Using Simulations to Teach End-of-Life Care: A Research Study

In 1997, The Institute of Medicine (IOM) conducted an investigation to obtain data on the end of life care education and training practices provided to healthcare professionals and students of the health professions.  According to their report, there was a tremendous lack of education on death and dying at all levels of healthcare. The IOM mandated that the healthcare industry as a whole needed to do a better job in caring for dying patients.  While some progress has been made in educating healthcare professionals on end of life care (EOL), it is clearly not enough. Educators need to place greater emphasis in their curriculums on the dying patient and their families.                                                                                                                                                                                                                                                                                                   According to the literature, most nursing programs integrate death and dying into their various courses.  Unfortunately when this is done EOL content competes with other important topics and usually does not get the amount of time needed. It also depends on the level of comfort that the faculty/instructor has with EOL. Some find this topic sensitive and distressing and shy away from teaching it.                                                                                                                                                                                                                                                                                                                                                     This research study compared the use of the traditional pedagogical strategy, the interactive case study, to the innovative simulation experience to teach end of life care to baccalaureate nursing students. The researcher sought to compare these educational strategies, to determine which method provided the better outcome when teaching death and dying.  The study measured teaching EOL care using instructional case studies and simulated experiences. Students in the simulation group were experientially involved in caring for patients who were dying.           The design for this study was a quantitative experimental two group pre-test and post-test design. The researcher attempted to measure knowledge gains, critical thinking abilities, and comfort levels with death and dying. Students were randomly placed in either the case study Group A, or the simulation Group B. Four case studies were used by both groups. The results of this study showed a marginal increase in the mean scores of the simulation group as compared to the case study group. The pretest scores for the case study control group were: pretest mean = 707.18.and the mean of the posttest scores = 802.90. The mean of the pretest scores of the simulation group = 839.46 and the posttest mean scores were 914.50. Regarding comparison by gender, shows that the females had higher pretest scores F = 799.94, M = 676.67 and posttest scores F = 886.06, M = 804.33. However, males had the greater score change M = 127.6667, F = 86.1250.

Posttest results showed that students in the simulation group scored higher than those in the case study group. There were several key findings that emerged from the students’ responses to the experience of caring for a dying patient in a simulated environment; students expressed that participating in this research helped them to gain confidence, decrease their anxiety, and most importantly, know what to say to patients and their families when they are experiencing traumatic events. This was significant as it was a consistent theme throughout the research.

The goal of this research was two-fold. The main goal was to conduct a comparison of two teaching methodologies and determine which one provided the best EOL learning outcome. The second goal of this research was to increase interest and awareness of the tremendous need facing our profession and patients. We do both groups an injustice; nurses are not getting the proper education on EOL care and patients are not benefiting from EOL prepared nursing’s. This research has numerous implications for use in nursing practice, nursing academia, and in hospital settings.