Experiencing and Implementing ... - LIU Post Dissertation

1 Running head: SIMULATION AND CARING 1 Experiencing and Implementing Caring Behaviors in Undergraduate Nursing Students in a Simulation Environment Geraldine Cornell Long Island University post Campus 2 SIMULATION AND CARING Abstract Teaching and learning of caring behaviors are an integral part of nursing education. Internalization and practice of caring in a general sense can pave the way toward global citizenship. Caring behaviors relative to nursing practice can be taught in various ways. In response to recent technological advances, high fidelity patient simulation in a simulation environment can be used to teach caring behaviors to undergraduate nursing students.

2 This paper will refer to the overarching theme of caring as written by Nel Noddings, while supporting the recommendations of Dr. Rudy Crew and Bob Fecho for specific actions to be used by educators to support caring and caring behaviors. Specific to the purpose of this paper, how these actions are implemented in a simulation setting by faculty and undergraduate nursing students, as well as the relation to Nel Nodding s concept of caring for and caring about. Keywords: Caring, Dialogue, Environment, Safe, Simulation 3 SIMULATION AND CARING To teach a behavior such as caring to undergraduate nursing students may be a challenging task for educators.

3 In order to successfully implement, and measure the success and outcomes of teaching caring behaviors, students themselves should feel that they are cared about prior to learning how to care for others. In Nel Nodding s (2005) book Educating Citizens for Global Awareness the concept of cared about and cared for were discussed allowing for differing interpretations of this notion. Within the context of undergraduate nursing education in a simulated environment, this paper will align with ideas of Dr. Rudy Crew in the creation of a safe environment, and Bob Fecho on the importance of dialogue in education in order to create an environment which supports caring.

4 Nel Nodding s(2005) believes that the marks of citizenship would need to include affection, respect, care, curiosity and concern for the well-being of all living beings (p. 23). In order to teach and provide humanistic nursing care, these concepts are infused into nursing curricula. Approaches to teaching such concepts may vary within the context and setting to which they are presented. Concepts such as caring may require thought and creativity on the educator s behalf. Current literature and technology support the use of the human patient simulator in a simulation environment to teach caring behaviors.

5 However, caring behavior must be transferrable and therefore students must feel cared about before they can learn to care for others. Caring about as defined by Nel Nodding s (2005) requires us to work toward the establishment of conditions under which caring for can flourish (p. 7). In a simulation environment, faculty may wish to consider the individual learning needs of each student. This environment enables faculty to teach to the different learning needs of students, which in turn demonstrates a caring attitude. When placed in a simulation environment to learn, Brewer (2011) 4 SIMULATION AND CARING found that simulation has been shown to be an effective learning mode for students of differing learning styles (p.)

6 314). Zigmont, Kappus and Sudikoff (2011) developed a 3D model of debriefing effective for use in high-fidelity simulation and found that in order for learning to be effective and ultimately change practice, educators must consider the immersive relationship that exists between learning and factors related to the individual learner ( ). Additionally, Crew found that teachers can create a protected zone amid all the hostility surrounding kids where they can develop on their own terms with constant feedback, encouragement and adjustments (p. 61). The premise of the simulation environment is the same that Rudy Crew speaks about to which care is where nurturance and cognitive instruction meet (p.

7 66). In the context of nursing education, faculty influence on both the students and the environment pre-simulation and post -simulation experience is crucial to establishing a trusting, caring and safe environment. The International Nursing Association for Clinical Simulation and Learning defines a simulation safe environment as a positive emotional climate, where participants feel at ease taking risks, making mistakes or extending themselves beyond their comfort zone (p. 56). This environment is created by faculty to enable students to learn and to practice and to make mistakes without consequences.

8 Prior to participating in simulation, students are expected to sign and adhere to a confidentiality agreement which enables them to trust that they are in a safe environment. The premise for the creation of a safe environment is to allow for risk taking which aligns with Rudy Crew and his idea that caring teachers make it possible for children to take risks (p. 61). If the student does not feel that this is occurring, the establishment of trust will be null and the student will not feel free to be open and to participate fully in this educational experience. Crew also found that the caring and high expectations that a great teacher brings to the student- teacher relationship are really just extensions or variations of 5 SIMULATION AND CARING the parent-child relationship (p.)

9 156). Hence in the simulation setting, students must feel protected and nurtured by faculty at all times to avoid negative consequences to the student s emotional and cognitive well-being. The goals of simulation should be well articulated to the students prior to this experience in order for them to feel that they will not be judged in this situation no matter what the outcome may be. In the post -simulation experience, the debriefing period begins for the student. This period of self-reflection has been found to be one of the most integral parts of the learning experience for the student in this environment.

10 According to Zigmont, Kappus & Sudikoff (2011) the process of debriefing students leads them to a defusing stage where there is discussion of emotions and a discovering phase which both fall under the category of reflective observation (p. 53). In this period, students have the ability to reflect on their experience and their actions based on either their own observations during the scenario or from observations shown from a video recording post scenario. According to INASCL (2011) the participants or students in this case are encouraged to explore emotions, question, reflect and provide feedback to each other (p.)