The Use of Simulation to Teach Nursing Students and Clinicians Palliative Care and End-of-Life Communication: A Systematic Review

Pediatric Palliative Care Simulation Improves Resident Learning Outcomes: An 11-Year Review

CONTEXT

Many general pediatrics residents lack sufficient opportunities to conduct difficult conversations with families, particularly about end-of-life care. Simulation learning is an effective means of practicing professional skills. A pediatric palliative care (PPC) physician is uniquely suited to mentor residents and fellows learning to lead difficult conversations through simulation. Co-facilitation of the simulated difficult conversation by a bereaved parent or family member enhances the learning experience.

OBJECTIVES

To report 11-years' experience simulating difficult conversations with bereaved parent-actors.

METHODS

PPC physicians developed two simulations to teach difficult conversations to clinical learners at a midwestern quaternary pediatric medical center. Bereaved parents and hospital chaplains co-facilitated the simulation. The first portrayed the death of an infant following emergency resuscitation, and the second, a goals-of-care conversation with the parent of a child with a degenerative condition. A de-novo evaluation rubric was prepared using the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies to evaluate the participant's performance in the simulation.

RESULTS

For the first simulated scenario (N = 194 residents; N = 16 fellows), residents improved significantly on 16/21 ACGME-based criteria between encounters; for the second (N = 118 residents; N = 14 fellows), residents improved significantly on 10/21 criteria. Fellows' performance did not improve significantly in either scenario, but they presented with high baseline scores.

CONCLUSIONS

Simulations with bereaved parent actors improved general pediatrics residents' performance and comfort during difficult conversations and are transportable to diverse settings.

Successful Development and Implementation of Communication Skills Simulation Training Within Pediatric Hematology-oncology Fellowship Education

Difficult discussions with patients and families are a primary component of pediatric oncology care. We report our experience in the development and implementation of a longitudinal simulation-based Communication Skills Curriculum within a pediatric hematology-oncology fellowship training program. A 6-session simulation curriculum was created for fellows to practice difficult oncology related discussions with a standardized patient (SP). This program was implemented in 2017 and continues presently. Throughout fellowship training the scenarios progress in content and scope. Each simulation was observed and recorded, and written and verbal feedback was provided. The Gap-Kalamazoo Communication Skills Assessment Form was used to assess communication skills in each session. A total of 15 fellows (100% of possible participants) have participated in this curriculum to date. Across all domains of communication skills assessed, the ratings given by the physician evaluators and self-evaluations improved over the course of the scenarios completed throughout fellowship training. This type of simulation-based communication skills curriculum within a pediatric hematology-oncology fellowship training program is feasible to implement. This training is useful to fellows beyond training in improving communication skills, which has the potential to directly benefit the future patients they care for.

Clinical emergencies in inpatient hospice: simulation-based training to improve nursing confidence

OBJECTIVES

This study aims to assess whether a simulation-based training programme focusing on palliative care emergencies conducted in a hospice setting could improve the self-reported confidence and competence of nursing staff.

METHODS

A training programme was developed to enable nursing professionals to practice clinical skills necessary for recognising and managing palliative care emergencies including opioid induced respiratory depression, catastrophic haemorrhage, anaphylaxis, seizure and acute airway obstruction. Eight sessions were conducted. A prequestionnaire and postquestionnaire design was employed to collect data. Participants self-reported their confidence and perceived competence in responding to the relevant scenario before and immediately after simulation training and provided free text feedback. Paired t-tests were applied to assess for a change in competence and confidence scores, while free text responses were analysed thematically.

RESULTS

Findings demonstrated a statistically significant increase in the mean scores for both confidence and competence when comparing pretraining and post-training. Participants valued the opportunity to develop emergency response skills and recognised the value of simulation as an educational tool. Debrief was perceived to be important for maximising learning and facilitating self-reflection.

CONCLUSION

Participation in simulation-based training focused on palliative care emergencies in a hospice setting improved both confidence and perceived competence of nursing professionals.

Better general paediatric and neonatal palliative care skills: simulation teaching

OBJECTIVES

To assess the role of simulation to teach 'palliative care' skills to the multidisciplinary team (MDT) within general paediatric and neonatal settings.

METHODS

Five simulation sessions were undertaken. The themes were acute presentation of a patient with a deteriorating life-limiting condition with no advance care plan (ACP) in place and parents not wishing for escalation of treatment; putting wishes expressed in an ACP in place for a dying child; managing an expected death; putting an antenatal ACP into place at delivery; and withdrawal of life-sustaining respiratory support in an extremely preterm neonate. Simulations were attended by the MDT. Participants completed feedback rating enjoyment, organisation, quality and relevance of sessions, and likelihood of attending further paediatric palliative medicine (PPM) simulation sessions, alongside a 10-point confidence scale rating confidence in dealing with 'palliative care' scenarios and talking to families about death.

RESULTS

Participants reported they enjoyed the sessions (mean score 4.5, range 1-5) and felt they were well organised (4.7/5, range 1-5) and of high quality (4.7/5, range 1-5). They felt sessions were relevant to their training (4.6/5, range 1-5) and that they would attend further simulation training in the area of PPM (mean 4.8/5, range 1-5). Confidence in managing PPM scenarios increased by a mean of 2.3 confidence points (range -1 to 5) and confidence in talking about death increased by a mean of 1.7 confidence points (range 0-5).

CONCLUSIONS

PPM simulation training was acceptable to participants and effective in increasing confidence with PPM skills. Training in PPM simulation should be a routine part of paediatric and neonatal training across the MDT.

Patient card games in palliative care: integrative review

BACKGROUND

In the context of palliative care, a new approach has been documented that allows for sensitive end-of-life conversations to be established through a game of cards.

OBJECTIVE

This study aimed to identify the use of card games with patients in palliative care, assess self-reported satisfaction and synthesise findings on the effectiveness of its application.

DESIGN

We performed an integrative review study. The studies were collected from five databases, with no time limit until February 2021: Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Psychology and Behavioral Sciences Collection, SCOPUS and Scientific Electronic Library Online. The inclusion criteria were studies describing the use of card games in adult patients undergoing palliative care, in which the authors performed some type of evaluation. The methodological evaluation of the studies was carried out using the different standardised assessment tools from the Joanna Brigg's Institute.

RESULTS

Of the 685 articles identified, 9 met the inclusion criteria. Regarding methodological aspects, 4 studies were quantitative, 4 mixed-method methodologies, and 1 was qualitative. Card games have been in use for the last decade. The use of card games not only allows for participation in the game without any inhibitions and with a high degree of satisfaction, but also allows for the discussion of sensitive topics related to the end of life, motivating participants to engage in advanced care planning behaviours.

CONCLUSION

Our findings suggest that using a card game to facilitate conversations with patients in palliative care is a useful and effective approach to discussing uncomfortable topics of death, dying and end-of-life care.

Video Feedback Improves Anesthesia Residents' Communication Skill and Performance on Showing Empathy During Preoperative Interviews

OBJECTIVES

To determine the impact of scenario-based lecture and personalized video feedback on anesthesia residents' communication skills during preoperative visits.

METHODS

A total of 24 anesthesia residents were randomly divided into a video group and a control group. Residents in both groups took part in a simulated interview and received a scenario-based lecture on how to communicate with patients during preoperative visits. Afterwards, residents in the video group received personalized video feedback recorded during the simulated interview. One week later all the residents undertook another simulated interview. The communication skills of all the residents were assessed using the Consultation and Relational Empathy measure (CARE) scale by two examiners and one standardized patient (SP), both of whom were blinded to the group allocation.

RESULTS

CARE scores were comparable between the two groups before training, and significantly improved after training in both groups (all P < 0.05). The video group showed significantly greater increase in CARE score after the training than the control group, especially assessed by the SP (t = 6.980, P <0.001). There were significant correlations between the examiner-assessed scores and SP-assessed scores (both P = 0.001).

CONCLUSIONS

Scenario-based lectures with simulated interviews provide a good method for training communication skills of anesthesia residents, and personalized video feedback can enhance their performance on showing empathy during preoperative interview.

