Ethical Considerations for Children Undergoing Surgery: Evaluation of Graduate Nursing Students’ Learning

Ariane Gautrin; Yi Wen Wang; Raissa Passos dos Santos; Franco A. Carnevale; Amanda Cervantes; Argerie Tsimicalis

doi:10.25071/2291-5796.168

Authors

Ariane Gautrin, RN, MSc N. McGill University
Yi Wen Wang, RN, M.Ed., PhD(c) McGill University https://orcid.org/0000-0002-6824-6678
Raissa Passos dos Santos, RN, PhD McGill University, Université de Montréal, Hôpital Sainte-Justine
Franco A. Carnevale, RN, PhD McGill University, Shriners Hospitals for Children-Canada
Amanda Cervantes, RN McGill University https://orcid.org/0009-0006-5543-203X
Argerie Tsimicalis, RN, PhD McGill University, Shriners Hospitals for Children-Canada https://orcid.org/0000-0002-5963-9728

DOI:

https://doi.org/10.25071/2291-5796.168

Keywords:

Surgery, Children, Nursing, Online Learning, Ethics

Abstract

Background: To challenge dominant conceptions of children and innovate nursing education, our team created an open-access training module (https://childsxethics.net/) addressing ethical considerations for children undergoing surgery.

Objective: To evaluate the level of Bloom’s Taxonomy cognitive, affective, and psychomotor learning reached by graduate nursing students after completing the training module.

Methods: A qualitative descriptive study was conducted using Bloom’s Taxonomy. Data sources comprised of participants’ course assignments.

Results: Participants (n=19) wrote 19 online reflections, 43 peer responses and completed two group assignments. The module and associated class assignments promoted high levels of cognitive and affective learning. The type of assignment influenced participants’ levels of learning. Cognitive and affective learning processes were enhanced when integrating reflections and fostering interactions among learners.

Implications: Study findings will inform future iterations of the training module. Our innovative educational resource will facilitate the recognition of children as active moral agents and improve their surgical experiences.

Downloads

Download data is not yet available.

Author Biographies

Ariane Gautrin, RN, MSc N. , McGill University

Ariane Gautrin is a registered nurse working at the Alberta Children’s Hospital. She completed both her Master’s degree in Nursing and her Bachelor’s degree in Arts (Philosophy) at McGill University. Her research interests focus on improving nursing care for children and incorporating ethics into clinical practice.

Yi Wen Wang, RN, M.Ed., PhD(c), McGill University

Yi Wen Wang, RN, M.Ed., BScN is a PhD student at McGill University. She is the recipient of the Pierre Elliott Trudeau Foundation Scholarship and the Canadian Institutes of Health Research (CIHR) Fellowship. Her research focuses on the us of arts-based methods to elicit children's perspectives, foster partnerships, and create child-centric educational health resources.

Raissa Passos dos Santos, RN, PhD, McGill University, Université de Montréal, Hôpital Sainte-Justine

Dr. Raíssa Passos dos Santos is a postdoctoral researcher at CHU Sainte-Justine Research Center and Université de Montréal. She specializes in pediatric pain management and knowledge translation, with a particular focus on innovative non-pharmacological interventions such as virtual reality. Dr. Santos holds a PhD in Nursing Science from McGill University, where her research focused on the health experiences of children with medical complexity. She has received numerous awards, including the David McCutcheon Pediatric Palliative Care Doctoral Fellowship and the Fonds de recherche du Québec – Santé McGill University scholarship. Dr. Santos is committed to integrating ethical perspectives into clinical practice and improving the quality of life for children with complex medical needs. Her expertise in participatory research approaches is particularly relevant to her work with marginalized populations, including children with complex needs.

Franco A. Carnevale, RN, PhD, McGill University, Shriners Hospitals for Children-Canada

Franco A. Carnevale (RN, PhD) is a nurse, psychologist and clinical ethicist. Professor Carnevale's primary research interests include a wide range of concerns in childhood ethics. Professor Carnevale is the founder and principal investigator for VOICE (i.e., Views On Interdisciplinary Childhood Ethics); a McGill-based international initiative to advance knowledge and practices relating to ethical concerns in childhood. Professor Carnevale’s current academic appointments include (all at McGill University): Full Professor, Ingram School of Nursing; Associate Member, Faculty of Medicine (Pediatrics); Adjunct Professor, Counselling Psychology; Affiliate Member, Biomedical Ethics Unit. His clinical appointments include: Clinical Ethicist for Child, Adolescent, and Family Services and Director of the Nursing Research Program (Research Centre) at the Douglas Mental Health University Institute; Chair of the Clinical Ethics Committee at the Shriner's Hospitals for Children (Canada); Clinical Ethics Consultant at The Lighthouse, Children and Families (pediatric hospice); and Associate Member of Pediatric Critical Care and Nursing Advisor at the Montreal Children's Hospital-McGill University Health Centre. Professor Carnevale is a founding member of the McGill Qualitative Health Research Group (MQHRG).

