Using Simulation to Train Nurse Residents on Bedside Legal Ethical Dilemmas
Other Titles
Using Simulation to TrainAbstract
Problem: Nurse residents at a medium-size urban medical center reported a gap in knowledge on how to handle legal-ethical issues at the bedside. Objective: To develop a sustainable approach to integrate legal-ethical simulations into a nurse residency curriculum. Methods: In this quality improvement project, classroom content on ethics was replaced by a ten-minute presentation followed by two simulations depicting legal-ethical dilemmas at the bedside. The project leader designed the two legal-ethical simulations using a format consistent with the NLN/Jeffries simulation design. The topics of the simulations were cancer and pneumonia. The simulations for the first nurse resident cohort (N=9) were directed by the project leader; after training, the nursing residency coordinator directed the second cohort (N=19). Targeted training for nurse educators was also developed. Prior to and after the simulation, students completed a ten-item test to measure legal-ethical knowledge. Immediately after the simulation, students also completed the Student Satisfaction and Self-Confidence in Learning questionnaire, a 13 item Likert scale, 1= strongly disagree to 5 =strongly agree. Results: Comparison of pre and post legal-ethical knowledge scores showed a statistically significant increase in scores (Wilcoxon Signed-Rank Test p < .001, effect size medium to strong, r = .48). Scores for the Student Satisfaction and Self-Confidence in Learning showed consistency. There were no significant differences in scores between cohorts (Mann-Whitney U =256, z= 1.39, p= .1, two tailed) or between simulations (Mann-Whitney U= 371, z= 0.11, p= .9 two tailed). Implications: Providing nurse residents with a ten-minute presentation and two simulations appears sufficient to refresh knowledge of basic legal-ethical concepts. Satisfaction and self-confidence scores were high after each of the two simulations, suggesting that their implementation in the residency program could assist in filling the reported knowledge gap.Keyword
nurse residency programsEducation, Nursing
Ethics, Nursing--education
Simulation Training--methods