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students the possibility to exchange their ideas both with their peers and their educators, to discuss the best decisions (i.e. problem-based learning) and to analyse the ethical implications. This leads to what Vanlaere et al.2 describe as a ‘care-ethical lab’, a learning environment where ‘care ethics focuses on unearthing the valuebased vision underlying all of the care practices’. This enables students to analyse also the context of the situation but would also need to take into account the beliefs, feelings, sensations and experiences of those involved, which are linked to moral theory and influenced by cultural and social factors. The latter aspects could be addressed in the simulation lab with the support of a real person who plays the role of a patient. Another very important element that plays an important role in ethics education is the way educators are trained to teach ethics and their ethical knowledge base. Educators who teach ethics to nursing students are required to have both a solid experience in the field of clinical practice and a sound theoretical knowledge base in the field of ethics. In this way, educators should be able to adequately apply ethics theories to the clinical cases that can be used as practical examples for nursing students, both in classes and in the simulation ethics lab. In addition, educators would also have the skills and competences to select the best clinical cases from the students’ clinical apprenticeship experience, which would help students reflect deeper during their storytelling sessions. To conclude, we agree with Cannaerts et al. when they state that there is still a paucity of research studies focusing on the perceptions of educators about the contribution of ethics education, and to this, we would like to add that more attention needs to paid to the way educators who teach nursing ethics are prepared to do this work, both in classes and in simulation labs, to improve the effectiveness and quality of education in nursing ethics. References 1. Cannaerts N, Gastmans C and Dierckx de Casterle´ B. Contribution of ethics education to the ethical competence of nursing students: Educators’ and students’ perceptions. Nurs Ethics. Epub ahead of print 8 April 2014. DOI: 10. 1177/0969733014523166. 2. Vanlaere L, Coucke T and Gastmans C. Experiential learning of empathy in a care-ethics lab. Nurs Ethics 2010; 17(3): 325–336.
Response to Commentary (1): Effectiveness of Nursing Ethics education: Much more research needed Nancy Cannaerts, Chris Gastmans and Bernadette Dierckx de Casterle´ Catholic University of Leuven, Belgium In their comment, Dr Bagnasco and colleagues suggest the simulation lab as a strategic, safe learning environment to develop nursing students’ ethical competences. A simulation lab may offer the opportunity to students to recognize everyday ethical issues in nursing practice; to integrate technical, communicative and social Corresponding author: Nancy Cannaerts, Department of Health Care and Technology, University College of Nursing, Herestraat 49, 3000 Leuven, Belgium. Email: [email protected]
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behaviours; to discuss the best options on good care; and to reflect from an explicit ethical perspective. A simulation lab may indeed be one of the strategies to promote the development of ethical competencies and to translate ethical knowledge into ethical reflection and ethical behaviour. In Belgium, two care-ethics labs are founded in 2008 and in 2012 to provide training that focuses on improving caregivers’ empathic capacities.1 However, until now, it remains unclear what ethical skills are developed in students through the simulation experience. After their simulation experience, students from our college mainly reported the promotion of communication skills, more than ethical decision-making and reflective skills. More empirical research is needed to investigate students’ perceptions on the effectiveness of the simulation lab and the impact of this simulation experience on the development of students’ ethical capacities. Although the simulation lab offers a learning environment where students are stimulated to become aware of and to reflect on the consequences of their care to the patient, the simulation remains an artificial environment. Translation into real clinical practice and continuation and translation into long-term behaviour require particular attention. The simulation experience will provide added value only when its effects can be validated into real clinical practice. We therefore agree with Dr Bagnasco and colleagues’ comment that the use of a simulation lab needs to be embedded in an educational and organizational culture of excellent care, which really nurtures and facilitates ethical reflection and ethical behaviour by focusing on dignity-enhancing care.2 Clinical practice internship providing students with opportunities to gradually take the responsibility for the care of a group of patients – instead of imposing a set of tasks to be performed on behalf of the nurse – can be another strategy in addition to the simulation experience. If supervised professionally, this kind of internship can advantage the learning effects of the simulation experience in their clinical practice. By reflecting on their caring decisions, the underlying values and rationales of those decisions and on the translation into behaviour in practice, students are stimulated to discuss real-life clinical situations in depth and in ‘real time’. Indeed, this requires a sound ethical knowledge base in combination with a solid clinical practice experience of the nursing ethics educator as well as of all those involved in the education of the student. References 1. Vanlaere L, Timmermann M, Stevens M, et al. ‘My body knows’: An exploratory study of experiences of healthcare providers posing as simulated care receivers in a ‘care-ethical’ lab. Nurs Ethics 2012; 19(1): 68–79. 2. Gastmans C.Dignity-enhancing nursing care: A foundational ethical framework. Nurs Ethics 2013; 20(2): 142–149.
