End-of-life simulation: a cross-field evaluation in an undergraduate nursing programme

BACKGROUND

Death can cause a great deal of anxiety in nursing students for a variety of reasons. They are expected to provide a high level of care for patients, give the family the respect and patience they deserve and contend with the associated emotional attachments. This raised the question in today's educational world-can the use of technology and simulation aid students in preparing for an end-of-life scenario as part of an undergraduate nursing programme?

AIM

To explore the efficacy of the use of simulations in end-of-life care.

METHOD

A small study focusing upon the evaluation of an end-of-life simulated scenario for undergraduate second year cross-field Bachelor of Nursing students in a university setting. The simulated scenario consisted of a young patient who was dying and her mother. This project used a mixed approach to address varied students' learning styles and combined the need for visualisation and more structured base-sessions on the topic of death and end-of-life care. One student from the cohort group was randomly assigned as the nurse in charge, while other students were allocated to a scenario (out of a potential four) and provided care in real time. Subsequently, the impact of the scenario was assessed and students were immediately debriefed. Students' response to the scenario was important and needed to be considered, as it directly influenced the debriefing. There were some significant differences between how the students approached the scenario and their reaction to it.

RESULTS

Of the students who took part in the end-of-life simulated scenario, the majority strongly agreed that the simulation increased their clinical reasoning and learning.

CONCLUSION

The end-of-life scenario was deemed beneficial, despite the emotional impact on the learners involved.

Predicted difficulties, educational needs, and interest in working in end of life care among nursing and medical students

BACKGROUND

The need to provide care for the dying patient and his/her family may occur in every medical setting. Newly graduated nurses and physicians should therefore be prepared to deliver it at a high-quality level.

OBJECTIVES

To explore (a) the primary difficulties participants anticipate they will encounter whilst working with dying patients, (b) their interest in developing competencies in caring for dying patients, and (c) their interest in working in palliative/hospice settings or with dying patients in the future.

DESIGN

A cross-sectional study.

SETTINGS

A medical university in Poland.

PARTICIPANTS

Convenience sample of nursing (=112) and medical students (=101) at the end of their undergraduate education.

METHODS

Questionnaire distributed online and in hard-copy format.

RESULTS

Half of the participants anticipated experiencing various emotional and professional difficulties in caring for dying individuals, especially medical students. These difficulties pertained mostly the reaction of family members to the patient's death, addressing the psychological needs of the dying person, and coping with his/her own emotions when dealing with the patient's death. Students reported that working with dying patients could cause occupational stress - more so among medical students. The majority of them showed an interest in improving knowledge regarding palliative care and also in this case this was mostly true of medical rather than nursing students. However, more than half of the participants preferred avoiding work in palliative/hospice settings, with no differences between the two groups. Participants attributed this attitude to two factors: (a) the desire to avoid negative emotions and stress that could be triggered by dealing with death and dying; and (b) because they felt they lacked the required skills and personal abilities to handle such situations.

CONCLUSIONS

Undergraduate curricula that include strategies for coping with negative emotions associated with facing the process of death and dying should be developed. Interprofessional education should be encouraged, especially regarding the psychosocial aspects of end-of-life care.

The rationale for making a short DVD in relation to the last offices procedure

Background:

This article outlines the rationale of developing a DVD using a simulated patient to show students how to perform the last offices in the UK and what they can expect when a patient dies.

Aim:

This is an aspect of the curriculum that students felt was not adequately covered and they were anxious about experiencing the death of a patient for the first time. The DVD allowed a large number of students to receive extra teaching on this topic and was a time-effective way of introducing more teaching into the curriculum.

Conclusion:

Students felt more prepared for the death of a patient during their first clinical placement.

Facilitating affective elements in learning - In a palliative care context

The aim of this study was to explore ways clinical supervisors facilitate the learning of the affective elements of professional competence in a clinical palliative care environment. The secondary aim was to advocate for and raise awareness of the importance of the affective domain in medical education. A clinical palliative care learning environment has been reported to be emotionally challenging. The affective and transformative learning processes taking place requires special support. However, little is known about how clinical supervisors facilitate this learning processes. A qualitative, explorative study was designed to capture supervisors' perceptions of their supervision using semi-structured interviews. Six experienced clinical supervisors working within a palliative care context were recruited using convenience sampling. Data were analyzed using inductive content analysis. The affective elements were viewed as essential for learning, clinical supervision, and professional competency. Supervisors use a variety of different ways of facilitation. Four main themes were identified; building a relationship, creating space for learning, creating a pedagogical environment, and Mirroring.

