Nursing Students Learning to
Provide End-of-Life Care Through
Simulation
Rita Ferguson, PhD, RN, CHPN, CNE
Patricia Cosby, BSN student, RCEU 2015
Recipient
2016 Nursing Education Research Conference
Faculty Disclosure
Faculty Name:
Rita Ferguson, PhD, RN, CHPN, CNE
Conflicts of Interest:
None
Employer:
The University of Alabama in Huntsville
Sponsorship/Commercial Support:
None
Faculty Name:
Patricia Cosby, BSN student, May 2016
Conflicts of Interest:
None
Employer:
The University of Alabama in Huntsville
Sponsorship/Commercial Support:
Recipient RCEU summer 2015
Goals & Objectives
• Session goal
– Report findings related to nursing students perceived
comfort with end-of-life care and their response after
providing end-of-life care through simulation.
• Session objectives
– The learner will be able to discuss the impact of
simulation on end-of -life nursing education.
– The learner will be able to discern advantages of using
simulation for learning end-of-life care.
Background
Review of the Literature
• Emotions noted by
students included
–
–
–
–
–
–
–
Hesitancy
Discomfort
Helplessness
Apprehension
Anxiety
Distress
Guilt
–
(Ek, Westin, Osterlind, Strang, Bergh, Henoch and
Hammarlund, 2014; Smith-Stoner, 2009; Peterson,
Johnson, Scherr and Halvorsen, 2013)
• Students may not have
opportunity to care for a
dying patient in the
clinical setting (Fabro, Schaffer, &
Scharton, 2014)
• Simulation provides a safe
setting to practice end-oflife skills (Powell-Laney, Keen, & Hall, 2012)
• Exposure decreases
student anxiety
(Moreland et. Al.,
2012)
Conceptual Framework
Silver Hour: Flexible
Model for End-of-Life Care
(Smith-Stoner, M., 2014)
Simulation
• Technology to improve
the clinical experience
• Safe environment
• Learning occurs by
doing and observing
• Debriefing allows
reflection and learning
(Hicks, F. D., Coke, L., & Li, S., 2009)
Purpose
• Identify nursing students’ perspectives and
concerns related to providing end-of-life
nursing care.
Research Question
• Will students report improved comfort
providing end-of-life nursing needs to patient
and family members after a simulation
experience?
Methodology
•
•
•
•
Mixed method QUAL-quan
IRB obtained
Convenience and snowball sampling
Surveyed students’ attitude prior to
simulation
• Debriefed after simulation
Inclusion Criteria
• Completed the first semester of upper division
nursing school but have not started the last
semester
• At least 19 years old
• Able to speak and understand English
• Male or female
• Any race or ethnicity
Sample & Setting
• Nursing students in 2nd/3rd semester
• Pre-survey completed
• Simulation lab at College of Nursing –
patient simulator
Data Collection
• Demographic data
• Pre-simulation survey of attitude
• Two participants in simulation which is
video/audio recorded
• Debriefing audio recorded and transcribed
verbatim (personal identifying information
given pseudonym in transcription)
Data Analysis
Demographic Information
Age range
n = 17
Gender
19 - 24
10
Male = 3
25 - 29
4
30 - 34
0
35-39
0
Completed Clinical
Course
40 - 44
2
Fundamentals
2
45 - 49
0
Medical Surgical I
14
> 50
1
Medical Surgical II
1
Female = 14
Skills Provided During Simulation
n=9
Wash hands
Body positioning, raise HOB
Comfort assessment, perform oral care, replace
nasal cannula
Therapeutic communication
Take vital signs & monitor
0
2.25
4.5
6.75
9
11.25
Strongly Disagree Neutral
Disagree
Agree Strongly
Agree
3. I would be comfortable
to give care to a dying
patent.
0
0
1
6
10
4. I would feel powerless
caring for a dying patient.
7
6
2
2
0
5. It would be difficult
emotionally to work with a
dying patient.
5
2
2
8
0
Themes
• Unknown territory
• Reverence and dignity
• Preparation
• Communication
Unknown Territory
• Not sure of the next step and felt lost
• “I felt like I was going into unknown territory”
Reverence and Dignity
• “feeling when people who are caring for your
loved one are actually caring. . . . I think that is
conveyed . . . By the way we were taking care of
him.”
• “Just because they are dying doesn’t mean they
get any less of our care.”
• “Naturally, it is in us to want to do something for
him”
Preparation
• “felt good going in and then when he actually
died, I felt a bit lost”
• “I want to feel more confident and
comfortable”
• “As a nurse that is something very real that we
need to be exposed to”
Communication
• “figured it was best to let (the patient) know .
. . even if he couldn’t respond.”
• “a huge thing for patients”
Synthesis Statement
Implications
• Nursing students
lack experience in
end-of-life care
• Students’ clinical
time is limited
• Simulation is a safe
place to practice
skills
Significance
• Emotional
preparation for
the real thing
• Debriefing an
integral part of
simulation
• Students
verbalized
increased comfort
after simulation
Recommendations
• Include end-of-life care simulation in prelicensure nursing education
• Provide simulation opportunities for nursing
students to practice communication with
family members of patients who are receiving
end-of-life care
• Allow students occasions to express emotions
associated with end-of-life care
Reflection
Acknowledgments
• Special thanks to Mrs. Gold: Florence Helman,
MSN, RN
• Photographs by Gary Cosby
• Smith-Stoner, M. (2014). Silver Hour: Flexible
Model for End-of-Life Care, Guide for
educator: Simulation v 1.0,
http://silverhour.info
References
Ek, K., Westin, L., Prahl, C., Osterlind, J., Strang, S., Bergh, I., … & Hammarlund, K. (2014). Death and caring for dying patients:
Exploring first-year nursing students’ descriptive experiences. International Journal of Palliative Nursing. 20, 509-515.
Fabro, K., Schaffer, M., & Scharton, J. (2014). The development, implementation, and evaluation of an end-of-life simulation
experience for baccalaureate nursing students. Nursing Education Perspectives. 35, 19-25.
Hicks, F. D., Coke, L., & Li, S. (2009). The effect of high-fidelity simulation on nursing students’ knowledge and performance: A
pilot study. NCSBN Research Brief, 40.
Moreland, S. S., Lemieux, M. L., & Myers, A. (2012) End-of-life care and the use of simulation in a baccalaureate nursing
program. International Journal of Nursing Education Scholarship. 9, 1-16.
Peterson, J. L., Johnson, M. A., Scherr, C., & Halvorsen, B. (2013) Is the classroom experience enough? Nurses’ feelings about
their death and dying education. Journal of Communication in Healthcare. 6, 100-105.
Powell-Laney, S., Keen, C., & Hall, K. (2012) The use of human patient simulators to enhance clinical decision-making of nursing
students. Education for Health. 25, 11-15.
Smith-Stoner, M. (2009). Using high-fidelity simulation to educate nursing students about end-of-life care. Nursing Education
Perspectives. 30, 115-120.
Smith-Stoner, M. (2014). Silver hour: Flexible model for end-of-life care. Retrieved from http://silverhour.info/wpcontent/uploads/2014/04/ silver_hour_introv1.0.pdf
Questions