Methods: A pretest and posttest nonequivalent two-group design consisted of a sample of 65 undergraduate nursing students enrolled in a community health course. All students enrolled in the community health course have one day for hospice experience, and a two-hour orientation from the nurse educator at a local hospice agency. Students enrolled in the first seven weeks were paired with a hospice nurse and conducted home visits. Students enrolled in the second seven-week session participated in two simulated hospice experiences on campus. Thirty-two students were in the experimental group (simulated hospice) and 33 were in the control group (actual hospice). Attitudes toward end-of-life care was measured pre and post intervention with the The Frommelt Attitude Toward Care of the Dying (FATCOD) scale, Form B (Frommelt, 2003).
Results: The findings indicated positive attitude changes toward end-of-life care, and clinically relevant information for the development of a hospice clinical experience. After the clinical hospice experience, both groups appeared to show increases in their mean FATCOD scores possibly indicating a greater comfort with caring for dying patients. Paired t-tests for each group were conducted. The increase in the mean FATCOD score for the control group, 8.6 (SD = 9.4), was statistically significant (p < 0.001) indicating the students in the control group did experience a significant rise in their positive attitudes toward end of life care, on average. The increase in the mean FATCOD score for the experimental group was significantly smaller, 1.7 (SD = 11.4), and was not statistically significant (p = 0.42). Thus the students in the experimental group had little to no change in their mean FATCOD score indicating their positive attitudes toward end of life care was virtually unchanged
Conclusions: The findings have important implications for incorporating didactic and clinical components of end-of-life care throughout the undergraduate nursing curriculum. The clinical hospice experience can increase student comfort with caring for dying patients and families. The greatest increase in comfort with when caring for dying or end-of-life patients was from actual hospice clinical experiences. Since this is not always available, simulated experiences provide an acceptable substitute. The end-of life clinical can be a transformative experience allowing nursing students to develop greater compassion and increased decision-making skills when caring for the dying patient. Further research is needed to evaluate the efficacy of a hospice clinical compared to a simulated hospice experience.