Simulation to Teach Nursing Students About
End-of-Life Care
Lisa Hjelmfors, Anna Strömberg, Katarina Karlsson, Louise Olsson and Tiny Jaarsma
Journal Article
N.B.: When citing this work, cite the original article.
Original Publication:
Lisa Hjelmfors, Anna Strömberg, Katarina Karlsson, Louise Olsson and Tiny Jaarsma,
Simulation to Teach Nursing Students About End-of-Life Care, Journal of Hospice and
Palliative Nursing, 2016. 18(6), pp.512-518.
http://dx.doi.org/10.1097/NJH.0000000000000279
Copyright: Lippincott, Williams & Wilkins
http://www.lww.com/
Postprint available at: Linköping University Electronic Press
http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-133105
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Title
Simulation to teach nursing students about end-of-life care
Abstract There is minimal education on death and dying in undergraduate nursing programs,
leaving the students unprepared to provide sufficient care to dying patients and their families.
This paper describes a teaching innovation on how end-of-life care simulation can provide a
successful and appreciated learning situation for nursing students, teaching them
communication skills in challenging situations. Modifications in the setup of the simulation
might help the students to focus more on communication and existential issues instead of
mostly practical ones.
Keywords: End of life care education; Simulation; Undergraduate nursing students;
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Introduction
In nursing education, the development and learning of clinical skills are shifting from learning
in clinical situation to learning by simulation.
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Simulation can be defined as a situation or an
event which is made to resemble clinical practice to enhance student learning. In the most
advanced simulations, technologically lifelike, full-body sized manikins with visible
respiration, palpable pulse and vocal sounds are used to produce a high level of realism and
interaction.
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The manikins are used for training basic clinical nursing skills such as for
example, post-operative care, acute respiratory problems and resuscitation.
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In a simulation
situation, the student can improve skills in a non-threatening environment that also provides
opportunities for critical thinking, decision- making, clinical skill performance and team
building.
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Students have demonstrated high levels of learner satisfaction with using high
fidelity manikins as patients in simulation situations, and this might enhance the students’
motivation and facilitate the learning process.
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There is minimal education on death and dying in many undergraduate nursing programs,
often leaving the students unprepared to provide sufficient care to dying patients and their
families in these difficult situations.
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There is also a notable lack of attention to developing
nursing students’ ability to communicate in a satisfying way with patients at the end-of-life,
and teaching the students to truly listen to the patients ‘concerns, values and goals.
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Recently,
simulation has been introduced as a teaching innovation for nursing students to practice end-
of-life and it appears to be an attractive learning strategy. End-of-life care simulations can
produce an effective and safe learning situation were the students increased their knowledge
about palliative care principles and felt more comfortable and confident in communicating
with patients and their families.
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In a recent review of the literature, it was described that the
main positive concept in the simulation were the scenarios used in the simulations, which
provided the students with a personal and realistic experience of death and dying.
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However,
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despite these positive examples, there is still little research published exploring the delivery
of, and students’ experiences of, such end-of-life care simulations.
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Therefore, this paper aims to increase the knowledge about end-of-life care simulation in
nursing education by describing and evaluating the delivery of simulation when teaching
third-year nursing students about end-of-life care.
Context of the teaching innovation
Problem-based learning (PBL)
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is used as the teaching method for nursing students at
Linköping University. Traditional lectures are mixed with tutorial groups, each comprised of
8-9 students. Supportive learning elements are provided, such as training in “real life”
situations using simulated patients and family members. Each group has their own tutor
present during the preparation, simulation and debriefing sessions. The tutors are nurses, most
of them are experienced in end-of-life care, and they have an important role in facilitating the
learning process for the students using PBL.
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They are trained in the PBL curriculum
provided by the university and they conduct practice runs of the simulation and the debriefing
process. During faculty meetings that take place once a semester, they discuss learning goals,
pitfalls and possibilities of the simulation with other tutors. The simulation described in this
study was part of an end-of-life care simulation used during the last term of the 3- year
bachelor degree level nursing education when the students learn and practice basic palliative
care, something they are expected to be able to handle as nurses.
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Besides lectures on chronic illness, the students had lectures about symptom relief, good
communication in challenging situations, and supportive care for for the family experience in
end-of-life situation. Before the simulation sessions, the students had readings of the end-of-
life care scenario. They also prepared and familiarized themselves by discussing the situation
of the patient and the family in their tutorial group. The students practiced communication
skills in clinical meetings with patients and family during trainee periods before the
simulation takes place. At the simulation centre, the students were further informed about the
simulation that would take place, they were introduced to the location of the patient and the
family and the available medical equipment.
Simulation procedure
At the clinical simulation center, the tutorial group was faced with three scenarios that all took
place during the same day. These were presented to the students as taking place during one
week in the patient’s life, on day 1, 3 and 7. The simulation procedure ended with a post-
simulation debriefing.
Scenario 1
A high fidelity manikin played the patient, a 40- year-old woman named Karin who was dying from cancer. The
students met Karin in her home. She was lying in bed wearing a long T-shirt, underwear, trousers and a scarf
around her head. She had a stoma and a subcutaneous port- a - cath. She had terminal cancer and was expected
to die soon. The simulation room was decorated as a home with furniture, flowers, photos, candles and books.
Karin lay in bed and, in some simulation sessions, her partner Petra/Peter, 28 years old (played by a student)
sat next to her on the bed. She was in a lot of pain and worried about her son, Erik, 16 years old, who seemed to
avoid visiting her. Her partner felt powerless and worried about their financial situation.
Scenario 2
In this scenario, Karin was alone and very tired. She had no appetite and sores in her mouth. She was worrying
about the upcoming birthday of her daughter Olivia, 13 years old. Karin wanted to bake a cake as she would
usually do, and she also wanted to be able to eat some cake, in order to give Olivia a good feeling about her