Right-sizing interprofessional team training for serious-illness communication: A strength-based approach

Objective

Palliative care communication skills help tailor care to patients' goals. With a palliative care physician shortage, non-physicians must gain these serious illness communication skills. Historically, trainings have targeted physician-only groups; our goal was to train interprofessional teams.

Methods

Workshops were conducted to teach palliative care communication skills and interprofessional communication. Participants completed surveys which included questions from the Interpersonal Reactivity Index, the Ekman Faces tool, the Consultation and Relational Empathy measure, open-ended questions about empathy, and measures of effective interprofessional practice.

Results

Participants felt the workshop improved their ability to listen (p < 0.001), understand patients' concerns (p < 0.001), and show compassion (p = 0.008). It increased the perceived value of peer observation (p < 0.001) and ability to reflect (p = 0.02) during complex conversations. Different types of professionals adopted different communication goals, though all affirmed the importance of active listening. Participants felt they improved their ability to work within an interprofessional team.

Conclusions

The course effectively trained 71 clinicians, the majority non-physicians, in serious illness communication and interprofessional team communication skills, and could be reproduced in similar settings.

Innovation

We adapted an approach common to physician-only trainings to diverse interprofessional groups, added a team-based component using Applied Improvisation, and demonstrated its effectiveness.

Evaluating the impact of a standardised intervention for announcing decisions of withholding and withdrawing life-sustaining treatments on the stress of relatives in emergency departments (DISCUSS): protocol for a stepped-wedge randomised controlled trial

INTRODUCTION

The decisions of withholding or withdrawing life-sustaining treatments are difficult to make in the context of emergency departments (EDs) because most patients are unable to communicate. Relatives are thus asked to participate in the decision-making process, although they are unprepared to face such situations. We therefore aimed to develop a standardised intervention for announcing decisions of withholding or withdrawing life-sustaining treatments in EDs and assess the efficacy of the intervention on the stress of relatives.

METHODS AND ANALYSIS

The DISCUSS trial is a multicentre stepped-wedge cluster randomised study and will be conducted at nine EDs in France. A standardised intervention based on human simulation will be codesigned with partner families and implemented at three levels: the relatives, the healthcare professionals (HCP) and the EDs. The intervention will be compared with a control based on treatment as usual. A total of 538 families are planned to be included: 269 in the intervention group and 269 in the control group. The primary endpoint will be the symptoms of post-traumatic stress disorder (PTSD) at 90 days. The secondary endpoints will be symptoms of PTSD at 7 and 30 days, diagnosis of PTSD at 90 days and anxiety and depression scores at 7, 30 and 90 days. Satisfaction regarding the training, the assertiveness in communication and real-life stress of HCPs will be measured at 90 days.

ETHICS AND DISSEMINATION

This study was approved by the ethics committee Est III from Nancy and the French national data protection authority. All relatives and HCPs will be informed regarding the study objectives and data confidentiality. Written informed consent will be obtained from participants, as required by French law for this study type. The results from this study will be disseminated at conferences and in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT06071078.

Knowledge and training among nursing students regarding the conspiracy of silence in palliative care: A participatory action research

AIM

To develop and implement specific training based on the knowledge and management of conspiracy of silence among nursing students.

BACKGROUND

Conspiracy of silence refers to the concealment of information from a patient on the family's request, under the influence of a paternalistic culture that seeks to protect the patient.

DESIGN

Participatory action research.

METHODS

Was conducted in the following stages: reconnaissance (focus groups); planning, action and observation (theoretical sessions); and reflection (analysis of care plans). The focus group consisted of six fourth year and eight second-year students. The intervention was conducted with 42 s-year students and a total of 93 s-year students participated in the resolution of the clinical case. The study was conducted between October 2022 and June 2023 at the Faculty of Nursing, University of Valencia. For data analysis, the process described by Carrillo et al. (2011) was followed, involving coding and the creation of categories and subcategories.

RESULTS

The focus group deficiencies were detected in the students' learning of palliative care competence, breaking bad news and the conspiracy of silence (reconnaissance stage). Therefore, an intervention was conducted to reinforce these knowledge areas, specifically addressing the conspiracy of silence (planning, action and observation stages). The resolution of the case showed how students with training approached the situation more comprehensively, including the family and proposed activities that were consistent with managing the situation (reflection stage).

CONCLUSIONS

An active feedback process was successfully established, where the students' feedback helped create specific training on oncological palliative care and provided the students with tools to manage the conspiracy of silence. The results underscore the importance of providing students with training in palliative care and managing conspiracy of silence, through therapeutic communication training, active training or enhancing emotional intelligence. This training is essential for cultivating the attitudes and skills required to deliver high-quality palliative care.

Spirituality, Religiosity, Caring Behavior, Spiritual Care, and Personalized Care Among Student Nurses: A Descriptive Correlational Study in the Philippines

This study sought to determine the student nurses' spirituality, religiosity, caring behavior, spiritual care, and personalized care. Further, it sought to determine the relationship between spirituality, religiosity, and caring behavior in student nurses' spiritual care and personalized care. The study used a descriptive correlational design using convenience sampling to collect data from 1248 student nurses in the Philippines from December 2023 to February 2024. We collected data using the Spirituality and Spiritual Care Scale rating scale and the Caring Behaviors Inventory. The study revealed that the mean scores of the students in their "spirituality" and "religiosity" were 4.08 (SD = 0.98) and 2.99 (SD = 1.26), respectively. Student nurses had sufficient confidence and skills in spiritual care, caring behavior, and personalized care. The students' age had a weak and negative association with the students' spirituality and religiosity. Students from University A had higher levels of spirituality and religiosity than students from University B, University C, and University D. Students in the 4th year level were more religious than 3rd year students. Students who had their last clinical exposure in the Admission and emergency room reported poorer caring behaviors than those who had previous clinical exposure in the Medical-surgical ward, Obstetrics and gynecology, Intensive Care Units, and Community. There is no significant relationship between a student nurse's spiritual care and caring behavior. This trend is similar to caring behavior and personalized care. The students' age predicts their personalized care.

Technology-based interactive communication simulation addressing challenging communication situations for nursing students

BACKGROUND

Simulation-based interventions for nursing students addressing challenging communication situations involving geriatric patients and end-of-life care are limited.

PURPOSE

This study evaluated the effects of technology-based interactive communication simulations on nursing students' communication knowledge, self-efficacy, skills, compassion, and program satisfaction.

METHOD

A randomized controlled repeated-measures design was used with third- and fourth-year nursing students enrolled in five nursing colleges located in five regions in Korea as participants. Participants were randomly assigned to either a technology-based interactive communication simulation or an attention control group. Changes in communication knowledge, self-efficacy, skills, compassion, and program satisfaction were assessed using three self-reported measures and communication skills were measured by the raters. Statistical analyses included descriptive analyses, chi-square tests, t-tests, and a generalized estimating equation model.

RESULTS

Eighty students participated in one of the two programs, and 77 in the four-week follow-up test. The intervention group indicated significant improvements in communication knowledge, self-efficacy, skills, and compassion, as well as higher program satisfaction compared with the attention control group. Communication skills as assessed by raters also showed significant change at all assessment time points.

CONCLUSION

The technology-based interactive communication simulation program is effective in improving communication skills among nursing students managing geriatric patients and end-of-life care.

Implementation and Evaluation of an End-of-Life Standardized Participant Simulation in an Adult/Gerontology Acute Care Nurse Practitioner Program

ABSTRACT

Graduate nursing programs must provide end-of-life (EOL) content to prepare nurse practitioners to manage the holistic needs of patients. This project aimed to measure the End-of-Life Nursing Education Consortium curriculum's impact on student self-confidence and anxiety levels. A pretest/posttest study design was implemented using an EOL simulation and the Nursing Anxiety and Self-Confidence With Clinical Decision-Making Scale (NASC-CDM©) to compare baseline self-confidence and anxiety levels related to clinical decision-making. Results showed that the simulation increased student self-confidence, but anxiety level remained unchanged. Nurse educators should consider incorporating EOL simulation into graduate curricula to improve student confidence with clinical decision-making.