Lessons Learned From a Theory of Planned Behavior-Derived Study on Educational Interventions Inspired by the Affective Domain

BACKGROUND

A paucity of literature exists on use of the affective domain to improve adherence to pressure injury prevention. The purpose of this study was to assess the use of emphasizing the cognitive domain versus education based on combination of the affective and cognitive domains focusing on medical-surgical nurses' behavioral intent to use evidence-based practices to prevent pressure injury.

METHOD

A cluster randomized, controlled design was used to compare differences between groups. Medical-surgical nurses in units with low performance in pressure ulcer prevention were studied. A total of 77 nurses participated. This study employed the theory of planned behavior.

RESULTS

Attitudes toward pressure ulcer predicted behavioral intent. Nurses who experienced the affective domain education showed improvements over the control group for attitude and perceived behavioral control.

CONCLUSION

Affective domain interventions have the potential to favorably impact nurses in valuing pressure ulcer prevention, despite any barriers. J Contin Educ Nurs. 2017;48(12):543-551.

An Introduction to Unexpected Grief for Pre-Licensure Nursing Students: A Simulation and Interprofessional Expert Panel Regarding Fetal Demise

To provide pre-licensure nursing students with a safe, clinically appropriate learning experience in unexpected grief in the obstetric setting, a simulation scenario involving intrauterine fetal demise was implemented. Narrative feedback from students following the simulation indicated that the death of a fetus and the grief of the family were upsetting. For this reason, an interdisciplinary panel to provide pastoral care and grief support was invited to take part in debriefing during subsequent simulations. Evaluations of subsequent simulations were positive.

Reported clinical outcomes of high-fidelity simulation versus classroom-based end-of-life care education

BACKGROUND

Nursing students often experience increased anxiety, lack of clinical skills and poor coping mechanisms when dealing with death and dying for the first time.

AIMS

To design, use and assess the effectiveness of high-fidelity simulation teaching versus classroom-based end-of-life care (EoLC) teaching for first-year nursing students on dealing with their first death experiences in clinical placements.

METHODS

A qualitative phenomenography approach was taken. First-year nursing students (n=187) were randomly allocated to receive either classrtoom-based (n=139) or high-fidelity simulation-based EoLC teaching (n=48). When all participants had returned from their first clinical placement, 12 individual in-depth interviews were carried out. Data were analysed using framework analysis.

RESULTS

Comparative data analysis revealed four key themes as clinical outcomes: recognising death and dying; knowledge into practice; preparedness for clinical eventualities; and emotional preparedness.

CONCLUSIONS

Despite the fact that both strategies improved students' knowledge of EoLC, simulation-based EoLC education was perceived as better in terms of enhanced practical skills and improved emotional experience in their first clinical placement.

A modified systematic review of research evidence about education for pre-registration nurses in palliative care

BACKGROUND

We undertook a modified systematic review of research regarding educational approaches to and effectiveness of pre-registration palliative care nursing, to inform the development of a short course in palliative care for pre-registration nursing students in Cameroon. The aim of this review was to examine educational approaches applied to pre-registration palliative care nursing education and their effectiveness, and to discuss implications for the development of palliative care curricula in resource-poor countries.

METHOD

A modified systematic review of research on palliative care educational interventions, conducted with pre-registration student nurses was undertaken. Relevant literature was gathered from CINAHL, EMBASE, MEDLINE and PsychINFO databases for the period 2000-2013. Inclusion was limited to studies of educational interventions evaluating the effectiveness and outcomes of palliative and end of life care education with pre-registration student nurses.

RESULTS

17 studies were found, all of which were conducted in resource-rich countries: United States of America, Canada, Australia, and United Kingdom. Palliative care nursing education at pre-registration level is either delivered as a discrete course within the curriculum or palliative care content is embedded into other nursing specialty courses throughout the wider curriculum. Palliative care education is delivered to students at a variety of stages in their nursing program, using a mix of both didactic and experiential educational strategies. Course facilitators span palliative care specialists, educators who have attended 'train-the-trainer' courses in palliative care, and nurses with hospice experience. Education is underpinned by transformative and experiential learning theories and reported as effective in improving students' attitudes towards care of the dying.

CONCLUSION

The educational strategies identified in this review may be applicable to resource-poor countries. However, there are challenges in transferability because of the lack of availability of specialist palliative care practitioners who can serve as educators, specialist palliative care units/institutions for experiential learning, funds to design and use high fidelity simulations, and palliative care textbooks and other educational materials. There is thus a need for innovative educational strategies that can bridge these barriers in resource-poor countries. There is also a need for further research into how palliative care education impacts on pre-registration student nurses' knowledge and practice.

