End of Life Simulation for Pediatric Critical Care Nurses

Abstract : Background. Newly licensed Pediatric Intensive Care Unit (PICU) nurses face distinct challenges in transitioning from the protected world of academia into post licensure clinical practice. Nurse educators concur there is a dearth of curricular content on death and dying in pre-licensure nursing programs. New PICU nurses have neither the education or experience to deal with death and dying and report a wide array of emotions including feeling scared, sad, helpless, trapped and useless. The purpose of our project was to create, implement and assess the efficacy of a high fidelity end of life (EOL) simulation for novice PICU nurses.

Guiding framework. The Healthcare Simulation Standards of Best Practice TM guided this project and participants were debriefed utilizing the “Debriefing with Good Judgment Model”.

Description. A 4-step unfolding simulation utilizing standardized participants as grieving parents was created by PICU and simulation content experts practicing at a quaternary care hospital in the United States. The case involved a child with spinal muscle atrophy who experienced a ventilator malfunction while living at home.

Target population. 24 PICU nurses, 75% with less than 4 years of experience.

Results. Data from the Simulation Effectiveness Tool, Modified demonstrated this was a positive learning experience that helped bridge the gap between academia and practice.

Conclusion. The EOL PICU simulation is a robust teaching tool that supports the unmet needs of the PICU nurse where death can be a regular occurrence. It offers a unique opportunity to practice procedural and communication skills, without risk for patient harm.