Designing and Implementing a Nursing Education Simulation to Improve Confidence and Competence in Providing Palliative Care for the Dying Patient (QI810)

Abstract

•Identify simulation components designed to improve pre-professional nursing palliative care curricula through simulation, in accordance with recent AACN recommendations.•Compare perceived student confidence and competence in providing patient-centered end-of-life care based on pre- and post-simulation evaluations. The AACN has recommended improved palliative care competencies and curricular guidelines, as there is limited clinical preparation for nursing students. In response to this gap in nursing curricula, three graduating nursing students utilized a literature-based approach to address nursing student anxiety and low perceived competence to provide end-of-life care. The purpose of this Quality Improvement Project was to develop a high fidelity simulation for pre-professional nursing students to improve confidence and competence in providing care for the dying person in the hospital setting. With support from Johns Hopkins School of Nursing faculty specializing in simulation and palliative care, student leaders developed an initiative to involve other pre-professional students in an introductory scenario in which a patient died while hospitalized for a heart failure exacerbation. Pre-professional nursing students with a variety of backgrounds and an interest in palliative care participated in the simulation. Participants were asked to complete pre- and post-test surveys to demonstrate perceived confidence and competence in physiological and psychosocial support for the dying patient. In the simulation pre-brief, student leaders facilitated identification of the intent of the simulation, the physiological and psychosocial needs of the patient, symptom management strategies, communication techniques, challenges they anticipated, and personal concerns. During the simulation, students experienced decompensation and simulated death of a standardized patient actor and were tasked with providing comfort measures for the patient and two standardized family members. During the debrief faculty utilized concept maps to guide discussion regarding plan of care, comfort measures, ethical issues, communication techniques, and personal reactions to the simulation. Student evaluations will be utilized to guide future simulation delivery in palliative care to the entire student body as well as to develop other palliative care simulations.