Abstract
Background: The United States is experiencing a significant rise in the number of older adults and the demand for palliative end-of-life (EOL) care. To meet this rising demand, the Institute of Medicine (IOM) has called for enhanced competence of the interprofessional palliative care team. Research indicates that most new graduate nurses have not received adequate education or experience in EOL care and view caring for dying patients as a source of anxiety. |Purpose: In response to this need, Creighton University's College of Nursing partnered with the university theatre department and local chaplains to implement realistic end-of-life (EOL) simulations to enhance competence and self-efficacy in the delivery of palliative EOL care among senior-level undergraduate nursing students. Research Question: What impact does enhanced realism and participation in an EOL theatre simulation have on nursing students’ self-awareness and self-efficacy? Hypothesis: Nursing students will report increased self-efficacy and self-awareness from pre- to post-simulation. |Methods: This interdisciplinary pilot project was designed using mixed methods (quantitative pre-test/post-test quasi-experimental and qualitative descriptive design) to assess the effects of enhanced realism in an EOL theatre simulation on nursing students’ (n=73) self-efficacy and self-awareness. The Shared Theory of Palliative Care was adopted because it proposes relationships among three concepts: palliative care nursing competence (comprised of self-awareness, knowledge, and experience), self-efficacy, and the delivery of high quality palliative nursing care. |Results: The Frommelt Attitudes Toward Care of the Dying, Form B (FATCOD-B) scale, a validated 30-item Likert-scale tool for college-level students, was utilized to measure one aspect of students’ self-awareness (attitudes toward caring for dying patients). Respondents’ level of agreement with each item was tallied for overall scores ranging from 30-150. Higher scores indicate more positive attitudes in caring for dying patients. The instrument had adequate internal consistency reliability (α=0.84 for all 30-items), and a paired samples t-test revealed a statistically significant increase (p<.05) in the overall FATCOD-B scores from pre-test to post-test (from 121 [SD=9.3] to 126.5 [SD=9]). Increases in student self-efficacy were also measured at pre-test by several researcher developed survey questions and repeated at post-test. Students reported significant increases in their understanding of palliative care and confidence in their ability to communicate with and deliver care to dying patients and their family members (all p<.05).Content analysis of open ended responses by students post-simulation indicated several positive themes including: student satisfaction with the learning experience, importance of fidelity in EOL simulations for a realistic experience, and preparedness to communicate and deliver care to dying patients and their families. |Conclusion: EOL simulation positively influences student self-efficacy and self-awareness in caring for dying patients. Future research is needed to understand the relationship between self-awareness and the delivery of high quality palliative nursing care.