Educational content and strategies to support nurses from culturally and linguistically diverse backgrounds caring for patients considering voluntary assisted dying: The Australian experience

OBJECTIVES

Drawing on findings from a qualitative study that aimed to explore the knowledge and attitudes of nurses from culturally and linguistically diverse (CALD) backgrounds about voluntary assisted dying (VAD). The study also aimed to identify the strategies that assist nurses in their readiness and preparation for exposure to VAD. This paper reports on the educational content and strategies that could assist nurses from CALD backgrounds to be better prepared when they encounter VAD requests.

BACKGROUND

Around the world, healthcare professionals have roles to play in caring for patients requesting voluntary assisted dying. Nurses, particularly those from diverse geographic and clinical settings, have voiced inadequate knowledge and understanding about voluntary assisted dying.

DESIGN

A qualitative descriptive approach was undertaken.

METHODS

Data collection involved one focus group and 16 in-depth interviews. A total of 21 nurses from CALD backgrounds were recruited from one Australian state. Thematic analysis was conducted to interpret the data.

FINDINGS

Nurses identified their knowledge gaps and specified the need for education and workplace training on VAD, its legal and ethical aspects, clarity on their role, communication techniques and how VAD intersects with their practice. They suggested various teaching strategies that could prepare nurses to work safely and confidently in a clinical environment where voluntary assisted dying is an option for patients.

CONCLUSION

Given the high number of nurses from diverse backgrounds working in the Australian health sector, these nurses need to be fully prepared to care for patients requesting VAD.

Using simulation to teach nursing students how to deal with a euthanasia request

Nursing students are confronted with euthanasia during their internship and certainly during their later career but they feel inadequately prepared in dealing with a euthanasia request. This study presents a simulation module focused on euthanasia and evaluates nursing students' perceptions after they have completed the simulation practice. The 'euthanasia module' consisted of a preparatory online learning module, a good-practice video, an in-vivo simulation scenario, and a debriefing session. The module's content was validated by four experts in end-of-life care. The module was completed by three groups of students from two different University Colleges (n = 17 in total). The students were divided into three groups: one with no previous simulation education experience, one with all students having previous experience, and another with a mix of experiences. After completing the entire module, each group had a discussion regarding their perceptions and expectations concerning this simulation module. Thematic content analysis was conducted on audio-recorded group interviews using NVIVO® software, involving initial open coding, transformation into specific themes and subthemes through axial coding, and defining core themes through selective coding, with data analysis continuing until data saturation was reached. Students generally found the online learning module valuable for background information, had mixed perceptions of the good-practice video, and appreciated the well-crafted scenarios with the taboo of euthanasia emerging during simulations, while the debriefing process was seen as enhancing clinical reasoning abilities. Students considered the simulation module a valuable addition to their education and nursing careers, expressing their satisfaction with the comprehensive coverage of the sensitive topic presented without sensationalism or taboos. This subject holds significance for nations with established euthanasia laws and those lacking such legal frameworks. The findings of this study can aid teachers in developing and accessing euthanasia simulation training programs, contributing to broader education's emphasis on integrating euthanasia-related knowledge and skills.

Palliating Serious Illness During Disasters and Public Health Emergencies

ABSTRACT

The increase in disasters and public health emergencies in recent years is a serious public health concern. The needs of suffering victims can be multifaceted, particularly the needs of those who are from systematically marginalized populations. Palliative care nurses play a vital role in mitigating the suffering of those affected by these events. Despite the acute need, there is a lack of nurses who specialize in hospice and palliative care and generalist nurses are not sufficiently prepared to provide palliative care during disasters and public health emergencies. Nurses and nursing students should use national and global resources and training opportunities to hone their palliative care skills as well as learn self-care skills to increase their resiliency. Outcomes from research and collaborative efforts should be used to educate the future nursing workforce and advocate for equitable delivery of quality palliative care for all people who are affected by disasters and public health emergencies.

Nursing students' perspectives and learning experiences of participating in a palliative and end-of-life care simulation programme: A qualitative study

BACKGROUND

Simulation-based learning has become an integral part of the nursing curriculum, allowing students to acquire clinical knowledge and relevant skills and apply them to real-life clinical encounters. However, little is known about the best practices in palliative and end-of-life care simulations.

OBJECTIVE

To explore the perspectives and learning experiences of undergraduate nursing students participating in a newly developed advanced practice nurse-led palliative and end-of-life care simulation program.

DESIGN

A descriptive qualitative study based on focus group discussions.

SETTINGS

A healthcare simulation centre at a university in Singapore.

PARTICIPANTS

A purposive sample of 75 third-year undergraduate nursing students who had attended a palliative and end-of-life care simulation program.

METHODS

Eight face-to-face focus group discussions were conducted and audio recorded. Data were analysed using inductive thematic analysis.

RESULTS

Four themes encompassing 12 subthemes were derived: (1) Patient, family and caregiver needs during palliative and end-of-life care, (2) Nursing competencies in palliative and end-of-life care, (3) Experience of palliative and end-of-life care simulations and (4) Suggestions for future palliative and end-of-life simulations. The students expressed their support for including advanced practice nurses as facilitators and suggested the use of other simulation modalities such as virtual simulations to enable the participation of all students and provide a wider range of simulated scenarios.

CONCLUSIONS

Simulation-based learning plays a crucial role in the palliative care curriculum. Clinical experts should be involved as facilitators to provide essential insights. It is also vital to consider students' prior experiences with death and dying, which may positively or negatively influence their palliative and end-of-life care competencies.

RECOMMENDATIONS

Nursing schools should utilise clinical experts and other simulation modalities to improve students' learning experiences, provide more simulation experiences and overcome resource constraints such as limited curriculum time.

Clinical Simulation in Palliative Care for Undergraduate Nursing Students: A Randomized Clinical Trial and Complementary Qualitative Study

BACKGROUND

a lack of adequate training in palliative care leads to a greater emotional burden on nurses.

PURPOSE

to assess the effect of a simulation using standardized patients on self-efficacy in palliative care, ability to cope with death, and emotional intelligence among nursing students.

METHODS

a randomized clinical trial and qualitative study. A total of 264 nursing students in a palliative care module completed the Bugen, trait meta-mood, and self-efficacy in palliative care scales after active participation in the simulation (n = 51), watching the simulation (n = 113), and the control group (n = 100). An ANOVA with a multi-comparative analysis and McNemar's tests for paired samples were calculated. Active participants were interviewed, and a thematic analysis was conducted.

RESULTS

there was an improvement after the assessment in all three groups assessed for coping with death (p < 0.01), emotional intelligence (p < 0.01), and self-efficacy (p < 0.01). In addition, the active group improved more than the observer group and the control group in coping with death, attention, and repair. The students in the interviews identified sadness and an emotional lack of control.

CONCLUSIONS

the simulation improved nursing students' self-efficacy in palliative care. This effect was partially stronger in the active group.

Training perinatal nurses in palliative communication by using scenario-based simulation: A quasi-experimental study

AIM

This study aimed to assess the impact of two educational modules on enhancing the communication confidence, competence and performance of perinatal nurses in the context of palliative care.

BACKGROUND

Concerns have arisen regarding the preparedness of perinatal nurses in delivering palliative care, especially in terms of deficiencies in communication skills and negative attitudes toward making life-support decisions for parents facing neonates with terminal conditions. Bridging this gap necessitates improved perinatal palliative care education for healthcare providers. Research has shown that simulation-based teaching effectively enhances procedural competence, communication skills and confidence among healthcare professionals. However, comprehensive curricula focusing on perinatal palliative communication remain limited.

DESIGN

This study used a quasi-experimental design employing a two-group repeated measure approach. It involved a purposive sample of 79 perinatal nurses from a hospital in northern Taiwan.

METHODS

A palliative communication course specifically designed for registered nurses in perinatal units was developed. Participants were allocated to either the experimental group (Scenario-Based Simulation, SBS) or the control group (traditional didactic lecture). Communication confidence and competence were assessed before and immediately after the course through structured questionnaires. Learning satisfaction was collected post-intervention and participants underwent performance evaluation by standardized parents one week later.

