felt inadequately trained to lead a
50.3% felt that standard ACLS training did not
provide necessary team leadership skills related
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)
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,
In the UK, average 12.2 hours of EOL education
in degree programs and 7.8 in diploma
programs (Lloyd-Williams & Field, 2002)
Medical Students lack educational experience
related to delivering death notification and legal
aspects of death investigation
How Can Simulation Help?
Experience death in a safe environment
Pattern recognition for expected or
See consequences of actions or inactions
Improve communication skills
Increase comfort in caring for patient at
Do everything right; sometimes patients
still die “Bad Pathology is Bad Pathology”
Opportunity to talk about current or
(Squire, 2006; Gee 2003)
Debriefing is vital: support, reassurance,
guidance, knowledge (Allchin, 2006; Walsh & Hogan, 2003;
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)
Psychiatric nurse practitioner
Backup for the instructor
Psychological Safety:Take Home Message
Have a psychological safety
plan in place prior to
death and dying training
NOW What Do You Think?
Should the simulator die?
What are the benefits?
How do we prevent potential harm?
What will YOU do?
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
Dr. Eric Bauman, Faculty Associate
Department of Anesthesiology
University of Wisconsin School of Medicine and Public Health
Dr. Kim Leighton, Dean of Educational Technology
BryanLGH College of Health Sciences
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Cooper, J., & Barnett, M. (2005). Aspects of caring for dying patients which cause
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