End of life care education, past and present: A review of the literature
Background: Research on end of life care education suggests that undergraduate nursing students are largely unprepared to provide end of life care to dying patients and their families. Although there have been attempts to address the issue of lack of preparedness, little is known on how to improve this. Literature Review Aims: To examine how end of life care education has been delivered to undergraduate nursing students and to critically discuss the research on modes of delivery and teaching strategies. Review Methods: An extensive literature search on end of life care education in the undergraduate nursing curriculum was conducted in CINAHL, Mosby's Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 18 research papers published between 1984 and 2012 that met the selection criteria are included in the review. Findings: Findings of these 18 articles are reported under two main themes: Modes of End of Life Education Delivery and End of Life Care Education Initiatives. Conclusion: This review highlights issues with end of life care education and suggests that end of life care simulation is an innovative strategy that may help to prepare undergraduate nursing students to provide quality end of life care.
Australian nursing students' stories of end-of-life care simulation
Because nurses are at the forefront of end-of-life care, it is imperative that nursing students are prepared for this role upon graduation. Research suggests that many nursing students are unprepared to deliver compassionate and quality end-of-life care. There have been many attempts to address this need; one emerging method is end-of-life care simulation. This paper explores the experiences of 18 undergraduate nursing students of end-of-life care simulation. Participants' stories were obtained via observation during end-of-life care simulation, audio-recorded post simulation debriefing, and semi-structured interviews. Using Clandinin and Connolly's three dimensions of Narrative Inquiry (temporality, spatiality, and sociality) participants' stories reflected convergence of time, place, and person. Findings revealed three distinct plotlines along a time continuum, specifically surrounding time of death: (i) "The privilege of end-of-life care;" (ii) "Witnessing death as surreal;" and (iii) "The honor of providing after-death care." Participants' narratives suggest that end-of-life care simulation is an important means of preparing students for clinical end-of-life care experiences. This has implications for nursing educators wishing to consider simulation in end-of-life care education.
End of life care simulation: A review of the literature
Background: Simulation is an evolving pedagogical approach to teaching in many undergraduate nursing curricula, however, there is little published literature on end of life care simulation as an effective means of teaching nursing students about end of life care. Literature review aims: To examine available literature on end of life care simulation. Review methods: An extensive literature search on end of life care simulation in the undergraduate nursing curriculum was conducted in CINAHL, Mosby's Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 6 research articles and 10 descriptive articles published between 2009 and 2013 that met the selection criteria are included in the review. Findings: Findings of these 16 articles are reported under 4 main themes: 1) Increased knowledge of end of life care through 'experiential learning'; 2) Impact of family presence on student learning; 3) the Debriefing imperative, and 4) Methodological issues raised from studies. Conclusion: The findings of the studies reviewed support end of life care simulation as a strong and viable pedagogical approach to learning for its positive effects on knowledge acquisition, communication skills, self-confidence, student satisfaction and level of engagement in learning. However, the important factors including psychological safety of students and the costs involved require careful consideration. Research on the use of simulation in nursing is still in its infancy, further research using various research designs is required to adequately explore the issues surrounding end of life care simulation.
The experience of end of life care simulation at a rural Australian University
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.
Undergraduate nursing students' transformative learning through disorientating dilemmas associated with end-of-life care simulation: A narrative inquiry study
Background: Despite attempts, there remains a theory practice gap for undergraduate nursing students transitioning to clinical practice on graduation, especially for specialty areas of clinical practice, such as palliative care, where there are limited opportunities to gain specialty knowledge and skills. As a result, undergraduate nursing students largely feel unprepared for end-of-life care in clinical practice. End-of-life care simulation is gaining momentum for helping prepare students to undertake this important care. However, little is known of whether end-of-life care simulation is a transformative learning strategy that can be transferred to clinical practice.
Aim: The aim of this paper is to report on undergraduate nursing students transformative learning through endof-life care simulation.
Design: A qualitative research design using narrative inquiry was used with data collected through semistructured interviews and analysed using Clandinin and Connelly's three dimensions of narrative inquiry.
Methods: Eighteen 3rd year undergraduate nursing students enrolled in a compulsory palliative care unit, at an Australian university participated in an immersive end-of-life care simulation. Data were collected through semistructured interviews and analysed using Clandinin and Connelly's three dimensions of narrative inquiry.
Results: This study revealed that transformative learning occurred through three disorientating dilemmas of: caring for a dying patient" approaching difficult conversations" and witnessing death for the first time. Knowledge of palliative care and clinical skills were also found to be transferred to clinical practice.
Conclusions: End-of-life care simulation can be an effective method of promoting transformative learning and can help to reduce the gap from nursing theory to clinical practice.