Incorporating End-of-Life Content Into the Community Health Nursing Curriculum Using High-Fidelity Simulation

Abstract

Because nurses are the healthcare providers who spend the most time with patients and their families at the end of life, baccalaureate nursing students should be adequately prepared for this role before they graduate. However, many undergraduate nursing programs fail to provide adequate end-of-life content, and many undergraduate nursing students often do not have the opportunity to care for dying patients during clinical rotations. Faculty in an undergraduate community health nursing course incorporated an end-of-life clinical experience using high-fidelity patient simulation to allow students to provide holistic care to a dying patient and his family in a safe learning environment. The simulator was used to play the role of the dying patient, and a course faculty member acted as the patient's daughter. Students were given the role of the hospice nurse. At the end of the experience, students expressed a greater understanding of the pathophysiology at the end of life, as well as enhanced communication skills. Because many nursing students may not encounter an actively dying patient during their clinical rotations, high-fidelity patient simulation is an effective mechanism for providing students with exposure to end of life. KEY WORDSend-of-life care, nursing education, simulation D espite the growth in hospice and palliative care and the publication of undergraduate nursing competencies for providing quality end-of-life (EOL) care, 1 EOL content continues to be inadequate in undergraduate nursing curricula, 1 and both new graduates and qualified nurses report not feeling adequately prepared to deliver EOL care. 2 Nursing programs in the United States typically focus their curricula on acute care interventions in the context of medical-surgical nursing and cover EOL content sparingly, 3 and EOL content is typically limited to lectures that may be scattered throughout various courses. 4 In addition to providing theoretical content related to EOL care, nursing programs should incorporate hands-on experiences that will allow students to recognize their own feelings and expectations about death while demonstrating respect for the patient's and family's views, concerns, and wishes during EOL care. 1

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

“…The undergraduate nursing student was a target learner in a majority of the articles (n ¼ 22). 10,25,[27][28][29][30][31][32][33][34][35][36][38][39][40][42][43][44][45][48][49][50] In the remaining 8 articles, the main target learners were the graduate nurse trainee, 46 the practicing nurse, 23,24,26,37,51 and both nursing students and practicing nurses together. 41,47 Other members of the health team participated (were physically present) in 7 of the SBLEs.…”

“…The specific communication content varied widely across SBLE scenarios, with the majority (n ¼ 18) focused on EOL conversations. 10,23,26,27,[32][33][34]38,[40][41][42][43][44][45][46][47]50,51 The remaining 12 articles 24,25,[28][29][30][31][35][36][37]39,48,49 focused on palliative care-related communication. Over half (n ¼ 16) of the scenario conversations involved only nurses, patients, and family members.…”

“…44,50 Other technology used included online modules, 29 audio recordings, 31,38 virtual and phone communication, 37 social media, 39 and manikins with programmable physiologic changes. 40,41,43,45,51 Scenario Enactment…”

“…Eight of the 30 scenarios utilized externally developed scenarios and 2 of the articles provided no scenario source information. The externally developed scenarios utilized in these SBLEs included the following: (1) the Memorial Sloan Kettering Cancer Center for EOL care 53,54 adapted curriculum, 26 (2) the adapted Scheikl and O’Neill 55 simulation scenario, 28 (3) the National League for Nursing (NLN) Advancing Care Excellence for Seniors (ACE.S) 56 module, 39 (4) the adapted Simulation Clinical Experience (SCE) EOL care scenarios from CAE Healthcare (previously known as Medical Education Technologies [METI]), 40,43,45 (5) “A Lion in the House” 57 video, 35 and (6) “Evan Mayday’s Good Death” 58 video. 39…”

Person-centred end-of-life curriculum design in adult pre-registration undergraduate nurse education: A three-year longitudinal evaluation study

“…Students who have personal experiences of loss have demonstrated increased awareness of the challenges in care provision and Jie et al (2018) recommend that educators should be aware of the needs of students who have, and who have not, experienced loss and adapt student group composition to reflect both perspectives. Other pedagogical approaches that improve knowledge and confidence include online courses (Conner et al 2014), high fidelity and gaming approaches (Montgomery et al 2016) and use of real-life case studies (Bailey and Hewison 2014). The use of multiple learning strategies was used by Bailey et al (2017) in a global classroom education experience where students collaborated, interacting on a virtual learning platform and enhancing their individual learning.…”