Embedding Microethical Dilemmas in High-Fidelity Simulation Scenarios: Preparing Nursing Students for Ethical Practice

Background: Despite the inclusion of ethics education in the formal curriculum, students felt ill-prepared to manage ethical issues and protect patients' health and wellbeing. Nursing students reported knowing what should be done to promote optimal patient care; however, they also reported an inability to act on their convictions due to fear of reprisal, powerlessness, and low confidence. Method: Bloom's Taxonomy guided the development and implementation of experiential-applied ethics education via microethical dilemmas embedded in existing high-fidelity simulation (HFS) scenarios. Students were unaware that ethical dilemmas would be presented, replicating complex and spontaneous practice environments. Results: Students reported that the educational strategy was powerful, increasing ethical decision-making confidence, empowering effective advocacy, and building courage to overcome fears and defend ethical practice. Conclusion: Simulation extends ethics education beyond the cognitive domain, ensuring the purposeful integration of affective and psychomotor learning, which promotes congruence between knowing what to do and acting on one's convictions.