RESULTS

A significant training gap in palliative care exists among nurses in OB/GYN wards, delivery rooms and neonatal critical care units, highlighting the need for continuing education. All 79 participants completed the training course. Following the intervention, nurses in the SBS group (n=39) exhibited significant improvements in self-reported confidence (p <0.05), competence (p <0.01) and performance (p <0.001) in neonatal palliative communication compared with the traditional didactic lecture group (n=40). The SBS group also received higher satisfaction ratings from nurse learners (p <0.001).

CONCLUSIONS

The research findings support scenario-based simulation as a more effective educational approach compared with traditional didactic lectures for enhancing communication confidence and competence. These results were further reinforced by evaluation from standardized patients, highlighting the value of direct feedback in enhancing nurses' performance. Tailoring SBS designs to diverse nursing contexts and incorporating a flipped approach can further enrich the overall learning experience. Given its high effectiveness and positive reception, we recommend integrating this educational module into palliative care training programs for perinatal nurses.

The impact of virtual clinical simulation on nursing students' palliative care knowledge, ability, and attitudes: A mixed methods study

BACKGROUND

Palliative care is fraught with numerous challenges when it comes to conducting practical teaching as it involves caring for people facing the complexities of end-of-life and death. Insufficient clinical practice hinders nursing students from mastering knowledge, attitude and ability of hospice care. Virtual clinical simulation has demonstrated its effectiveness as a valuable educational tool in nursing. However, there is a dearth of evidence supporting its utilization in the context of palliative care practice education.

OBJECTIVE

To develop a virtual clinical simulation education system and assess its impact on enhancing nursing students' knowledge, ability, and attitudes toward palliative care.

DESIGN

A single-group pretest-posttest design and focus group interviews were employed.

SETTING

The study was conducted at a medical university in southwest China.

PARTICIPANTS

A total of 76 third-year nursing students participated.

METHODS

Participants underwent a 1-hour learning session using the virtual clinical simulation education system. Pre-test and post-test evaluations were conducted to assess the participants' knowledge, ability, and attitudes toward palliative care. Survey questionnaire was administered to gauge the students' acceptance and perception of virtual clinical simulation. Focus group interviews were integrated to gain insight into students' subjective perceptions and feedback on the virtual clinical simulation.

RESULTS

There were notable enhancements in the students' overall scores of palliative care knowledge, ability, and attitudes after the learning session. Students positively evaluated the usefulness and usability of virtual clinical simulation. Students' feedback regarding virtual clinical simulation can be categorized into four themes: the value of virtual clinical simulation education system, its role as a complement to clinical practice teaching, the enjoyment and accessibility of learning, and the technological challenges encountered.

CONCLUSION

Virtual clinical simulation is an effective learning tool in palliative care practice education, which has the potential to enhance students' knowledge, ability, and attitudes toward palliative care.

Using palliative and end-of-life simulation to enhance pre-licensure nursing students' emotional intelligence, palliative care knowledge and reflective abilities: A single group, pretest-posttest study

BACKGROUND

Nursing students have reported that they lack skills and knowledge in palliative and end-of-life care, and as a result, they faced numerous challenges caring for patients and families receiving palliative and end-of-life care during clinical attachments.

OBJECTIVES

To develop a palliative and end-of-life care simulation program and evaluate its effects on nursing students' emotional intelligence, palliative care knowledge and reflective abilities.

DESIGN

A single group, pretest-posttest quasi-experimental study.

SETTINGS

A simulation center in a Singapore university.

PARTICIPANTS

A convenience sample of 135 third-year undergraduate nursing students.

METHODS

Students attended a two-day simulation program consisting of four scenarios in total. Outcomes were measured before and after the study. Palliative care knowledge was measured using the Palliative Care Knowledge Test, emotional intelligence using the Trait Meta-Mood Scale-24, and reflective abilities using the Groningen Reflective Ability Scale. Outcome and demographic data were analyzed using descriptive and inferential statistics.

RESULTS

Total Palliative Care Knowledge Test scores (p = 0.003) and total Trait Meta-Mood Scale-24 scores (p < 0.001) improved significantly, but there was no significant change in Groningen Reflective Ability Scale scores (p = 0.650). Demographic characteristics did not significantly influence most outcome variables. Students' highest education level and experience with caring for a person receiving palliative or end-of-life care significantly affected the posttest scores of the Palliative Care Knowledge Test. Students with prior experience in caring for a person receiving palliative or end-of-life care scored significantly better in the Palliative Care Knowledge Test post-simulation compared to those who did not (p = 0.011).

CONCLUSIONS

The palliative and end-of-life simulation program significantly improved nursing students' emotional intelligence and palliative care knowledge. Further research is needed on developing a reliable tool to measure nursing students' palliative care knowledge. Future simulations should include structured and deliberate reflection features aside from debriefings to enhance reflective abilities, which is an important nursing competency. More research is needed on the effect of palliative and end-of-life care simulations on emotional intelligence and reflective abilities, and the influence of demographic variables on nursing students' outcomes.

Experiential Education About Patient Death Designed for Undergraduate Nursing Students

ABSTRACT

New graduate nurses are unprepared for patient death, leading to a potential negative impact on patient care and an increase in turnover. This study investigated the use of high-fidelity simulation to teach about patient death. Senior nursing students ( n = 124) were randomly assigned to rescue or failure-to-rescue scenarios. Outcomes included knowledge and emotional affect. Data analyses included comparative statistics, t -tests, and two-way analysis of variance. Both groups had equal knowledge gain. The failure-to-rescue group had significantly lower emotional affect following simulation but was equal to the rescue group following debriefing.

The Development of a Communication Tool to Aid Parent-Centered Communication between Parents and Healthcare Professionals: A Quality Improvement Project

Good communication is central to good healthcare. As a result of poor communication between parents and healthcare professionals (HCPs) in clinical settings, this study aimed to address this problem by developing a communication tool to empower parents and act as a prompt for HCPs to talk about the child's care and gather information at the point of admission to hospital about what is important to families, therefore supporting patient-centered communication. A design thinking process was used to develop a physical copy of Chloe's card and evaluate its use. Design thinking is a problem-solving approach, which uses an empathetic lens to integrate viewpoints of different stakeholders throughout the process of creating solutions. Design thinking involves five processes: (1) empathise-including a literature review and data synthesis, (2) define-by completing semi-structured interviews with parents about their experience of communication and HCPs perceptions of parent's experience of communication, (3) ideate-iterate the design of Chloe's card with parents and HCPs, (4) prototype-develop the design of Chloe's card, and (5) test-pilot test in clinical practice. Results from this initial study suggest that a small hand-held card, with emoticons and a place to write concerns, was acceptable to parents and feasible to use in clinical practice. Parents do not always feel heard by HCPs and a tool such as Chloe's card may help facilitate sharing of information about matters important to them and their child. However, some HCPs felt the need for a communication tool undermined their clinical skills. Feedback from HCP participants suggests that the idea of Chloe's card was acceptable and perceived as potentially being useful in clinical practice. Further work is required, as part of a larger study, to further refine this communication tool, identify those parents who would benefit most from Chloe's card, as well as to further refine the HCP process prior to implementing it into clinical settings. It was noted future iterations would benefit from a digital version linked with a child's electronic record, as well as multi-language versions and information for parents.

Determining current approaches to the evaluation of the quality of healthcare simulation-based education provision: a scoping review

Background: With an increase in simulation being used in healthcare education, there is a need to ensure the quality of simulation-based education is high. This scoping review was conducted to answer the question: What are the current approaches to the evaluation of the quality of health-care simulation-based education provision? Methods: Databases PubMed, Cochrane, ERIC, CINAHL and Medline were searched in March 2023 to retrieve peer-reviewed healthcare research and review articles written in the English language within the last 20 years. All data were extracted from six studies, themed and presented in the main text and in tabular form. Results: Two scoping reviews, one systematic review and three research articles were included. Three main themes were found: adherence to existing design frameworks, lack of validation of these frameworks and lack of evaluation frameworks, and a proposed evaluation framework. Many of the excluded articles focussed on gaining participant feedback to evaluate simulation activities, rather than evaluating the quality of the design and implementation of the simulation. Conclusions: Benchmarking of current United Kingdom (UK) healthcare simulation against UK and international simulation standards is required to increase its quality, therefore, an agreed UK template framework to evaluate simulation packages is recommended.

