For the project team, this was the first attempt to use simulations to this extent in learning and teaching ethics to nursing students. In clinical simulations quality and safety will be improved – simulating ethics leads to better-educated nursing students who develop more humanistic care towards patients. This international project was a good start to simulate ethical issues and a great opportunity to learn and share expertise. This collaboration should be continued – the handbook hopefully helps to highlight and maintain the results of the project.

Reflection of Basic ethics in healthcare

Feedback for course 1 Basic ethics in healthcare was collected from the students (n=30) participating the course. The following aspects were considered: The ways of learning, learning tasks and the logic of the content. The students consider discussion and video simulations followed by face-to-face seminar the best way of learning ethics. It is open to question, whether an ethics course implemented purely online is efficient enough to address the diverse aspects of the topic. One of the students wrote: “during the course, I needed someone to discuss with me; I don’t like to write, but like to talk, don’t like to read, but like to listen; see and listen to a real person…” The cases, both written and video cases as learning tasks, seem to be good ways of making students think by themselves, they are considered challenging and interesting.

Course 1 proceeded constructively from the basic ethics knowledge and literature to more challenging tasks. It seems that the logic of the content of course 1 was successful. It is worth noting that all the courses are planned so that the knowledge and skills cumulatively increase from the basics, through reflection in the Ethical coffee room (course 2), to more challenging simulation cases in course 3, Simulations in ethical issues.

Reflection on the Ethical coffee room

Students really need to read the pre-course material, the discussion remained somewhat superficial when they could not relate ethical issues to ethical theories and concepts. One suggestion is that the mentor/teacher poses questions or reflections connected to the theoretical underpinnings. It means also that the teacher/mentor should allocate a certain amount of time every day.

As mentor/teacher you should not have too large groups in order to be able to comment and follow the discussions.

Even though this is an online course and students are anonymous, they appreciate highly the feedback from the mentor/teacher, so it is important that they are actively involved.

Reflection on Simulations in ethical issues

When creating the scenarios try to emphasize and problematize the complexity of the whole situation. One way to do this is to make different versions of one situation. The reflection session after the simulation should be linked to the theoretical concepts.

Videos are a very good starting point for discussion and also for the simulation work.

If the students have not taken the previous courses, it is important the they read all the pre-course material for all courses.

Simulations are a highly recommended learning activity for inter-professional and peer learning. Also, simulations are appreciated as a learning activity by international students allowing the participants to discuss and contrast inter-cultural aspects.

In ethics simulations there should not be too much technical content. The students should have time to think and concentrate on encountering the patient instead of performing a technical action. In the debriefing discussion it is important to direct the discussion towards ethical knowledge and skills, not towards technical aspects. The teacher needs skills to support the ethical debate.

Reflection on the Online learning environment

It is a challenge to create a learning environment online both considering the content and the technology. Interaction with peers and teachers is a vital part of learning, and interacting online is a challenge and the greatest challenge is to create an interactive learning environment online with the technical solutions that we have today. There are no simple solutions, but one key aspect is that the course leaders, teachers and mentors are actively involved throughout the course and give feedback to the student in various ways and that they are explicit in communicating this with the students. It is also worth considering the instructions given for the tasks, as they are given only online. They should be clear enough for the students. The best option is to use a learning platform that the students are already familiar with.