Abstract
The Joint Commission (2021) recommended that hospitals train their employees on how to act and respond during an AS event. Students are required to complete agency trainings (i.e. fire, HAZMAT etc.) prior to attending practicum but are not required to complete AS response, sending them into clinical settings ill prepared.
The purpose of this study was to examine healthcare professional students’ moral and ethical challenges experienced from an interprofessional active shooter (AS) simulation. This simulation also explored ethical decision-making and provided students an opportunity to practice critical thinking in high-stress situation and had a secondary impact on their development of psychological resilience.
The quasi-experimental study use a convenience sample of students (n = 233) from Nursing, Osteopathic Medicine, Public Health, and Athletic Training. Students participated in interdisciplinary teams to care for a patient when an AS event happened. Students choose patient and/or personal safety. Pre-briefing, access to mental health support, and structured debriefings were necessary to promote psychological safety. Participating students completed the investigator-developed questionnaire three times to assess changes in moral beliefs and perceived preparedness.
A paired sample t-test showed a statistically significant difference between moral beliefs from before to after participation and following the second debriefing T1 and T3 [t(55) = -2.84, p = .003]. There was no change in attitudes or beliefs by program of study, gender, or ethnicity. Students reported more confidence in managing emergency situations and greater awareness of teamwork and communication.
This AS simulation was a unique pedagogical tactic that provided students an opportunity to reflect on moral and ethical challenges of caring for patients in an emergency that integrated ethics, emergency preparedness, and interprofessional collaboration. Students had the opportunity to recognize the challenges healthcare professionals may face when personal and patient safety are at risk. This simulation also helped to prepare HCP students to respond to threats and protect themselves in high-stress situations. Future research should explore the use of AI to enhance scenario realism, develop patient and victim scripts, and refine pre-briefing and debriefing protocols to ensure consistency in implementing the teaching innovation over multiple cohorts and to deepen resilience outcomes.
Notes
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References:
Mannenbach, M. S., Fahje, S. J., Sunga, K. L., & Sztajnkrycer, M. D. (2019). An in situa simulation-based training approach to active shooter response in the emergency department. Disaster Medicine and Public Health Preparedness, 13(2), 346-352. https://doi.org/10.1017/dmp2018.39.
McKenzie, N., Wishner, C., Sexton, M., Saevig, D., and Rega, P. (2019). Active shooter: What would health care students do while caring for their patients? Run? Hide? Or Fight? Disaster Medicine and Public Health Preparedness, 14(2), 173-177. https://doi.org/10.1017/dmp.2019.67
Quick Safety 4: Preparing for active shooter situations. (2021, June). The Joint Commission. https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety--issue-4-preparing-for-active-shooter-situations/preparing-for-active-shooter-situations-addendum-february-2017/
Sanchez, L., Young, V. B., & Baker, M., (2018). Active shooter training in the emergency department: A safety initiative. Journal of Emergency Nursing, 44(6), 598-604. https://doi.org/10.1016/j.jen.2018.07.002
Walden, M., Lovenstein, A., Ramick, A., Spray, B., Denton, A., McGinley, J., Eisenberg, L., Adams, G., Plunkett, J., Moore, H., Goddard, C., Wooley, C., & McElroy, S., (2021). Perceptions of moral obligations of pediatric nurses during an active shooter event in a children’s hospital. Journal of Pediatric Nursing, 60, 252-259.
Sigma Membership
Alpha Alpha Xi
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quasi-Experimental Study, Other
Research Approach
Quantitative Research
Keywords:
Ethics, Teaching and Learning Strategies, Interprofessional, Interdisciplinary, Simulation Methods in Education, Active Shooter Preparedness, Student Attitudes
Recommended Citation
James, Linda S. and Hirsch, Sarah, "Decisions Under Fire: Healthcare Students Reactions to an Active Shooter Simulation" (2026). International Nursing Research Congress (INRC). 188.
https://www.sigmarepository.org/inrc/2026/presentations_2026/188
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-23
Decisions Under Fire: Healthcare Students Reactions to an Active Shooter Simulation
Toronto, Ontario, Canada
The Joint Commission (2021) recommended that hospitals train their employees on how to act and respond during an AS event. Students are required to complete agency trainings (i.e. fire, HAZMAT etc.) prior to attending practicum but are not required to complete AS response, sending them into clinical settings ill prepared.
The purpose of this study was to examine healthcare professional students’ moral and ethical challenges experienced from an interprofessional active shooter (AS) simulation. This simulation also explored ethical decision-making and provided students an opportunity to practice critical thinking in high-stress situation and had a secondary impact on their development of psychological resilience.
The quasi-experimental study use a convenience sample of students (n = 233) from Nursing, Osteopathic Medicine, Public Health, and Athletic Training. Students participated in interdisciplinary teams to care for a patient when an AS event happened. Students choose patient and/or personal safety. Pre-briefing, access to mental health support, and structured debriefings were necessary to promote psychological safety. Participating students completed the investigator-developed questionnaire three times to assess changes in moral beliefs and perceived preparedness.
A paired sample t-test showed a statistically significant difference between moral beliefs from before to after participation and following the second debriefing T1 and T3 [t(55) = -2.84, p = .003]. There was no change in attitudes or beliefs by program of study, gender, or ethnicity. Students reported more confidence in managing emergency situations and greater awareness of teamwork and communication.
This AS simulation was a unique pedagogical tactic that provided students an opportunity to reflect on moral and ethical challenges of caring for patients in an emergency that integrated ethics, emergency preparedness, and interprofessional collaboration. Students had the opportunity to recognize the challenges healthcare professionals may face when personal and patient safety are at risk. This simulation also helped to prepare HCP students to respond to threats and protect themselves in high-stress situations. Future research should explore the use of AI to enhance scenario realism, develop patient and victim scripts, and refine pre-briefing and debriefing protocols to ensure consistency in implementing the teaching innovation over multiple cohorts and to deepen resilience outcomes.
Description
Students enter clinical settings with some preparation for events such as fires, however, they are not prepared for what to do during an active shooter. This study examined healthcare professional students’ moral and ethical challenges from an interprofessional active shooter simulation. Students also practiced critical thinking and coping strategies during the scenario to enhance their resilience. Differences in beliefs and attitudes, and confidence from before to after simulation was evident.