Utilizing simulation based learning to teach ethical decision making within the context of crisis standards of care in Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) education.

Abstract : The Seattle University College of Nursing’s Adult-Gerontology/Acute Care Nurse Practitioner (AG-ACNP) curriculum lacked a student learning experience regarding ethical decision-making with the context of crisis standards of care (CSC). CSC are enacted during public health emergencies during natural disasters and pandemics when the demand for healthcare exceeds the resource capacity of the institution or the healthcare system. To address this curricular need, we created a Simulation Based Learning (SBL) module for advanced nursing practice students to better understand how to engage in and process ethical decision-making specifically contextualized to pandemic and disasters situations. More specifically, the SBL experience we developed facilitates students’ evaluation of how implicit bias and moral distress enters and influences decision-making that may deviate from an established CSC Triage Algorithm which is intended to provide a guideline of triage recommendations utilizing prognostic factors and prioritization criteria for decision-making during pandemics. In 2021, this SBL was beta tested as a table-top exercise with AG-ACNP student volunteers (n=3), and, results indicated that implicit bias and clinical judgement/experience indeed manifested in such a deviation. Based on the beta test results, we developed a next iteration “live” SBL and implemented it in 2022 (n=11), and revised it based on the results, and implemented it again in 2023, (n=12). This presentation will compare the effectiveness of the two “live” versions of the ethical decision-making SBL in preparing students to better meet CSC decision-making and mitigate the potential for bias and moral distress in simulated nurse practitioner practice.