According the Zheng, Lee, and Bloomer (2016) death is a source of high anxiety for nursing students. In addition, practicing nurses have been able to recall in detail their first experience with the death of a patient in the clinical setting (Anderson, Kent, & Owens, 2015). Simulation scenarios may be the most effective manner to assist nursing students to anticipate the challenges of managing a death or dying patient in the clinical setting (Keene et al., 2010). Nursing education literature suggests that more simulated experiences surrounding end-of-life (EOL) should become integrated into nursing curricula (Heise, Wing, & Hullinger, 2018).
Almost every registered nurse will experience a patient death at some point in his or her career. To assist final-semester associate degree nursing students in preparing to encounter an EOL/patient death scenario in professional practice, an EOL simulation was conducted using trained simulated patients as family members of a dying patient. The simulated patients were student actors enrolled in Improvised Simulated Performance, a 3-credit course co-taught by nursing and theatre faculty. To make the simulation as real as possible, students actors utilized the Michael Chekhov technique to portray the emotionality often experienced by individuals dealing with a dying family member. The purpose of the simulation was to teach future nurses to therapeutically communicate with family members/friends of dying loved ones, as well to evaluate students’ personal attitudes toward death and dying.
Methods:
Institutional review board approval was obtained to conduct a quantitative pre-test/post-test study to assess the impact of the EOL simulation on a convenience sample of 28 students preparing to graduate from an associate of science in nursing program. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale was administered to nursing students prior to a course lesson on hospice care. Two weeks later, an EOL simulation took place during class time. Four students directly participated in the simulation while the remaining students observed via live video feed. Once the simulation was completed and debriefing occurred, the FATCOD and a demographic questionnaire was administered.
Results:
Of the 28 students invited to participate, 24 provided consent. The sample was primarily Caucasian females in the age range of 18-24 years. Seventy percent of the sample reported being currently employed in healthcare, and ninety-two percent reported having experienced the death of a patient, friend, or family member. A Wilcoxon Signed Rank Test revealed a statistically significant increase in attitude toward care of the dying, z = -2.07, p < .05, with a medium effect size (r = .44). The median score on the FATCOD increased from pre-simulation (Md = 90.75) to post-simulation (Md = 91.75)
Conclusion:
This study’s findings provide insight on the importance of teaching nursing students to be prepared to care for the dying patient. Nurse educators must equip students to be prepared for all aspects of nursing practice, including patient death. Nurse educators should consider incorporating EOL simulation scenarios early in the nursing education curriculum, with continued exposure to varying EOL simulation scenarios across the curriculum.