Nursing students experiences of end-of-life care

BACKGROUND

Undergraduate nursing students spend a significant amount of time in clinical placements where they are involved in care at the end of a person's life and care after death. While their role is to provide compassionate care, some students feel wholly unprepared.

AIMS

The aim of this qualitative study was to explore student nurses' experiences of care in death, dying and post death care, and to explore how students can be better prepared to provide such care.

METHODS

This is a qualitative descriptive study that is concerned with the subjective reality of participant's experiences.

FINDINGS

Six themes were developed from the analysis: first encounters with death and dying; preparedness; mentoring and support received; the caring role; striving to cope; working with families and working through COVID-19.

CONCLUSION

Students described their experience of placements in end-of-life care as challenging, yet were also able to adopt ways to develop as compassionate practitioners.

A Qualitative Study of Stakeholders' Perspectives of Implementing Interprofessional Shared Decision-Making Education in Palliative Care

Introduction Shared decision-making (SDM) in palliative care is a highly complex process that requires an interdisciplinary team. Interprofessional team members need education on how to facilitate discussion of patient/family wishes at the end of life in hospital settings. So far, interprofessional shared decision-making (IP-SDM) education frameworks have been used to a limited extent in the area of education on palliative care. The aim of this study was to explore policymakers', health professionals', faculty members', and students' perspectives on implementing an IP-SDM educational framework in palliative care to identify aspects that should be prioritized to further develop interprofessional education for SDM in palliative care. Methods We used the qualitative method to capture the micro, meso, and macro factors using Oandasan and Reeves' model for the implementation of IP-SDM education regarding palliative care. Data collection tools included in-depth, face-to-face interviews with individual policymakers and focus group interviews with health professionals, faculty members, and undergraduate health professionals. The interview guide explores the teaching of SDM in palliative care, factors that could facilitate or hinder the implementation of IP-SDM education for health professions students in palliative care, and interventions to facilitate the implementation of this approach. This study was conducted at the Oncology and Palliative Care Department at King Abdulaziz Medical City in the Ministry of National Guard Health Affairs and at King Saud bin Abdulaziz University for Health Sciences in Jeddah, Saudi Arabia. Results The results indicated a high demand for IP-SDM in palliative care. The findings revealed factors that can facilitate or hinder the implementation of IP-SDM education in palliative care for undergraduate health professions students that is going to the local community. Factors include culture, religion, gender, power issues, team hierarchy, and respect among team members. Also, our findings have revealed potential solutions to the hindering factors. Conclusions IP-SDM education in palliative care is a highly relevant topic for improving patient outcomes. However, it might be a complex process to implement, especially given the challenges of palliative care settings. We recommend starting such a course in the early clinical phases of undergraduate health professional education.

Room of horrors simulation in healthcare education: A systematic review

OBJECTIVES

A room of horrors simulation is one tool that healthcare educators use to improve learners' awareness of patient safety hazards and other critical matters in a safe and controlled environment. This review aimed to summarize research on use of room of horrors simulation in healthcare education, examine its effectiveness, and recommend directions for future education and research.

DESIGN

A systematic review of the literature.

DATA SOURCES

Relevant publications in English were identified in PubMed, Embase, CINAHL, Scopus, and dissertation databases, and through a manual search of the reference lists of included articles.

REVIEW METHODS

The systematic review and its reporting process conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Included articles were evaluated for quality using the Mixed Methods Appraisal Tool. Two authors independently extracted data from each article, and two additional authors confirmed the accuracy of the extracted data. The "horrors" used in the studies' simulations were mapped into 13 different incident types.

RESULTS

Sixteen studies were included in the final review. All of them were conducted in Western countries. Simulation scenarios were developed based on existing resources, expert guidance, or patient safety concerns frequently reported at a particular institution. The number of horrors per scenario ranged from nine to 68, with the most common being medication-related and clinical procedure-related incidents. Participants completed a room of horrors simulation as individuals, a team, or both. When competing as a team, the team sizes ranged from two to 11. Studies reported high participant satisfaction.

CONCLUSIONS

Room of horrors simulation is a useful teaching tool for healthcare students and professionals. However, there is little conclusive evidence about the ideal composition and size of teams, and therefore this merits more research attention, as does attention to the longer term impacts on learners.

Academic-Clinical Collaborations to Build Undergraduate Nursing Education in Hospice and Palliative Care

With the current shortage of hospice/palliative care (HPC) workforce, there is an urgent need to train a generation of nurses with clinical competency in HPC to ensure equitable access and optimal care for patients living with serious illness or at the end of life. The recent demand for HPC teaching in nursing education calls for innovation in establishing clinical placements. Palliative care nursing experts in New York State were surveyed between June and August 2022 about facilitators of academic-clinical partnerships between nursing schools and clinical settings. Inductive content analysis of open-ended responses revealed six major interconnected themes: (a) Increase Awareness of HPC in the Nursing Program, (b) Build a Relationship With Administrators, (c) Look Beyond Acute Care Partnerships, (d) Offer Incentives, (e) Develop Direct Care Experiential Opportunities, and (f) Develop Non-Direct Care Experiential Opportunities. Findings provide rich insights into key considerations for successful collaboration between nursing schools and clinical sites. [Journal of Gerontological Nursing, 49(6), 13-18.].

Effectiveness of a standardised patient simulation programme in undergraduate nursing students 6 months after implementation: A quasi-experimental study

AIMS

The objectives were to evaluate the effectiveness of a standardised patient simulation programme and to analyse to what extent the students transferred the skills covered in the simulation to clinical practice 6 months after the intervention.

DESIGN

A quasi-experimental study was carried out, with measurements taken pre-, post- and 6 months after the implementation of a standardised patient simulation programme in a single group.

METHODS

Eligible to participate were all final year nursing undergraduates during the 2020-2021 academic year. In total, 41 undergraduate nursing students took part in all stages of the study. It was measured attitude towards communication, self-efficacy, communication skills and resilience. The degree to which communication skills were used in the real setting was also assessed.

RESULTS

The students' scores for self-efficacy and perceived communication skills improved and were maintained after six months. Regarding to resilience, improvement was even evident six months following the intervention. In terms of the transfer to clinical practice, the students were making moderate to high use of the communication skills learned in the simulation.

Informing Simulation Design: A Qualitative Phenomenological Study of the Experiences of Bereaved Parents and Actors

INTRODUCTION

Simulations, which represent reality, are effective in pediatric healthcare communication skills education and training. Parents are increasingly engaged in simulation development, particularly for authentic character development, to help achieve greater psychological fidelity. For simulated encounters related to a child's end-of-life, involvement of bereaved parents would make sense. However, this is challenging because there is limited research to guide their inclusion and significant responsibility for any approach to be thoughtful and psychologically safe for participating parents. This study explores the impact and experiences of bereaved parents and actors who participated in simulation design.

METHODS

This qualitative phenomenological study involved five bereaved parents and two actors who participated in a full-day workshop to design and develop characters for use in a simulation. Individual semistructured interviews were conducted up to four weeks after the workshop. Data collected from these telephone interviews were analyzed using inductive content analysis.

RESULTS

Bereaved parents found the workshop emotionally challenging but positive, worthwhile, and beneficial. Similarly, actors found the workshop helpful in character development and, although it was an intense experience for them, it validated the importance of their work. Key elements of our research findings could inform future such activities.

CONCLUSIONS

Involving bereaved parents in simulation design can be psychologically safe and beneficial for both parents and actors. Ongoing involvement of bereaved parents may lead to higher-quality simulated experiences, allowing clinicians to practice skills to enhance care provided at a child's end-of-life.