Advances and Challenges

This study describes nursing students’ reflections on taking an online course on death and dying. In a semistructured paper, students described fears of caring for clients at end of life (EOL), important content learned, and remaining discomforts. Data were analyzed using directed content analysis. Consistent themes were noted among the papers. Student reflections on the knowledge they gained closely followed initial fears. Several students appreciated the ability to reflect on their experiences in a nonjudgmental setting. Overall, the data showed that nursing students can become more confident in EOL care through online education. Knowledge gains and continued fears about the same topics suggest EOL confidence lies along a continuum and may require ongoing education. Future research should focus on offering online continuing education on EOL to practicing nurses.

Nurse faculty perceptions of end-of-life education in the clinical setting: a phenomenological perspective

BACKGROUND

Caring for patients at the end of life is an emotionally and physically challenging task. When patients approach the end of life, nurses are in a key position to enhance their quality of life by providing emotional support and physical symptom management. Patients and their families need nurses who are comfortable discussing various treatment options and levels of care. Therefore, it is essential that nurses receive both didactic and clinical education on end-of-life nursing care in their nursing curriculum, before entering the healthcare workforce.

OBJECTIVES

The purpose of this interpretive phenomenological study was to explore the experiences of nursing clinical instructors as they guide nursing students who care for dying patients in the clinical setting.

DESIGN

The research design of this study was qualitative.

SETTING

This study sought to explore the experiences of nursing clinical instructors; however, due to the busy nature of hospital nursing units, participants were interviewed in a private location on their university campus.

PARTICIPANTS

Ten full-time nursing faculty members participated in this study. The average time spent in a full time faculty position was 16.5 years.

METHODS

A semi-structured interview was conducted with each participant. The interviews were recorded and transcribed. Data was analyzed utilizing Colaizzi's method of thematic analysis.

RESULTS

Six major themes emerged from the data, which will be discussed and illustrated with participants' descriptions.

CONCLUSIONS

It was evident from this study that educating nursing students on care of a dying patient is not only important but essential to future nursing practice. Nurses who learn about end-of-life care from trusted nursing educators may enter the profession prepared to address patient's questions regarding end of life issues.

An Integrated Literature Review of Death Education in Pre-Registration Nursing Curricula: Key Themes

Recent policy has raised the profile of end-of-life care internationally, with the aim of increasing access to quality care for everyone experiencing life-limiting illness. This reflects an international shift in the provision of palliative care to encompass chronic conditions other than cancer. Nurses have an important role in delivering this care and need to be equipped with particular knowledge and skills. However, pre-registration nursing curricula have traditionally had a limited emphasis on death and dying and nurses report feeling unprepared to care for dying patients. This has led to claims that death education in pre-registration curricula is inadequate. This integrated review explores the published literature that reports on death education within pre-registration nurse education. Presenting an international overview, the aim of the review is to contribute to knowledge about the nature and extent of death education in pre-registration curricula. In the context of this paper, death education encompasses both palliative and end-of-life care. Electronic searches of major bibliographic databases found inconsistencies across educational provision with variations in quantity, content, and approach. Despite an increasing amount of death education in pre-registration curricula, there remains a deficit in key areas such as knowledge, skills, organisation of care, and teamwork.

Nursing students' perceptions toward the nursing profession from clinical practicum in a baccalaureate nursing program-a qualitative study

The purpose of this study was to explore senior nursing students' perceptions toward the nursing profession and their experiences in clinical practicum in Taiwan. This study used semistructured interview guides and unstructured face-to-face dialogue with the participants based on a qualitative method. A purposive sample with a snowball method from a baccalaureate nursing program in Southern Taiwan was used to recruit participants. A total of 30 senior nursing students participated in this study. Data were collected from February to May 2011. The interviews were transcribed verbatim, and data were analyzed based on the phenomenological approach of qualitative methodology. Data were categorized into three major themes: in-depth recognition of nursing, recognition of the meaning and value of life, and decision conflicts for being a nurse. The findings of the study not only help nursing educators further understand the educational effects of clinical practicum, but also provide information for managers of medical organizations to recruit and train newly graduated nurses.

A perspective of end-of-life care education in undergraduate medical and nursing students in Buenos Aires, Argentina

BACKGROUND

The goals of this study were to evaluate: (1) the experiences and attitudes after exposure to dying patients in undergraduate medicine and nursing students with lack of training in end-of-life care issues; (2) whether or not exposure to terminally ill patients (TIPs) influences attitudes in students who had no training in end-of-life care; (3) students wishes regarding their future care of TIPs; and (4) if medicine and nursing students are indeed interested in receiving training in end-of-life care.

MATERIALS AND METHODS

A survey was administered to students in the first and last year in schools of medicine and nursing, comprising seven universities in the city of Buenos Aires, Argentina, and surrounding areas. Data were collected during the 2005 to 2010 time period. Data from 730 students were analyzed.

