Unless students have opportunities in hospitals specializing in critical or terminal pediatric care, pediatric EOL care opportunities are extremely rare in the clinical setting (Aldridge, 2017).Nurse educators must devise strategies to address the lack of clinical experiences related to EOL care. Simulation experiences provide alternative pedagogical methods for EOL education, knowledge acquisition, enhanced communication skills, and improved self-efficacy (Gillan, Jeong, & Van der Riet, 2014).
Unfortunately, the use of simulation has multiple barriers including time, expense, and laboratory space. Additionally, faculty may not be adequately trained to develop and deliver simulation scenarios specific to EOL care (Fabro et al., 2014; Gillan et al., 2014). Therefore, the purpose of this research was to explore vicarious learning as a practical alternative to traditional active learning in a simulated pediatric EOL setting. The aim of this study was to compare changes in self-efficacy related tos therapeutic communication during a simulated pediatric EOL care situation between vicarious learners and active leaners.
Design
This was a quasi-experimental, cross-sectional, repeated measures study. The intervention included a simulation scenario involving a dying pediatric patient who was not conscious.
Method
The sample included pre-licensure students from two baccalaureate nursing programs of similar size within one state in the U.S. southeast. After human subject approval was obtained at both sites, data were collected during spring 2018. Randomization of students to active versus vicarious learner groups occurred at the time of the scenario. Vicarious learners viewed the event in real time from a separate room, and debriefing occurred with all students in a face-to-face setting.
The nine-item Self-Efficacy in Communications Scale (SECS) assessed perceived self- efficacy prior to the simulation (SECS1), immediately after the active scenario (SECS2), and after debriefing (SECS3). Data were analyzed using a 2 X 3 mixed-design ANOVA to test for main effect and for the interaction effect of time and group.
Results
Findings were found to be both valid and reliable with a statistically significant increase in the perceived self-efficacy mean score from SECS1 (pre-simulation) to SECS2 (immediately post-simulation) for the entire sample; however, there was no statistically significant difference between vicarious learners and active learners. There was also a statistically significant increase in the perceived self-efficacy mean score from SECS2 to SECS3 (post-debriefing) for the entire sample, with no statistically significant difference between vicarious learners and active learners.
Conclusion
In conclusion, integration of EOL care curriculum is essential, both in a didactic and clinical sense. Because EOL clinical experiences are rare during the time students are in pre-licensure nursing programs, simulation provides an excellent alternative to impart education and experiences for pre-licensure nursing students regarding the soft skills required of therapeutic communication during difficult situations such as at the EOL. With simulation comes potential barriers that prevent integration of such learning experiences including limited simulation space and time, limited number of students who can effectively be in a simulated experience at one time, limited faculty trained to facilitate EOL simulations, and the overall cost of running simulations.
Vicarious learning provides an excellent alternative to traditional nursing simulation experiences. By observing relatable peers successfully perform in an active simulated scenario, vicarious learners have equal and sometimes even higher levels of improved perceived self-efficacy in performing the same tasks as those they observed while being acted out by their peers. Acceptance of non-traditional pedagogy in a simulated situation may transform the way EOL care has historically been taught and negatively perceived by pre-licensure nursing students. Such a transformation has the potential to promote greater understanding of the importance of therapeutic communication at EOL and to empower future nurses to participate in necessary, though difficult, conversations surrounding death.