Virtual Patient and Simulation: Strategies to Teach End-of -Life Care

How does the educator prepare students for the profound experience of providing care at end-of-life? Technology can be used to provide the knowledge and skills needed before the nursing student faces this situation in the reality of the clinical experience. The learning laboratory using simulation provides exposure in the affective area. In a gerontological course prior to the clinical experience, nursing students meet a virtual patient. Over the course of the semester, the students meet, interview, and assess this a virtual female adult patient. There is an unfolding case study that is presented to students throughout the semester. The students have practice communicating with the virtual patient before they are caring for patients in a long term care setting. This virtual patient is used as an exemplar in teaching various concepts such as communicating with a person who has sensory deficits related to aging or providing care to a person with a chronic condition. In addition to interaction in the virtual world, the faculty posts discussion board threads in BlackBoard incorporating other concepts related to caring such as safety risks, comfort in chronic conditions or the social isolation that can happen to older adults. Students post and respond to each other to share their plan of care and feelings about the situation. Most of the students are in the sophomore year of study and may have limited contact with older persons outside of possible personal experience. The technology and virtual setting support classroom learning and provide a safe place to practice and confront feelings about caring for someone whose health issues may not resolve. The use of technology can meet diverse learning styles. The students can virtually experiment by practicing interviewing and assessment. One section of the virtual experience is reflection on performance. Novice nursing students may approach nursing as solely health restoration. The technology is used to introduce the concept of the provision of palliative nursing care. The experience with this virtual patient concludes with an experience in the laboratory on campus with the human patient simulator. During the simulation, the simulated patient experiences a deteriorating change in status. In this scenario, there is another person in the role of family member or support person. The simulated patient dies during the scenario. This technology presents the opportunity to confront the end of life and the nursing care required for the patient and the family. The students apply the skills and knowledge related to end-of-life. During the debriefing of the simulation, students verbalize their feelings related to the scenario. The student has flexibility to interact with the virtual patient. The student encounters with this virtual patient meets the student need to manage the amount of time and schedule. The student has unlimited access to learning in the virtual world. The use of simulation can provides experience that offsets the variability of experience in clinical sites. Multiple technologies including virtual patient experience, web assisted learning management system, and high-fidelity human patient simulation  are used to educate  and support nursing students on the caring and compassion given at the time of death.