Ethical Consideration for Simulated Nursing Educational Training
Use of Simulators and Ethics
Simulation ethics is a framework used by educators and students who participate in simulated clinical experiences to define the correctness or incorrectness of their activities. The domains of this framework are beneficence and autonomy.
Simulation Training In Nursing Education
Simulation has become a growing component in nursing education both in schools and health care facilities. It is a constructive pedagogy, which has arisen out of a growth in technology, a decrease in clinical opportunities, and a shortage of nursing faculty. When the framework of ethics is applied to simulation, it raises issues related to patients, students, and the simulations.
Beneficence and autonomy as applied to simulation imply that patients should not be exposed to undue risk and should be permitted to determine who will care for them and what care they will receive. The majority of academic health care is delivered in large urban academic medical centers that care for a large portion of under served patients. The under served do not have many options for great care and are therefore in a place of limited choice.
The presence of large numbers of students seeking clinical experience in academic medical centers means that patients are at higher risk of receiving care from fewer than fully-qualified practitioners. These risks include multiple attempts at a procedure, increased discomfort, and unnecessary errors. The use of simulation for training reduces the number of experiences needed in the real world clinical settings and provides more accomplished and experienced students to the clinical area.
Beneficence is an important reason for the use of simulation in critical, high risk, low volume clinical situations. By preparing students and practitioners to deal effectively with each other in high risk/low volume occurrences, the likelihood of success and positive patient outcomes is enhanced. Also, the use of simulation permits the identification of errors and strategies used for error recovery. Many real world errors go undiscovered, whereas simulation based errors and recoveries are easily identified during debriefing and incident review. Thus, simulation permits educators to develop strategies to identify and prevent errors.
As a constructive pedagogy, simulation must be conducted in a transparent and reflective way. The debriefing process is a key component, which adds to learning, learning from mistakes and identification of opportunities enhances the learning and self-efficacy of the student. Constructive learning occurs when the student and teacher interact in a way that internalizes learning of external facts.The ethics of the simulation instructor is an important element. This person develops valid and appropriate scenarios.
In addition, he or she conducts appropriate debriefing and assessment, which will provide the student with insight and learning. The instructor treats students with respect and confidentiality. Thus, learning is a positive experience.Students have ethical requirements as well. They must maintain confidentiality of the scenario to assure the learning of others and be willing to suspend disbelief of the scenario as being authentic. Acceptance of the situation as reality is essential to the learning process. This places the burden on simulation creators to use authentic situations and responses presented in a realistic and engaging scenario.
Benefits of Simulation Training for Nursing Students
Simulation provides students with an opportunity to learn and practice in a controlled environment that closely reflects the realities and complexities of practice without-out the risk of causing harm to patients” (Ironside, Jefferies, & Martin, 2009, p. 333) . Patient autonomy and social justice rights are often violated in the pursuit of practitioner education. Simulation provides a beneficial outcome for the many underserved patients who are often the recipients of student care in large academic medical centers. Simulation brings improvements to the safety of patient care. Using simulation can help identify errors and how practitioners recover from errors.
This knowledge leads to changes in practice and process. These improved processes enhance patient safety.Simulation is often used to assist inter-professional practitioners to learn to communicate in a more effective manner. This improved communication increases patient safety and outcomes. By engaging in inter professional communication in both high and low risk simulations, and then reflecting on communication styles and effectiveness, practitioners learn new skills. Real world experiences do not always allow for this joint reflection on communication.
Educational Outcomes of Simulation Based Training
This pedagogy is evaluated in view of the needs of students and the effectiveness of the methodology. It is valuable in evaluating competency in procedures, decision making, and critical thinking by using methods such as role-playing, videos, and manikins (Jeffries, 2005, Piper & Czekanski, 2012) Ricketts (2011) believes that the primary goal of any simulation is to improve the safety of care and to help the learner achieve competence by applying theoretical knowledge to clinical practice. “The use of simulation wherever feasible conveys a critical educational and ethical message to all patients are to be protected whenever possible and they are not commodities to be used as conveniences of training” (Ziv, Wolpe, Small, & Glick, 2003, p. 783).
The question of what is appropriate for learning in simulation versus real clinical practice is still being debated. There is agreement that using simulation is appropriate in high-risk, low-volume situations and in situations where learners can practice basic skills without causing patient harm or discomfort. The question of how much simulation is appropriate and what is lost through simulation is still being determined. This is a question of benefit by providing the greatest good to the greatest number.Simulation does not provide the student with the variety of human encounters and human responses that are available in the real world.
Students do not enhance their ability to interpret the subtle clues conveyed by real life experiences. These subtle movements, facial expressions, and voice tones are not easily replicated. The ability to interpret factual signals is an important portion of competence in decision making and assessment (Watson et al. 2012). Therefore, the ethic of beneficence requires that careful monitoring of the use of simulation as a substitute for clinical experience is in place.
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