1. Miller-Saultz, Debbie Reviewer

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Ethics and End-of-Life Care CD-ROM and Work Book Mary Anne Sweeney, Catherine P. Murphy, and Zena Mercer The University of Texas Medical Branch at Galveston School of Nursing, Multimedia Lab 301 University Boulevard U.T. Box 35094 Galveston, TX, 77555-5094 Tele: 800-424-2575 Fax: 409-747-7813 Web site: Price: single-user copy: $35 plus shipping includes disk and workbook Multi-user single site license: $495 plus shipping includes disk and workbook, and disk for additional workbooks if needed


This CD-ROM software program is an interactive multimedia program that allows the learner to explore ethical and legal issues around one patient's clinical course from nursing home (subacute rehabilitation) through admission through the emergency department to the hospital (after cardiac arrest and resuscitation). A workbook is provided with the CD-ROM.


The program's intended audiences are students in educational settings, staff in clinical practice (staff development, clinical specialty courses, crisis intervention, family dynamics) and ethics committees. The user explores aspects of a clinical situation involving life and death decisions, and looks at conflict and ethical dilemmas surrounding the particular clinical situation.


The program uses video and text to illustrate each issue (ethical and legal) that arises during the course of subacute, emergency, and critical care. The user is introduced to the patient, healthcare providers, and family members, along with their prospective views through the course of illness.


The program is easy to install and use. The video portions can be accessed and interrupted at any point. Clicking on the picture frame stops the video portion. This can be cumbersome because viewing the video portion is key to the scenario. Although you can use the text alone, complete understanding of each scenario is not possible without the video portion. If you do not have computer capability for the video or the time to watch the video, some essence of the scenario will be lost. The workbook is intended to spark critical thinking by asking questions and can measure outcome, learner competency, and performance with immediate feedback. The answers are provided both in the CD-ROM and in the workbook.


The CD-ROM includes Staff Conference, Family Conflict, and Family Conference. Each section contains a case summary, video observation, participants, ethical framework, intervention framework, and lifestyle history. The user can access each section independently and does not have to go to every section to complete the scenario. The user can also move from scenario and section independent of the entire case. The program allows you to view the video alone or the video with text. Ethical dilemmas can be reviewed by repeating some portion of each video scenario. When the scene is complete, the user is asked if the scene just viewed represents an ethical dilemma-yes or no? The response triggers an explanation for the correct answer. The explanation is inside the video frame, which does not provide enough frame to see all of it, a drawback of the program. The user cannot enlarge the frame but from the words that are visible, the explanation can be understood.


The program provides a tally of correct and incorrect answers that can be used to assess competency and understanding.


Due to the increasing frequency of clinical issues involving older adults (represented by this program) that occur in the healthcare system, this program will be valuable as a learning tool for schools of nursing, nursing staff development, and ethics committee training. This program has the flexibility as a tool for both group and individual learning. The way in which this program is formatted makes it more suitable for individual use, but group discussion points and clarification of the scenarios are presented, so it is possible to be used with a group. The workbook can be reproduced for group learning by purchasing the multi-user single site version.


All in all, this is a useful program to interactively help nurses and others learn about common ethical dilemmas in healthcare.


Minimum system requirements: PC running Windows 95 or above with 32 megabytes of RAM (64 suggested); sound card and speakers required; video capability greatly enhances the use of the program.