Elsevier

Nurse Education Today

Volume 33, Issue 11, November 2013, Pages 1435-1439
Nurse Education Today

The experience of end of life care simulation at a rural Australian University

https://doi.org/10.1016/j.nedt.2012.11.015Get rights and content

SUMMARY

Providing end of life care is a challenging and anxiety provoking prospect for many undergraduate nursing students and many students report a lack of preparedness in providing care. The limited availability of appropriate clinical placements limits the opportunities for nursing students to gain experience in end of life care. Advances in simulation techniques using high fidelity mannequins enable the mimicking of complex patient scenarios such as cessation of life in the provision of end of life care. A group of nursing academics at a rural Australian University designed, developed and implemented end of life care simulation to a group of 3rd year nursing students. The aim of this paper is to report on the evaluation of this educational innovation. Five major themes were identified through analysis of student evaluations: 1) Linking of theory to practice; 2) Approaching families of dying patients; 3) An encounter with death; 4) ‘Hands on’ experience in a ‘protected environment’; and 5) Importance of post simulation discussion and debriefing. End of life care simulation has provided a valuable experience that can be difficult to obtain in clinical practice settings. However, the challenges discussed in this paper need to be taken into consideration for future use.

Section snippets

Background Literature

Providing end of life care is a challenging and anxiety provoking prospect for many undergraduate nursing students (Leighton and Dubas, 2009), and caring for dying patients is reported as a main source of stress for students during clinical placements (Gibbons et al., 2010). Many nursing students report a lack of preparedness and competence in providing this care (Leighton and Dubas, 2009, Lloyd-Williams and Field, 2002, Mallory, 2003). It is widely acknowledged that the most valuable learning

Project description

During 2011 a team of nursing academics engaged a group of third year undergraduate nursing students (n = 120) in simulated end of life care scenarios. Students, in small groups, were required to provide end of life care using a high fidelity mannequin and work within a challenging end of life care scenario which included communicating with the dying patient and family members.

The simulation sessions were designed to enable students to apply knowledge learned from group tutorial sessions and

Ethical Considerations

As part of the university's commitment to quality assurance, each year feedback on course is sought from students for the purpose of identifying areas of excellence and potential for improvement. Review of courses and teaching experiences form an important part of the quality assurance process at this university. In this manner students regularly participate in course evaluation. There is no coercion or obligation to complete course evaluation. All students are assured prior to the evaluation

Data Collection Methods & Analysis

Evaluation surveys that included quantitative and qualitative questions were distributed and collected by a member of the nursing school not involved in the simulation, and completed at the end of the debriefing session. All students (n = 120) completed the evaluation survey. The high response rate in this instance is considered to be a result of students undertaking evaluations as a quality assurance exercise in the evaluation of a new learning strategy. Table 2 presents the questions from the

Findings

Evaluations revealed that the majority of students found the end of life care simulation to be a valuable learning tool in preparation for care at the end of life. Five major themes were identified through analysis of student evaluations: 1) Linking of theory to practice; 2) Approaching families of dying patients; 3) An encounter with death; 4) ‘Hands on’ experience in a ‘protected environment’; and 5) Importance of post simulation discussion and debriefing.

The Importance of Debriefing in End of Life Care Simulation

Debriefing following clinical simulations is considered an integral component of the simulation experience (Cantrell, 2008). Further research suggests that quality debriefing takes precedence over the actual simulation and that learning is in fact in jeopardy without it. Therefore, debriefing following simulation is in itself an important pedagogical aspect of the simulated clinical experience (Parker and Myrick, 2010). In this instance, debriefing sessions allowed students the opportunity to

Strengths and Limitations

A strength of this paper is that this adds to the limited available literature on end of life care simulation. Although the sample size of this study limits the ability to generalise the findings of this project, it is of strength that the project represents an Australian rural perspective. Nevertheless, the limitations that have risen from the simulation itself need to be noted. Limited space in the simulation suite prevented larger groups of participants from participating in the end of life

Conclusion and Recommendations for Practice

It is well reported that undergraduate nursing students are underprepared for end of life care and find caring for dying patients during clinical placements stressful. One emerging strategy to rectify this is the use of simulation in end of life care. However, the actual impact of this end of life care simulation on undergraduate nursing students in preparation for providing end of life care is still undetermined and further research on the effects of end of life care simulation is warranted.

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