When The Simulator DiesExperiential Education about Death Designed for Undergraduate Nursing Students
Kelly Foltz-Ramos, PhD, RN, FNP-BC, CHSE, RHIA; Deborah Raines, PhD, EdS, RN, ANEF, FAAN; Jessica Castner, PhD, RN, AEN
Introduction• Education on death has been identified as a deficiency for
many nursing students and practicing nurses Without
proper training on how to handle and cope with patient
death, experiencing death in the clinical setting can cause
a significant emotional struggle for the practicing nurse
• Insufficient education on death, dying, and end of life care
in the pre-licensure period for a nurse can lead to a
decrease in the level of patient care and increased
turnover of recent nurse graduates.
MethodsDESIGN
• Participants were randomly assigned to either a rescue
or failure-to-rescue simulation followed by debriefing.
Data was collected before simulation, following
simulation and following debriefing.
PARTICIPANTS
• Senior nursing students participated as part of their
clinical course.
PROCEDURE
• Students participated in a scenario with a patient with
chronic heart failure who went into respiratory distress..
OUTCOME MEASURES
• Knowledge assessment
• Emotional Assessment
• Satisfaction and Self-Confidence in Learning
STATISTICAL ANALYSIS
• Descriptive statistics
• Independent samples t-tests, Two way ANOVA
Results
Conclusion
References1. Corvetto, M. A., & Taekman, J. M. (2013). To die or not to die? A
review of simulated death. Simulation in Healthcare, 8(1), 8-12.
2. Foronda, C., Liu, S., & Bauman, E. B. (2013). Evaluation of
simulation in undergraduate nurse education: An integrative review.
Clinical Simulation in Nursing, 9(10), e409-e416.Duis vitae tincidunt
tortor, vitae sollicitudin magna
3. Leighton, K. (2009). Death of a simulator. Clinical Simulation in
Nursing, 5(2), e59-e62.
Contact [email protected] for more information
• Simulation is an effective method to teach undergraduate
nursing students about death.
Nursing students and faculty in simulation.
Table 1. Participant characteristics (N=127)
Rescue Failure-to-Rescue P value (t-test)
Sample (counts) 63 64
Age (mean ± SD) 24.11 ± 4.69 24.83 ± 4.35 .380
Gender (male/female) 6/57 9/55 .288
Previous employment in healthcare
(yes/no)
45/18 47/17 .802
Types of healthcare setting
(counts)
Outpatient
Acute Care
Nursing Home
Home Care
EMS
Multiple Settings
Other
8
18
6
4
1
5
3
7
17
7
4
0
9
3
.427
Experience with death and dying
(counts)
Family Member
Patient in clinical
Patient at work
More than one
None
20
1
2
24
15
33
3
4
17
7
.618
Figure 1. Knowledge gain over time. Figure 2. Emotional affect over time.
Results
• A total of 127 nursing students participated in the simulation. There were no baseline differences between
student demographics.
• Rescue and failure-to-rescue groups had baseline pre-test knowledge scores that were not significantly
different and both groups had a knowledge gain that was not significantly different.
• Analyses showed a significant difference in emotion over time and between the rescue and failure-to-rescue
groups. Directly following simulation, students in the failure-to-rescue group had significantly more negative
emotional affect. Following debriefing, there was no significant difference in emotional affect between the
rescue and failure-to-rescue group.
• There was no significant difference in satisfaction and self-confidence in learning between groups.
Nursing students assessing a patient in simulation.
Discussion
• Debriefing following the failure-to-rescue scenario first
addressed patient death, allowing students to learn about
handling death and self-reflection. Students were able to
stabilize emotions and retain knowledge equal to that of
the rescue group.
• Students in both groups gave high ratings for their
satisfaction and self-confidence in learning following
simulation. While simulation can be stressful, students
appreciate the experiential learning gained where they
can put to use what they learn in the didactic setting.