Amanda Cervantes, RN, McGill University

Amanda Cervantes is a Faculty Lecturer and Assistant Program Director of the BScN at the Ingram School of Nursing, McGill University. Her teaching focuses on Children’s Nursing, Critical Care, and Anti-Racism in Undergraduate and Graduate nursing education. She started her career as a nurse in the Pediatric Intensive Care Unit at the Montreal Children’s Hospital.

Argerie Tsimicalis, RN, PhD, McGill University, Shriners Hospitals for Children-Canada

Argerie Tsimicalis, RN, PhD, is an Associate Professor at McGill University and Nurse Scientist at Shriners Hospitals for Children-Canada. Dr. Tsimicalis is the recipient of a Junior 2 Research Scholar Award from the Quebec Research Funds- Health (FRQS). Her research focuses on collaboratively creating new programs, structures, and resources to transform the delivery of children's health services locally and globally.

References

Behan, J. M., Arora, R. S., Carnevale, F. A., Bakhshi, S., Bhattacharjee, B., & Tsimicalis, A. (2021). An Ethnographic Study of the Moral Experiences of Children with Cancer in New Delhi, India. Global Qualitative Nursing Research, 8. DOI: https://doi.org/10.1177/2333393621995814

Boer, M. C. den, Zanin, A., Latour, J. M., & Brierley, J. (2022). Paediatric residents and fellows ethics (PERFEct) survey: Perceptions of European trainees regarding ethical dilemmas. European Journal of Pediatrics, 181(2), 561–570. DOI: https://doi.org/10.1007/s00431-021-04231-8

Bray, L., Appleton, V., & Sharpe, A. (2019). The information needs of children having clinical procedures in hospital: Will it hurt? Will I feel scared? What can I do to stay calm? Child: Care, Health and Development, 45(5), 737–743. DOI: https://doi.org/10.1111/cch.12692

Carnevale, F. A. (2020). A “rhick” conception of children’s voices: A hermeneutical framework for childhood research. International Journal of Qualitative Methods, 19, 1609406920933767. DOI: https://doi.org/10.1177/1609406920933767

Carnevale, F. A., Collin-Vézina, D., Macdonald, M. E., Ménard, J. F., Talwar, V., & Van Praagh, S. (2021). Childhood ethics: An ontological advancement for childhood studies. Children & Society, 35(1), 110–124. DOI: https://doi.org/10.1111/chso.12406

Chabeli, M. M. (2010). Concept-mapping as a teaching method to facilitate critical thinking in nursing education: A review of the literature. Health SA Gesondheid (Online), 15(1), 1–7. DOI: https://doi.org/10.4102/hsag.v15i1.432

Chao, S. Y., Chang, Y. C., Yang, S. C., & Clark, M. J. (2017). Development, implementation, and effects of an integrated web-based teaching model in a nursing ethics course. Nurse Education Today, 55, 31–37. DOI: https://doi.org/10.1016/j.nedt.2017.04.011

Dave, R.H. (1970). Psychomotor levels. In R. J. Armstrong (Ed.), Developing and writing behavioral objectives (pp. 20–21). Educational Innovaters Press.

Esser, F. (2016). Reconceptualising agency and childhood: New perspectives in childhood studies. Routledge, Taylor & Francis Group. DOI: https://doi.org/10.4324/9781315722245

Fortier, M. A., & Kain, Z. N. (2015). Treating perioperative anxiety and pain in children: A tailored and innovative approach. Pediatric Anesthesia, 25(1), 27–35. DOI: https://doi.org/10.1111/pan.12546

Gabriel, M. G., Wakefield, C. E., Vetsch, J., Karpelowsky, J. S., Darlington, A. S. E., Cohn, R. J., & Signorelli, C. (2019). Paediatric surgery for childhood cancer: Lasting experiences and needs of children and parents. European Journal of Cancer Care, 28(5), e13116. DOI: https://doi.org/10.1111/ecc.13116

Gabriel, M. G., Wakefield, C. E., Vetsch, J., Karpelowsky, J. S., Darlington, A. S. E., Grant, D. M., & Signorelli, C. (2018). The psychosocial experiences and needs of children undergoing surgery and their parents: A systematic review. Journal of Pediatric Health Care, 32(2), 133–149. DOI: https://doi.org/10.1016/j.pedhc.2017.08.003

Heath, C., Bavich, P., Sommerfield, A., & von Ungern-Sternberg, B. S. (2023). Kids Voices, the perioperative experience of emergency surgery from children’s perspectives: A qualitative study. Patient Education and Counseling, 110. DOI: https://doi.org/10.1016/j.pec.2023.107674

Heilporn, G., & Lakhal, S. (2020). Investigating the reliability and validity of the community of inquiry framework: An analysis of categories within each presence. Computers & Education, 145, 103712. DOI: https://doi.org/10.1016/j.compedu.2019.103712

Hogan, D. (2005). Researching ‘the child’ in developmental psychology. In S. Green & D. Hogan (Eds.). Researching children’s experience: Approaches and methods (22-41), Sage Publications.

