Evaluating Undergraduate Nursing Students' Knowledge Before and After a Palliative and End-of-Life Care Course

Monday, 30 October 2017

Susan E. Thrane, PhD
Center for Children, Women and Youth, The Ohio State University College of Nursing, Columbus, OH, USA

Purpose: The purpose of this study is to determine if undergraduate nursing students increased their knowledge of palliative and end-of-life care concepts after taking a semester-long course when compared to before the course.


There is a substantial need for nurses trained in palliative care. Over the past two decades, several professional organizations have made public comment on the need for palliative care. The American Association of College of Nursing (AACN), the Institute of Medicine, the American Academy of Pediatrics and many others have issued statements regarding the increased need for palliative care and palliative-care trained nurses and healthcare providers (American Academy of Pediatrics, 2013; American Association of Colleges of Nursing, 2016; Institute of Medicine, 2014). With over 90 million adults and approximately 3 million children and adolescents living with life-limiting and life-threatening illnesses, nurses trained in palliative care are essential (Centers for Disease Control and Prevention, 2013; Friebert & Williams, 2015). Nurses and other health care providers receive very little formal education regarding palliative and end of life care although undergraduate nursing programs and medical schools are adding palliative care content (Horowitz, Gramling, & Quill, 2014; Martins Pereira & Hernández-Marrero, 2016). As a culture, we are death-phobic and unwilling to discuss death and end of life. This contributes to nurses who are unsure and even afraid to care for dying patients (Peters et al., 2013). Education aimed at palliative and end of life care helps nurses feel prepared to care for dying patients (Autor, Storey, & Ziemba-Davis, 2013). Nurses who are comfortable caring for this population will give better care and patients and families will have higher quality of life as a result.


This study is a one-group pre-test/post-test survey design. The purpose of the study is to examine whether participants gained knowledge about the topic of palliative and end-of-life care during the course as evidenced by an increase in post-test scores when compared to pre-test scores. We will match pre- and post-test scores for each participant in addition to a group mean using the same survey each time to address internal validity.

In 2016, the AACN issued Competencies And Recommendations for Educating Undergraduate Nursing Students (CARES) (American Association of Colleges of Nursing, 2016). An online course based on the CARES recommendations was developed to educate undergraduate nursing students on palliative and end of life care. Based on course content, a 33-question survey consisting of multiple choice, multiple answer, true/false, and Likert scale questions was developed to assess the students’ knowledge and their comfort in caring for dying patients. This palliative care knowledge survey was created for this study and was reviewed by two palliative care experts. The range of questions covers the content of the course topics including palliative and hospice care; palliative and end-of-life symptoms; culture, spirituality, and end-of-life practices; communication; pediatric and perinatal; sexuality and lesbian, gay, bisexual, and transgender issues; homeless and prison populations; grief and bereavement; and end of life and post-mortem. Demographics including sex, age, program type (traditional BSN or RN-BSN completion program), years in nursing (if applicable), and healthcare work experience were collected.

The survey was completed anonymously and was not graded for correctness. Students who consented to participate in the study created an ID code for themselves based on prompts and completed the survey. If students choose not to participate in the research study they completed the survey but not the demographic information or ID code. All students were required to complete the survey and received course credit whether or not they participated in the research study. At the end of the semester, all students must re-take the survey. If the student is participating in the research study, they will enter their self-created ID code before completing the survey. If a student decides to drop out of the study, they will not enter their ID code and will go directly to the survey questions. Students who are not participating in the study will not enter an ID code and will go directly to the survey questions.

A staff member not associated with the course will hold all data until after final grades are posted at the end of the semester. Student anonymity will be protected through the student-created ID codes. Generic ID Codes will be created for all students participating in the research study before transferring data to the instructor after the end of the semester. All data including consent, demographics, and survey will be collected using Qualtrics online survey tool. All data will be stored on password-protected network drives on password-protected servers behind a firewall. All data will be stored. The Institutional Review Board of the university approved the study.

Data Analysis:

Descriptive statistics for demographics and overall score and individual survey questions will be computed. The differences between pre- and post-survey scores will be examined using paired t-test for overall mean survey scores, mean scores for individual survey questions, and participant-matched overall mean survey scores and individual survey questions. Mixed effect modeling for repeated measures will be used to explore the effects of different types of students (pre-licensure compared to registered nurses) and previous experience/training (those that have had previous exposure to palliative and end of life experience or training compared to those that have not had previous experience or training) on the change in pre- and post-survey scores.