Response to Commentary (2): A view from sTimul Linus Vanlaere sTimul, Belgium In our opinion, learning by simulation in a care-ethical lab is an extra contribution to the ethics education of nursing students. The reflection sought for from a care-ethical perspective basically boils down to a Corresponding author: Linus Vanlaere, sTimul, Sint-Maartenspleiin 13, 8560 Moorsele, Belgium. Email: [email protected]
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students the possibility to exchange their ideas both with their peers and their educators, to discuss the best decisions (i.e. problem-based learning) and to analyse the ethical implications. This leads to what Vanlaere et al.2 describe as a ‘care-ethical lab’, a learning environment where ‘care ethics focuses on unearthing the valuebased vision underlying all of the care practices’. This enables students to analyse also the context of the situation but would also need to take into account the beliefs, feelings, sensations and experiences of those involved, which are linked to moral theory and influenced by cultural and social factors. The latter aspects could be addressed in the simulation lab with the support of a real person who plays the role of a patient. Another very important element that plays an important role in ethics education is the way educators are trained to teach ethics and their ethical knowledge base. Educators who teach ethics to nursing students are required to have both a solid experience in the field of clinical practice and a sound theoretical knowledge base in the field of ethics. In this way, educators should be able to adequately apply ethics theories to the clinical cases that can be used as practical examples for nursing students, both in classes and in the simulation ethics lab. In addition, educators would also have the skills and competences to select the best clinical cases from the students’ clinical apprenticeship experience, which would help students reflect deeper during their storytelling sessions. To conclude, we agree with Cannaerts et al. when they state that there is still a paucity of research studies focusing on the perceptions of educators about the contribution of ethics education, and to this, we would like to add that more attention needs to paid to the way educators who teach nursing ethics are prepared to do this work, both in classes and in simulation labs, to improve the effectiveness and quality of education in nursing ethics. References 1. Cannaerts N, Gastmans C and Dierckx de Casterle´ B. Contribution of ethics education to the ethical competence of nursing students: Educators’ and students’ perceptions. Nurs Ethics. Epub ahead of print 8 April 2014. DOI: 10. 1177/0969733014523166. 2. Vanlaere L, Coucke T and Gastmans C. Experiential learning of empathy in a care-ethics lab. Nurs Ethics 2010; 17(3): 325–336.
Response to Commentary (1): Effectiveness of Nursing Ethics education: Much more research needed Nancy Cannaerts, Chris Gastmans and Bernadette Dierckx de Casterle´ Catholic University of Leuven, Belgium In their comment, Dr Bagnasco and colleagues suggest the simulation lab as a strategic, safe learning environment to develop nursing students’ ethical competences. A simulation lab may offer the opportunity to students to recognize everyday ethical issues in nursing practice; to integrate technical, communicative and social Corresponding author: Nancy Cannaerts, Department of Health Care and Technology, University College of Nursing, Herestraat 49, 3000 Leuven, Belgium. Email: [email protected]
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behaviours; to discuss the best options on good care; and to reflect from an explicit ethical perspective. A simulation lab may indeed be one of the strategies to promote the development of ethical competencies and to translate ethical knowledge into ethical reflection and ethical behaviour. In Belgium, two care-ethics labs are founded in 2008 and in 2012 to provide training that focuses on improving caregivers’ empathic capacities.1 However, until now, it remains unclear what ethical skills are developed in students through the simulation experience. After their simulation experience, students from our college mainly reported the promotion of communication skills, more than ethical decision-making and reflective skills. More empirical research is needed to investigate students’ perceptions on the effectiveness of the simulation lab and the impact of this simulation experience on the development of students’ ethical capacities. Although the simulation lab offers a learning environment where students are stimulated to become aware of and to reflect on the consequences of their care to the patient, the simulation remains an artificial environment. Translation into real clinical practice and continuation and translation into long-term behaviour require particular attention. The simulation experience will provide added value only when its effects can be validated into real clinical practice. We therefore agree with Dr Bagnasco and colleagues’ comment that the use of a simulation lab needs to be embedded in an educational and organizational culture of excellent care, which really nurtures and facilitates ethical reflection and ethical behaviour by focusing on dignity-enhancing care.2 Clinical practice internship providing students with opportunities to gradually take the responsibility for the care of a group of patients – instead of imposing a set of tasks to be performed on behalf of the nurse – can be another strategy in addition to the simulation experience. If supervised professionally, this kind of internship can advantage the learning effects of the simulation experience in their clinical practice. By reflecting on their caring decisions, the underlying values and rationales of those decisions and on the translation into behaviour in practice, students are stimulated to discuss real-life clinical situations in depth and in ‘real time’. Indeed, this requires a sound ethical knowledge base in combination with a solid clinical practice experience of the nursing ethics educator as well as of all those involved in the education of the student. References 1. Vanlaere L, Timmermann M, Stevens M, et al. ‘My body knows’: An exploratory study of experiences of healthcare providers posing as simulated care receivers in a ‘care-ethical’ lab. Nurs Ethics 2012; 19(1): 68–79. 2. Gastmans C.Dignity-enhancing nursing care: A foundational ethical framework. Nurs Ethics 2013; 20(2): 142–149.
Response to Commentary (2): A view from sTimul Linus Vanlaere sTimul, Belgium In our opinion, learning by simulation in a care-ethical lab is an extra contribution to the ethics education of nursing students. The reflection sought for from a care-ethical perspective basically boils down to a Corresponding author: Linus Vanlaere, sTimul, Sint-Maartenspleiin 13, 8560 Moorsele, Belgium. Email: [email protected]
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