While nurses are aware that therapeutic dialogue is a part of their role in providing end-of-life care, the literature reports that nurses are uncertain how to deliver quality communication to patients and families during this special time. There is often a sense of role ambiguity in communication at the end of life (EOL), evidenced by nurses not recognizing that it is their duty to obtain and share information with patients, families and the interdisciplinary team (Hjemlfors, et. al, 2015; Moir, Roberts, Martz, Perry and Tivis, 2015). In response to this uncertainty, nurses and students have reported that more education on communication is needed, in order to develop this skill and improve confidence (Croxon, Deravin and Anderson, 2017; Heise, Wing and Hullinger, 2018). The End-of-Life Nursing Education Consortium (ELNEC) training program, developed by Dr. Betty Ferrell, meets the need for continuing education on end-of-life care. The program consists of modules focusing on specific aspects of end-of-life care such as symptom management, grief and loss, and communication. These modules are taught to nurses in clinical practice as well as nursing students, by nurses who complete the ELNEC training course (XXX, 2018).
The purpose of this study was to examine the effect of an End-of-Life Nursing Education Consortium (ELNEC) Communication module on students’ communication self-efficacy following a simulated end-of-life scenario. A second purpose of this study was to explore the perceptions of end-of-life communication following a simulation on end-of-life care, focused heavily on communication.
Methods:
In this study, a mixed methods approach was used including quasi-experimental and qualitative descriptive designs. Fourth year nursing students enrolled in a Medical-Surgical Nursing III course participated in the study (n= 68). Prior to the study, Institutional Review Board approval was obtained from the university and participants were provided with an informed consent form detailing the purpose of the study.
Data collection involved three instruments. First, the investigator used a demographic questionnaire developed by the principal investigator for this study to collect information such as the participant's age, gender, experience with caring for dying patients in a clinical setting, experience with the loss of a family member or friend, ethnicity and religion. Second, the modified Self-Efficacy in Communication Scale (SECS) was used to assess student self-efficacy in communication at the end of life. Finally, the investigators were third instrument; focus groups were led by the investigator(s) to elicit students’ reactions to the end-of-life simulation and discuss their feelings regarding communication with patients and families.
The PI randomly assigned participants to two groups. One half of the students completed the ELNEC Communication module as a pre-assignment. The other half of the students read an article about end-of-life communication. During the first part of the simulation, students met with the patient’s wife and updated her about her husband’s progress in the ICU. The second part of the simulation involved students taking care of the patient in the ICU and several family members were present. Family members started arguing amongst each other about what treatments should be executed for the patient such as aggressive therapies, procedures or medications, or if the patient should stop these therapies and be allowed to die peacefully. Students were responsible for deescalating the argument and explaining to the family members about the patient’s condition (goals of care) and the best options for the patient.
Quantitative data analysis was conducted using descriptive statistics, including independent and paired t-tests. Qualitative data analysis was conducted using thematic analysis. Key phrases and themes were identified.
Results:
Findings include improved changes in student communication self-efficacy at the end of life, in both groups. Thematic analysis of the qualitative data offers student insights about communication skills required with a patient and their family who is near the end of life.
Conclusion:
The results of this study demonstrate the benefit of incorporating a simulation focusing on communication skills at the end of life as well as utilization of additional resources such as the ELNEC modules to supplement student learning about EOL care. Students in both groups reported an increase in communication self-efficacy. This study contributes to the advancement of nursing science and improvement of end-of-life care by highlighting an additional teaching strategy for end-of-life education. While education on communication skills in pre-licensure programs continues to evolve (Walczak, et. al., 2017), further research is needed on communication strategies that focus on the patient at the end of life.