Simulation-based learning in palliative care in postgraduate nursing education: a scoping review

BACKGROUND

Nurses require advanced competence in palliative care, but they face wide variations in education and a shortage in opportunities for clinical placement. Simulation-based learning (SBL) can enable students to develop clinical skills, critical thinking and confidence. No scoping reviews to date have mapped the use of SBL in palliative care within postgraduate nursing education.

METHODS

The aim of this scoping review was to systematically map published studies on the use of SBL in palliative care in postgraduate nursing education. A scoping review was conducted using Arksey and O'Malley's (Int J Soc Res Meth 8(1):19-32, 2005) methodological framework. A systematic and comprehensive search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), Ovid MEDLINE, Ovid EMBASE, Allied and Complementary Medicine and PsycINFO was performed for studies published between January 2000 and April 2022. Two authors independently assessed papers for inclusion and extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The protocol was registered on the Open Science Framework.

RESULTS

This review includes 10 studies. Three thematic groupings were identified: enhanced understanding of the importance of teamwork, interdisciplinarity and interpersonal skills; preparedness and confidence in one's ability to communicate during emotionally challenging situations; and impact and relevance to one's own clinical practice.

CONCLUSIONS

The use of SBL in palliative care in postgraduate nursing education seems to enhance students' understanding of the importance of teamwork and interdisciplinarity. The review shows contradictory results regarding whether SBL in palliative care increases students' confidence in their communication skills. Postgraduate nursing students experienced personal growth after participating in SBL. Because our findings indicate that limited research has been conducted within this field, future research should (1) explore postgraduate nursing students' experiences with SBL in palliative care with a focus on more practical content such as symptom management, (2) examine the relevance and application of SBL in clinical practice, and (3) be reported in line with recommendations on the reporting of simulation research.

Student nurses' end-of-life and post mortem care self-efficacy: A descriptive study

BACKGROUND

Student nurses providing end-of-life care reported that caring for a person dying created anxiety, fear, and increased stress and reflected low self-efficacy. New nurses felt unprepared academically and emotionally. High self-efficacy is necessary to handle adverse emotional reactions. However, the literature lacks an instrument to evaluate nursing students' self-efficacy in caring for someone who is dying.

OBJECTIVE

The study aims to investigate the reliability and validity of the "End-of-Life and Postmortem Self-Efficacy Scale" and explore nursing students' self-efficacy associated with the nursing duties and responsibilities of caring for individuals during the active phase of dying and immediately after death.

DESIGN

The study was a quantitative descriptive, cross-sectional design.

PARTICIPANTS

National Student Nurses' Association members enrolled in undergraduate registered nurse associate's, bachelor's degree programs, or a nursing diploma program.

METHOD

National Student Nurses' Association members responded to an electronic survey containing 18 items related to end-of-life and post mortem nursing responsibilities.

RESULTS

A total of 498 responses were analyzed. Cronbach's alpha (α = 0.938) showed high reliability of the 18 items on the instrument. The Kaiser-Meyer-Olkin was 0.925 and indicated sampling adequacy. Bartlett's test of sphericity was highly significant (p = .001). The nursing students' mean end-of-life and post mortem self-efficacy score was 62 (scale of 0-100).

CONCLUSION

The "End-of-Life and Postmortem Self-Efficacy Scale" showed high reliability in evaluating the latent concept of end-of-life and post mortem self-efficacy. The low mean self-efficacy score indicated that nursing students might be underprepared to provide EOL and post mortem care as new graduates. Faculty can use the "End-of-Life and Postmortem Self-Efficacy Scale" to assess student readiness and identify gaps in knowledge in the care of someone who is dying. Future research is needed to determine how increasing nursing students' end-of-life and post mortem self-efficacy influences the perception of end-of-life preparedness.

Exploring the use of games in palliative care: A scoping review

OBJECTIVE

There has been increasing recognition of the potential of games in health; however, knowledge of their application in palliative care is lacking. Therefore, this study aimed to identify and map the available evidence on the use of games in palliative care, analyzing how research has been conducted on this topic and identifying gaps in knowledge.

METHOD

A scoping review was carried out. The literature search was conducted using the respective descriptors and search syntax appropriate to each of the databases searched. The review included all study types with no time limits.

RESULTS

Of the 685 articles initially identified, 53 were included for final analysis. Several different game types were identified, with the majority of studies using role-play (n = 29) and card games (n = 17). The games analyzed were essentially aimed at empowering patients (n = 14), and in some cases, extended to families or caregivers, as well as to medical and nursing students. The analysis of the articles in this review resulted in two major themes: Role-playing for training in palliative care and card games to discuss end-of-life care.

SIGNIFICANCE OF RESULTS

Games allow space for the expression of emotions and promote creativity. They can be applied both in a training context, to enable health professionals to develop essential skills in palliative care, and for patients, families, and caregivers, allowing them to talk about serious things while playing.

Effects of advance care planning training on advanced practice nurse students' knowledge, confidence, and perception of end-of-life care: A mixed-method study

AIMS

This study aimed to assess how an advance care planning training program affected advanced practice nursing students' knowledge, confidence and perception of end-of-life care in South Korea.

BACKGROUND

Effective communication between healthcare providers, patients and their families is one of the most important components of quality end-of-life care. However, nurses in South Korea may feel uncomfortable helping patients and families with advance care planning because of the cultural taboo against talking about dying.

DESIGN

A mixed-method design was used with data obtained from self-administered questionnaires at the onset and end of the advance care planning training program and qualitative data from participant feedback after the program.

METHODS

Data collected from 65 advanced practice nursing students who participated in advance care planning training programs in June-July 2020 and 2021, conducted as part of a graduate clinical practice course, were analyzed. Data were originally collected to examine students' course outcomes. A training program was provided to advanced practice nursing students to improve their knowledge, confidence and perception in advance care planning conversations with their patients. The program comprised three sessions: online lectures, face-to-face simulations and discussions on advance care planning and ethical issues. Changes in advance care planning knowledge, confidence in supporting patients' advance directives, perceived nursing roles in end-of-life treatment decisions and perception of a good death were examined before and after the training.

RESULTS

There were statistically significant increases in participants' advance care planning knowledge, confidence in supporting patients' advance directives and perception of the active role of nurses in patients' end-of-life treatment decisions after the training.

CONCLUSIONS

The results indicate the effects of training programs on advanced practice nursing students' knowledge, confidence and perception of advance care planning communication. They also provide evidence about what contents and methods can be helpful in developing end-of-life care training for advanced practice nursing students.

End-of-Life Communication Skills Training for Undergraduate Nursing Students to Address Cultural Obstacles in China

Nurses face many difficulties and challenges related to how patients and their families deal with communication about end-of-life (EOL) care in China because of the strong influence of traditional Chinese culture. Moreover, education and training opportunities in EOL communication skills for nursing students are rare in mainland China. This study designed a progressive case involving a common EOL communication dilemma related to traditional Chinese culture and trained 50 undergraduate nursing students in EOL communication skills. A quasi-experimental design was used to compare the training outcomes of nursing students who were divided into a standardized patient simulation group and a role-playing group. The role-playing group (23 participants) was trained via group case discussion and role-playing among classmates, while the standardized patient simulation group (27 participants) completed EOL communication training by interacting with standardized patients and their families in a high-fidelity simulation. Attitudes toward death, self-confidence in EOL communication, and communication learning were evaluated in both groups during preintervention and postintervention. The results showed that all 3 variables improved after the intervention. This study shows that EOL communication skills training has a positive effect on nursing students to a certain extent.

An Explanatory Model of Work-family Conflict and Resilience as Predictors of Job Satisfaction in Nurses: The Mediating Role of Work Engagement and Communication Skills

BACKGROUND

The Job Demands and Resources (JD-R) model is used to examine predictors of well-being, work engagement, and individual or organizational outcomes. According to the model, work engagement and communication skills play a mediating role between work-family conflict and resilience to job satisfaction in nurses.

METHODS

A cross-sectional study was conducted considering 431 Peruvian nurses of mean age (M = 40.31 years; SD = 10.94) ranging from 22 to 68 years working in public hospitals in the Lima region. Data were collected using a self-reported form of the Job Satisfaction Scale, communication skills, work engagement, work-family conflict, and resilience. The theoretical model was evaluated using structural equation modeling (SEM).

