Nursing Students Learning to Provide End-of-Life Care Through Simulation

Nurses experience end-of-life occurrences regardless of their practice area.  The end-of-life situation may be a result of a terminal illness or may transpire unexpectedly.  Death does not respect age limits.  Therefore, nurses are to be prepared to provide end-of-life care and comfort in all practice settings.  However, nurses expressed receiving little or no education related to death and dying during their nursing pre-licensure education.  Individuals who did remember receiving end-of-life care education while in nursing school commented the learning focus was task oriented such as post-mortem care.

Opportunities for a clinical experience working with a patient who is actively dying can be limited for students.  Students who have not been exposed to a dying individual may experience distress and feel they did not provide the best care.  Also, students understanding of comfort care may be limited.  The purpose of the study was to identify concerns and improve nursing students' comfort when providing end-of-life nursing needs to patient and family members. This research was done to better understand nursing students' perceptions and needs for end-of-life care education. The purpose of this presentation is to publicize the findings of the research.

The research focused on nursing students' learning to provide end-of-life care for individuals and families.  A simulation scenario of imminent death was provided.  To enhance the scenario, a standardized patient played the role of the patient's wife.  Nursing students were recruited during the summer semester to participate in the simulated scenario of a patient and family member experiencing end-of-life care needs.  These needs included therapeutic communication, symptom management, and patient-centered care.  The research question was: Will students report improved comfort providing end-of-life nursing needs to patient and family members after a simulation experience?

Participants were nursing students who had completed at least the first semester of upper division nursing school but had not started their last semester of nursing school.  They were at least 19 years of age, were able to speak and understand English, and participants could be male or female.  Convenience and snowball sampling was done to recruit student participants.  The primary investigator was not teaching any courses the students were enrolled in during the time of the study.

Students completed a survey of attitude toward providing nursing care for a person who was actively dying prior to participating in the simulation.  After each participant completed the survey, students were paired together and completed the simulation.  Upon completion of the simulation, student participants, assistant investigator, and primary investigator met together to allow the student participants an opportunity to discuss their perceptions during the simulation.  The participants were aware the question and answer period was being audio recorded for verbal transcription and qualitative analysis by the research team.

Benefits of the study included identification of concerns and attitudes by the student nurses regarding caring for an individual and the family member at end-of-life.  These are concerns the students verbalized would prevent them from providing best practice care, providing comfort to the person and/or family member, and identifying needs of the patient or family during this time of care.  Through identification of students' needs, an end-of-life simulation scenario has been included in the curriculum.