Hsieh, H. F., & Shannon, S. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. DOI: https://doi.org/10.1177/1049732305276687

Kaddoura, M., Van-Dyke, O., & Yang, Q. (2016). Impact of a concept map teaching approach on nursing students’ critical thinking skills. Nursing & Health Sciences, 18(3), 350–354. DOI: https://doi.org/10.1111/nhs.12277

Khalil, M. K., & Elkhider, I. A. (2016). Applying learning theories and instructional design models for effective instruction. Advances in Physiology Education, 40(2), 147–156. DOI: https://doi.org/10.1152/advan.00138.2015

Kokotsaki, D., Menzies, V., & Wiggins, A. (2016). Project-based learning: A review of the literature. Improving Schools, 19(3), 267–277. DOI: https://doi.org/10.1177/1365480216659733

Krathwohl, DR. (2002). A revision of Bloom’s taxonomy: An overview. Theory into Practice, 41(Part 4), 212–218. DOI: https://doi.org/10.1207/s15430421tip4104_2

Krathwohl, D. R., Bloom, B. S , & Masia, B. B. (1964). Taxonomy of educational objectives, Book II. Affective domain. David McKay Co Inc.

Martakis, K., Czabanowska, K., & Schröder-Bäck, P. (2016). Teaching ethics to pediatric residents: A literature analysis and synthesis. Klinische Pädiatrie, 228, 263–269. https://doi.org/10.1055/s-0042-109709 DOI: https://doi.org/10.1055/s-0042-109709

Montreuil, M., & Carnevale, F. A. (2016). A concept analysis of children’s agency within the health literature. Journal of Child Health Care, 20(4), 503–511. DOI: https://doi.org/10.1177/1367493515620914

Mukhalalati, B. A., & Taylor, A. (2019). Adult learning theories in context: A quick guide for healthcare professional educators. Journal of Medical Education and Curricular Development, 6. DOI: https://doi.org/10.1177/2382120519840332

Pavin Ivanec, T. (2022). The lack of academic social interactions and students’ learning difficulties during COVID-19 faculty lockdowns in Croatia: The Mediating Role of the Perceived Sense of Life Disruption Caused by the Pandemic and the Adjustment to Online Studying. Social Sciences, 11(2). DOI: https://doi.org/10.3390/socsci11020042

Plantz, D.M., Garrett, J.R., Carter, B., Knackstedt, A.D., Watkins, V.S., & Lantos, J. (2014). Engaging pediatric health professionals in interactive online ethics education. Hastings Center Report, 44(6), 15–20. DOI: https://doi.org/10.1002/hast.383

Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (Tenth edition.). Wolters Kluwer Health.

Qureshi, M.A., Khaskheli, A., Qureshi, J. A., Raza, S.A., & Yousufi, S.Q. (2021). Factors affecting students’ learning performance through collaborative learning and engagement. Interactive Learning Environments. DOI: https://doi.org/10.1080/10494820.2021.1884886

Sandelowski, M. (1995). Qualitative analysis: What it is and how to begin. Research in Nursing & Health, 18(4), 371–375. DOI: https://doi.org/10.1002/nur.4770180411

Shoemaker, S.J., Wolf, M.S., Brach, C., & Amsterdam 201409. (2014). Development of the Patient Education Materials Assessment Tool (PEMAT): A new measure of understandability and actionability for print and audiovisual patient information. Patient Education and Counseling, 96(3), 395–403. DOI: https://doi.org/10.1016/j.pec.2014.05.027

Sorden, S.D. (2013). The cognitive theory of multimedia learning. In B. J. Irby, G. Brown, R. Lara-Alecio, & S. Jackson (Eds.), The Handbook of Educational Theories (pp.157–168). Information Age Publishing.

Stenbom, S. (2018). A systematic review of the Community of Inquiry survey. The Internet and Higher Education, 39, 22–32. DOI: https://doi.org/10.1016/j.iheduc.2018.06.001

Vlachopoulos, D., & Makri, A. (2019). Online communication and interaction in distance higher education: A framework study of good practice. International Review of Education, 65(4), 605–632. DOI: https://doi.org/10.1007/s11159-019-09792-3

Wang, Y. W., Carnevale, F. A., Chougui, K., & Tsimicalis, A. (2022a). On 'how Children’s participation ought to be practiced: A preliminary ethical framework to optimise the participation of children with osteogenesis imperfecta in health care?' Journal of Clinical Nursing. 32(15–16), 5410–5411. https://doi.org/10.1111/jocn.16609 DOI: https://doi.org/10.1111/jocn.16609

Wang, Y. W., Carnevale, F. A., Ezcurra, M., Chougui, K., Siedlikowski, S., & Tsimicalis, A. (2022b). The moral experiences of children with osteogenesis imperfecta. Nursing Ethics, 1773–1791. DOI: https://doi.org/10.1177/09697330221105635

Zhang, F., Zhao, L., Zeng, Y., Xu, K., & Wen, X. (2019). A comparison of inquiry-oriented teaching and lecture-based approach in nursing ethics education. Nurse Education Today, 79, 86–91. DOI: https://doi.org/10.1016/j.nedt.2019.05.006