RESULTS

A theoretical model with adequate fit was obtained [χ²(2) = 6.0, P < .001, CFI = 0.995, RMSEA = 0.068, SRMR = 0.015]. Results indicated an inverse relationship between work-family conflict with communication skills (β = -.24, P < .001) and work engagement (β = -.10, P = .003). Likewise, resilience had an influence on communication skills (β = .55, P < .001) and work engagement (β = .33, P < .001). In addition, the model explains 71% of job satisfaction. Also, the results indicate the influence of work-family conflict and resilience through the mediating role of work engagement and work-family conflict on job satisfaction.

CONCLUSIONS

The model confirmed that work engagement and communication skills are valid moderators to mitigate work-family conflict and strengthen resilience that favors job satisfaction in nurses.

Developing a Card Game for Assessment and Intervention in the Person and the Family in Palliative Care: "Pallium Game"

Communication between the multidisciplinary team, the person, and the family in palliative and end-of-life situations implies, in most situations, a high negative emotional burden. Therefore, innovative strategies are needed to reduce it. The goal of this study is to describe the various stages of development and validation of a collaborative card game for people in palliative care and their families. Phase one is an exploratory study, Phase two is a Delphi study, and Phase three is a multiple case study. Participants for phases 2 and 3 were recruited using a convenience sampling method. The results demonstrate in an organized and structured way the different phases required to build a collaborative card game. The use of the game was found to be useful and effective. Four categories emerged from the content analysis of the open-ended responses: usability, evaluation tool, communication and therapeutic relationship, and meaning when using the game. A collaborative game in palliative care helps to create a space for individuals and families to express feelings and experiences, meeting the myriad of physical, psychosocial, and spiritual needs. The "Pallium game" is a useful and impactful approach to discussing sensitive topics in palliative care.

Cultivating patient-centered care skills through engagement in difficult conversations

BACKGROUND AND PURPOSE

Appropriately engaging with patients around sensitive, challenging, or uncomfortable topics, often termed "difficult conversations," is a facet of patient-centered care. Development of such skills prior to practice often occurs in the hidden curriculum. Instructors implemented and evaluated a longitudinal simulation-based module aimed at advancing students' understanding and abilities to use patient-centered care skills to navigate difficult conversations within the formal curriculum.

EDUCATIONAL ACTIVITY AND SETTING

The module was embedded within the third professional year of a skills-based laboratory course. Four simulated patient encounters were revised to increase opportunities to practice patient-centered skills during difficult conversations. Preparatory discussions and pre-simulation assignments delivered foundational knowledge, and post-simulation debriefing allowed for feedback and reflection. Students completed pre- and post-simulation surveys to measure understanding of patient-centered care, empathy, and perceived ability. Instructors assessed student performance in eight skill areas using the Patient-Centered Communication Tools.

FINDINGS

Of 137 students, 129 completed both surveys. Students' definitions of patient-centered care grew in accuracy and detail following module completion. Eight of the 15 empathy items were significantly changed from pre- to post-module, signifying enhanced empathy. Student perception of ability to perform patient-centered care skills significantly improved from baseline to post-module. Across the semester, student performance on simulations significantly improved on six out of eight patient-centered care skills.

SUMMARY

Students deepened their understanding of patient-centered care, grew in aspects of empathy, and improved actual and perceived ability to deliver care that is patient-centered during challenging encounters.

A new pedagogical approach to enhance palliative care and communication learning: A mixed method study

BACKGROUND

As palliative care increases in importance due to chronic illnesses in ageing populations, there is a need to develop primary palliative care, including patient-centred communication for nursing graduates. Simulation-based education was adopted to develop students clinical skills and communication in a safer and more controlled environment prior to their clinical practice. However curricula in palliative care and communication remain limited. The current study was to develop a simulation-based programme with clinical modelling prior to the simulation experience. Authentic case scenarios were also constructed through collaboration between the researchers and clinical colleagues in palliative care.

OBJECTIVES

To explore the effects of palliative care simulation-based experience on nursing students' palliative care and caring communication.

DESIGN

Mixed-methods with pre- and post-questionnaires and focus groups after the simulation-based experience.

SETTINGS

A nursing school at a university in Hong Kong.

PARTICIPANTS

Twenty-nine senior-year undergraduate nursing students.

METHODS

Students shadowed senior nurses in a palliative clinical setting, then engaged in simulation learning with two palliative scenarios in a laboratory environment. Focus group debriefings were conducted after the simulations.

RESULTS

Quantitatively, findings from the pre- and post-questionnaires revealed an improvement in the students' knowledge (t = -2.83, p = 0.02), attitudes (t = -4.21, p = 0.00), and efficacy (t = -2.07, p = 0.05) in palliative care after participating in this study. Results from the focus groups also indicated an enhancement in the students' learning of palliative care and communication.

CONCLUSION

This collaborative design of palliative scenarios and clinical shallowing with senior nurses in a palliative care setting followed by simulation enhanced the students' confidence, knowledge, skills, and attitudes in palliative care and communication.

Novel approaches to communication skills development: The untapped potential of qualitative research immersion

Objective

Participation in qualitative research, particularly analysis of recorded medical dialogue, offers real-time, longitudinal immersion that can strengthen clinical trainee communication skills. The study objective was to explore how qualitative research participation impacts clinical trainees' self-perceived communication skills development and practice.

Methods

In this study, a 17-member multidisciplinary working group of child life specialists, advanced practice providers, undergraduate/medical students, residents, fellows, attending physicians, social scientists, and career researchers with recent qualitative and communication research experience assembled to discuss this topic using a structured discussion guide. Content analysis was used to identify concepts and themes.

Results

Three key themes characterizing the impact of qualitative research participation on aspiring clinicians' communication skills development and practice arose - the 3Cs: (1) Connection, therapeutic alliance, and accompaniment; (2) Clarity and prognostic communication; (3) Compassion, empathy, and understanding. Participants emphasized that qualitative research learning improved their understanding of patient/family lived experiences, preparing them for future clinical encounters, strengthening their emotional intelligence, and promoting self-care, resilience, and professional affirmation.

Conclusions

Immersion in clinical communication through participation in qualitative research is an under-utilized resource for supporting clinical trainees in communication skills development.

Innovation

The process of collaborative knowledge production through the collective exploration of an a priori question related to group members' collective experiences is methodologically innovative. Further, re-thinking qualitative research participation as an underutilized educational opportunity is pedagogically novel, and leaders in medical education and qualitative research should collaborate to realize the potential of this teaching tool.

The Effect of Two Different Simulation Modalities in Palliative Care Teaching on Nursing Students' Knowledge, Satisfaction, Self-confidence, and Skills: A Randomized Controlled Trial

Nursing students from developing countries have limited opportunities to experience palliative care. Standardized patient and low-fidelity simulations can provide realistic palliative care experiences for students. However, limited research is available on simulation-based education in Palestine. Testing and using these two types of simulation methods may be the best solution for developing countries that lack adequate resources. This study aimed to test the effects of low-fidelity simulation compared with standardized patient simulation in palliative care teaching on nursing students' knowledge, satisfaction, confidence, and skills. The study was a randomized controlled trial of 70 nursing students in their sophomore year. Students' knowledge was assessed with the Palliative Care Quiz for Nursing test; satisfaction and confidence with the Learner Satisfaction and Self-confidence in Learning; and skills rated by two researchers. Students' knowledge improved significantly on the posttest compared with the pretest, without significant differences between both groups. The findings showed that the utilization of the two methods in students' clinical training for scenario has the same effect on the satisfaction and confidence. The skills of the standardized patient group improved significantly more than the low-fidelity group. The study revealed that both simulation modalities are effective for palliative care nursing students.

