A scoping review of the integration of ethics education in undergraduate nursing high-fidelity human simulation-based learning

Educational needs for virtual reality-based simulation training in the nursing care of adult respiratory patients: an explanatory sequential mixed-methods study

BACKGROUND

We aimed to ascertain the current state of and needs for virtual reality (VR)-based simulation training in the care of adult respiratory patients. Learning to care for patients with infectious respiratory disease is crucial in nurses' practical education. Thus, studies on the state of VR-based simulation-training are required.

METHODS

We used an explanatory sequential mixed-methods design. The sample included 122 new nurses at two advanced general hospitals and five educators at a nursing college. The educational needs of virtual reality-based simulation education were measured by the tool developed in this study. Research data were collected from August 31 to September 26, 2022. Quantitative data were subjected to a descriptive analysis, while qualitative data were subjected to content analysis.

RESULTS

The new nurses in this study had a mean age of 24.51 years and total clinical experience of 11.18 months; 82.8% of the participants had experience in adult respiratory patient care, and 94.3% were aware of the need for this training. In the qualitative data analysis of six new nurses, all participants had experience with simulation training and were aware of its need. Moreover, all participants wanted repeated VR-based simulation training using real clinical cases. Regarding the qualitative data analysis of five nursing college educators, most of them had experience providing and receiving simulation training, and they were aware of its need in caring for respiratory patients. They reported the need for VR learning spaces that reflect the clinical environment, alongside sufficient duration and frequency of learning. Our findings could help develop simulation training programs for nursing students to assist adult respiratory patients.

CONCLUSIONS

We provide a basis for developing VR-based simulation training for respiratory care by studying the current state of and demand for nurses' VR-based simulation training. The results can contribute to improving the quality of nursing for adult respiratory patients.

Fostering Moral Resilience: Evaluating a High-Fidelity Ethics Simulation With Prelicensure Nursing Students in Their Practice as New Graduates

BACKGROUND

Despite the high prevalence of moral distress in nursing, empirical evidence is lacking about the best educational approaches to foster moral resilience.

PURPOSE

This study evaluates the effectiveness of an ethics simulation in a prelicensure program, 6 months into nursing practice.

METHODS

We used an exploratory design, including 2 instruments and open-ended questions. One instrument measured moral distress, the other measured moral resilience. Alumni who participated in the simulation were compared to alumni who received didactic teaching only.

RESULTS

Six months into practice, the quantitative data from this study did not show a statistical significance between those who received didactic training only and those who received a simulation, except for one element of the moral resilience scale (relational integrity), in which the control group had a higher score. Open-ended questions confirmed that alumni recognized the positive impact of the simulation in practice.

CONCLUSIONS

Further study is needed to determine the best educational strategies for teaching ethics in prelicensure nursing programs, with a focus on improving retention and resilience in practice.

Embedding Nursing Ethics Within Teaching Strategies in Nurse Residency Programs

Exposing new nurses to theoretical teaching strategies that help them to navigate the ethical challenges in clinical practice is essential for retention and long-term job satisfaction. This article explores the rationale for teaching ethics content in nurse residency programs and ways to navigate ethical decision-making in the clinical setting. Examples of evidence-informed teaching strategies that enhance knowledge retention and reduce the gap between ethical theory and practice are included.

Brave spaces in nursing ethics education: Courage through pedagogy

BACKGROUND

Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners.

RESEARCH OBJECTIVE

The aim of this research is to explore the influence of a structured self-assessment tool called the ESA "Engagement Self-Assessment" on the alignment and creation of a brave space in a nursing ethics course.

RESEARCH DESIGN

This study used an exploratory, cross-sectional survey design.

PARTICIPANTS AND STUDY SETTING

Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited.

ETHICAL CONSIDERATIONS

Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03).

FINDINGS

The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual "commitment to others."

CONCLUSION

A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space.

Promoting moral imagination in nursing education: Imagining and performing

Moral imagination is a central component of moral agency and person-centred care. Becoming moral agents who can sustain attention on patients and their families through their illness and suffering involves imagining the other, what moral possibilities are available, what choices to make, and how one wants to be. This relationship between moral agency, moral imagination, and personhood can be effaced by a focus on task-driven technical rationality within the multifaceted challenges of contemporary healthcare. Similarly, facilitating students' moral agency can also be obscured by the task-driven technical rationality of teaching. The development of moral agency requires deliberate attention across the trajectory of nursing education. To prepare nursing students for one practice challenge, workplace violence, we developed a multimodal education intervention which included a simulated learning experience (SLE). To enhance the realism and consistency of the educational experience, 11 nursing students were trained as simulated participants (SP). As part of a larger study to examine knowledge acquisition and practice confidence of learners who completed the SLE, we explored the experience of being the SP through interviews and a focus group with the SP students. The SP described how their multiple performances contributed to imagining the situation 'on both sides' prompting empathy, a reconsideration of their moral agency, and the potential to prevent violence in the workplace beyond technical rational techniques, such as verbal de-escalation scripts. The empirical findings from the SP prompted a philosophical exploration into moral imagination. We summarise the multimodal educational intervention and relevant findings, and then, using Johnson's conception of moral imagination and relevant nursing literature, we discuss the significance of the SP embodied experiences and their professional formation. We suggest that SLEs offer a unique avenue to create pedagogical spaces which promote moral imagination, thereby teaching for moral agency and person-centred care.

A scoping review of alternative methods of delivering ethics education in nursing

AIM

We conducted a scoping review of nursing ethics education to examine educational formats that go beyond traditional lectures.

DESIGN

This study was a scoping review.

METHODS

We used seven databases and relevant search terms, including nursing ethics, morals, values, nursing students and nursing ethics education.

RESULTS

Of 5,190 papers, 14 quasi-experimental studies met the inclusion criteria. All papers examined practices and self-study added to traditional lecture styles (i.e. the control group). Five practices emerged as follows: combined web (i.e. Internet) and lecture, web-based self-study, simulation, group learning and analysing ethical issues. The purpose, method and evaluation method differed based on the country in which the study was conducted. These educational interventions yielded significant differences in knowledge and in nursing students' critical thinking and ethical sensitivity postintervention. Multi-faceted ethics education will lay the foundation for effective practical training and practice.