DISCUSSION AND CONCLUSION

We found that nursing and medical undergraduate students at nursing and medicine schools in the city of Buenos Aires and surrounding areas: (a) come in direct contact with TIPs and perceive their suffering; and (b) have a highly positive attitude toward these patients, even though some of them referred to that relationship as arduous and in some cases they tended to avoid emotional involvement because they did not feel well trained. We also found that (c) this wish for avoidance was increased in final-year medical and nursing students who had been exposed to a higher number of TIPs; and (d) students unanimously manifested the opinion that the teaching about caring of TIPs should be included in the curricula and they would be well disposed to receive it. For all these reasons, we consider that the teaching of caregiving to TIPs in the academic degree programs of nursing and medicine should not be presented as a marginal issue.

Facing death, facing self: nursing students' emotional reactions during an experiential workshop on life-and-death issues

AIM AND OBJECTIVES

This study presents the findings of a qualitative study exploring the experiences of undergraduate nursing students imagining the possibility of their own death during a workshop on life-and-death issues.

BACKGROUND

Didactic instruction in end-of-life care is a critical element of nursing education and for most health professions training in general. Properly implementing this often-overlooked educational process requires providing students with opportunities to reflect on death and dying along with guidance during nursing practice in coping with emotional reactions to caring for dying patients.

DESIGN

An interpretive descriptive design was adopted.

METHOD

Data were gathered from the text of 20 students' reflective journals and workshop evaluations and researchers' field notes on observations during the workshop at a Taiwan university in August 2007.

RESULTS

Students experienced a process of dying, death and rebirth. Students not only expressed emotional responses that included surprise, reluctance to let go and gratitude but also realised the importance of cherishing the present, committing to the nursing profession and valuing their own lives.

CONCLUSIONS

Students can learn their fear of death and possible emotional reactions towards dying patients through self-reflection during a workshop on life-and-death issues. The foundation for facilitating students' self-awareness is a safe environment for them to gain experiential knowledge of the dying process and end-of-life care. Experiential education not only helps students grow personally but also increases their motivation to learn.

RELEVANCE TO CLINICAL PRACTICE

Students' ability to recognise and manage their own emotional reactions towards death and dying patients should be included as part of end-of-life education. A workshop on life-and-death issues can help students discover that they are not alone and that they can support each other and learn how to manage their own emotions.

Nursing education: the experience, attitudes, and impact of caring for dying patients by undergraduate Argentinian nursing students

BACKGROUND

There is extensive research documenting serious deficiencies in undergraduate nursing education related to end-of-life care. Many nurses and nursing students have difficulties in dealing with death and report feeling anxious and unprepared to be with patients who are dying. In Argentina, education on palliative care, death, and dying has not been made part of the undergraduate nursing curriculum.

METHODS

We performed a multicenter survey on undergraduate nursing education regarding the care of dying patients at eight schools of nursing in Buenos Aires, Argentina. We enrolled 680 students from first to fifth year.

RESULTS

Students acknowledged interacting directly with dying patients. Attitudes toward dying patients were highly positive. Students of the fifth year expressed a less satisfying relationship with their patients than those from the first year; considered it as a less gratifying occupation, and also showed a greater preference for avoiding emotional involvement with those patients.

DISCUSSION

Many of them described in short and very expressive phrases the emotional impact of their encounters with patients facing a life-threatening illness. Students perceived that this issue received more attention in humanistic rather than clinical subjects. Ninety-eight percent of students spontaneously demanded more training in end-of-life care. The interest and desire of undergraduate students to enhance their knowledge and experience in palliative care, demands more specific teaching contents.

CONCLUSION

This suggests that in Argentina, improvements in undergraduate nursing training are urgently needed and would be well received by the students. It could be very useful to consider this topic as part of accreditation standards for nursing programs.

End-of-life education in the pre-registration nursing curriculum: Patient, carer, nurse and student perspectives

Providing good quality care for dying patients has been highlighted as a national priority in the UK. The Department of Health’s end-of-life (EOL) care strategy outlines how patients should be cared for to ensure that they experience a ‘good death’. Nurses have an important role to play in the delivery of EOL care and need to be knowledgeable about the palliation of symptoms and the social context of death and dying. Traditionally, the pre-registration nursing curriculum has had a limited emphasis on EOL care. While there have been significant developments in nurse education in the last decade, the amount of EOL content in nurse education remains inadequate. Drawing on literature mainly from the UK and USA, this review explores from the perspectives of students, newly qualified nurses, patients and carers the outcomes of EOL education. It reviews the evidence to determine whether newly qualified nurses are adequately prepared to deliver quality care to patients at the end of their lives. The evidence suggests that despite a greater emphasis on EOL care in nurse training, adequately preparing nurses remains a challenge to educators.