Integrating Palliative Care into Nursing Care

ABSTRACT

The need for palliative care in our health care system has exponentially increased in the past few years as a result of the COVID-19 pandemic, the aging population, and the increasing number of people living with serious illnesses. While nurses play a critical role in delivering palliative care, many lack confidence and knowledge, causing practice gaps in the clinical and psychological management of seriously ill patients. The collective burden of the pandemic has demonstrated the importance of palliative care education and training, specifically in communication, symptom management, and continuing education. All nurses, including nursing students, transitioning nurses, and practicing nurses, should be trained to offer generalist (or primary) palliative care, in accordance with the American Association of Colleges of Nursing Essentials: Core Competencies for Professional Nursing Education. Provision of holistic, relationship-based, and integrated palliative care for patients and their families is an ethical obligation for all nurses.

Vicarious learning and communication self-efficacy: A pediatric end-of-life simulation for pre-licensure nursing students

BACKGROUND

End-of-life clinical experiences, particularly in pediatrics, are quite limited for pre-licensure nursing students. Though effective, end-of-life simulations can be costly, require facilitators trained in palliative and end-of-life care, and are restricted by limited space and time availability. Such barriers prompt the question as to whether there is an effective alternative to simulation by which students can gain improved self-efficacy in therapeutic communication during pediatric end-of-life situations.

PURPOSE

Bandura's Social Cognitive Theory and work exploring self-efficacy posits that vicarious learning provides learners opportunities to gain experience and knowledge through observation of peers in simulated settings. This study evaluated the effectiveness of vicarious versus active learning on pre-licensure nursing students' perceived self-efficacy in providing therapeutic communication during a pediatric end-of-life situation.

METHOD

Data were collected over three time points - pre-simulation, post-simulation, and post-debriefing - using a modified Self-Efficacy in Communication Scale.

RESULTS

Learners in both groups had significant improvement in self-efficacy across all time points. Only two items had significant differences between vicarious and active learner groups, but the effect was minor.

CONCLUSION

Vicarious learning presents as a viable pedagogical approach for providing pre-licensure nursing students important learning opportunities related to pediatric end-of-life simulations during both the scenario and debriefing.

Translating knowledge into practice for communication skills training for health care professionals

Despite the evidence that person-centred communication underpins all that we do in our interactions with patients, caregivers and team members, the knowledge about the implementation of systematic communication skills training is still in its infancy. This position paper describes some of the main contextual facilitators for translating knowledge about communication skills training for health care professionals (HCP) and recommends ways to guide practical implementation. Based on the literature that has been published over the last two decades, it seems evident that communication skills training programs should be underpinned by clinician self-reflection, be experiential, and focused on behaviour change and implementation of new skills into practice. The programs should be delivered by trainers possessing an understanding of communication micro skills, the skills and confidence to observe interactions, and coach learners through the rehearsal of alternative approaches. Communication skills programs should be flexible to adapt to individual learners, local needs, and circumstances. Interventions should not be limited to the empowerment of individual HCP but should be a part of the organisational quality assurance framework, e.g., by including communication skills in clinical audits. Implementation science frameworks may provide tools to align programs to the context and to address the determinants important for a sustained implementation process. Programs need to be embedded as 'core business', otherwise the culture change will be elusive and sustainability under threat if they are only dependent on provisional funding.

Impact of palliative care simulation on nursing students' learning outcomes and reported use in hospital placement

AIM

Nursing students report emotional distress and feelings of inadequacy to the complexity of palliative care. This study aimed to examine nursing students' attainment of learning outcomes in palliative care through simulation and hospital placement.

DESIGN

A longitudinal, intervention study.

METHODS

Fifty-five second-year bachelor nursing students participated. Three waves of assessments were performed: (1) pretest; (2) postsimulation test and (3) postplacement test after the completion of the placement. Non-parametric Wilcoxon's signed-rank test for paired samples was used to test for differences between assessments of knowledge, skills and competence before and after simulation, and between postsimulation and post hospital placement.

RESULTS

The results showed positive differences between pre- and postsimulation, indicating that learning outcomes were attained through simulation. However, negative differences between the postplacement test and postsimulation test scores indicated that the participants had practiced learning outcome from the simulation to a small degree during placement.

Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program

Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers (N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program (P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.

Effects of roleplay simulation on improving quality management of nursing service

OBJECTIVE

To observe the feasibility of roleplay simulation in improving the quality management of nursing services.

METHOD

In this retrospective study, 80 nursing staff were enrolled as the study subjects from January 2019 to December 2020. They were divided into a study group (n=40, trained in roleplay simulation) and a control group (n=40, trained in conventional nursing skills) according to different training methods. The self-efficacy and quality of nursing services of the staff in the two groups were assessed retrospectively. Spearman's correlation analysis was conducted to analyze the relationship between the self-efficacy score and nursing service.

RESULTS

After training, the self-efficacy scores of the nursing staff in the study group were higher than those in the control group (P<0.05). After training, the nursing staff in the study group had significantly higher service quality scores than those in the control group (P<0.05). Spearman's analysis showed that the self-efficacy scores were positively correlated with the quality of nursing scores (r=0.7091, P<0.0001). After training, the scores of the condition assessment of the nursing staff in the study group was higher than those in the control group (P<0.05).

CONCLUSION

Roleplay simulation for nursing staff is helpful to improve the quality of nursing and the ability to deal with emergencies. This can be related to the improvement of self-efficacy in nursing staffs.

The effect of home visit simulation on emotional intelligence, self-efficacy, empowerment, and stress in nursing students. A single group pre-post intervention study

BACKGROUND

Clinical simulation, the teaching methodology used in the Nursing Degree, helps students to acquire certain skills. Home visiting is a complex scenario in community care that requires certain critical skills in order to function successfully.

OBJECTIVES

The aim of this study was to analyze the improvement of self-efficacy, empowerment, management of emotions and perceived stress of nursing students through clinical simulation during home visits.

DESIGN

A quasi-experimental study was carried out.

PARTICIPANTS

A sample of Students of the 2nd year of the Nursing Degree.

METHODS

A high-fidelity simulation programme was implemented in two sessions. The variables that were measured were: self-efficacy (General Self-efficacy Scale), empowerment (Spreitzer Psychological Empowerment Scale), emotional intelligence (Trait Meta-Mood Scale-24), and perceived stress (Perceived Stress Scale).

RESULTS

170 students with a mean age of 22.2 years took part. An increase in general self-efficacy, self-determination, impact, empowerment (total score), and emotional clarity was observed after the intervention.

CONCLUSIONS

Clinical simulation as a teaching methodology allows the development of skills and competencies that are necessary for nursing students to be able to function in community settings such as home care. Therefore, this teaching methodology should be integrated into University Community Nursing training programmes.

Fifteen-minute consultation: How to approach the withdrawal of neonatal intensive care

Withdrawal of life-sustaining support on the neonatal unit presents a set of unique challenges specific in this age group of patients. This article aims to provide an overview of the key factors that should be considered during this process. It explores the practicalities of care delivery that reflects the psychological impact of undergoing end-of-life care on parents and team members. It will also highlight the role of clinical genetics that can be used to understand the underlying disease pathology and therefore can be a valuable tool in the difficult decision-making process.

Pediatric Basic Life Support among Nursing Students in Jordan: Stimulation-Based Education

Background:

In the context of seeking to reduce the neonatal mortality rate (NMR) in Jordan, there is a need to use simulation to teach and train nursing students in pediatric basic life support (PBLS) skills. This study aims to measure the preservation of PBLS knowledge and determine whether active observation of an immersive simulation using a simple checklist would improve PBLS skills.

Methods:

A single group pretest-posttest approach design was applied in the Jordan University of Science and Technology (JUST) pediatric simulation lab for 108 nursing students.

Results:

The result of the paired samples t-test showed that there was a statistically significant increase in PBLS knowledge between pretest and post-test. The result of the paired samples t-test in the group showed that there was a statistically significant enhancement in PBLS skills between pretest and post-test. PBLS skills at pretest were poor (M = 4.31, SD = 1.12). It was reported that place of residence is a significant predictor of knowledge in PBLS (p <.05).

Conclusion:

The results of this study showed that a simulation-based PBLS course positively impacted knowledge and skills in pediatric BLS. The findings also suggest that policymakers should establish continued professional development BLS training programs for healthcare providers, especially nurses, which can be provided at low cost in most of the settings around the country.