Nursing Students’ Experiences With Patient Death and Palliative and End-of-life Care: A Systematic Review and Meta-synthesis

Caring Beyond Cure: Perspectives of Pediatric Oncology Nurses on End-of-Life Care

Pediatric oncology patients should receive high-quality end-of-life care when needed. Little is known about nurses' attitudes toward providing end-of-life care in pediatric oncology and the role of work experience in developing comfort with providing this care. In a sample of nursing students and nurses working in pediatric oncology, this mixed-methods study aimed to describe attitudes toward and experiences of providing end-of-life care and examine the relationship between education, work experience, and attitudes. Participants completed a demographic survey and the Frommelt Attitude Toward Care of the Dying, modified for pediatrics. Qualitative interviews were then completed with 10 participants. Participants (N = 38) were primarily female (87%) and White (89%). Overall, participants held positive attitudes toward end-of-life care, with staff nurses more positive than student nurses. All participants had provided end-of-life care, yet only 2 (5.41%) thought their education thus far prepared them. Age, education, experience, and burnout were associated with attitudes toward providing end-of-life care. Qualitative themes included challenges of preparedness and training, the nurse's role, and parent team barriers. Training in pediatric end-of-life care is crucial to improve nurses' comfort with providing this care. Further research should explore the impact of burnout, compassion fatigue, and interdisciplinary conflict on end-of-life care.

Caring in uncertain territory: Nursing students' encounters with patients' existential concerns during clinical placements

AIM

To explore nursing students' experiences of encountering patients' existential concerns during clinical placements.

BACKGROUND

Existential concerns about the purpose of life, illness, and death are integral to human experience, and are common in healthcare. Illness disrupts life, intensifying these concerns and leaving patients in need of support. Nursing students often encounter these concerns during clinical placements, but their experiences in clinical settings are sparsely studied.

METHODS

Eleven second-year nursing students from a Swedish university participated in lifeworld interviews during clinical placements. These interviews were transcribed verbatim and analysed using reflective lifeworld research.

RESULTS

Encountering patients' existential concerns is described as a process of becoming a nurse through uncertainty and shared experiences with patients. Encountering patients' existential concerns is a transformative and emotional process. Despite theoretical preparation, these uncertain situations represent a challenge, as the tension between emotional engagement and clinical demands complicates their responses. These patient interactions foster compassion and deepen understanding of life's fragility, underscoring nursing's complexity-balancing competence with emotional presence. Encountering patients' existential concerns is essential for students' learning. This is further elaborated on in four constituents.

CONCLUSIONS

Encountering patients' existential concerns challenges students but creates personal and professional growth. Nursing students engage deeply in care, experiencing compassion that can evoke feelings of hopelessness and anxiety. They need educational support and preceptors' guidance to reflect on these emotional encounters. Integrating existential reflection, self-compassion, and structured support helps them become professional and compassionate nurses.

Latent profile analysis of death education needs and its relationship with hospice attitude among intern nursing students

BACKGROUND

As a critical force for the future development of hospice care, death education for nursing students plays an essential role in the provision of hospice care services. However, current research has overlooked the heterogeneity of death education needs among individuals, and few studies have explored the influencing factors of death education needs and its relationship with hospice attitude of nursing interns.

OBJECTIVE

A latent profile analysis (LPA) was conducted to identify the unique characteristics of death education needs among nursing interns in China and to explore the influencing factors of death education needs and its relationship with hospice attitude of nursing interns.

DESIGN

Cross-sectional survey.

SETTINGS

A tertiary hospital in Shandong Province, China.

PARTICIPANTS

The sample consisted of nursing interns (N = 225) from five medical universities.

METHODS

Latent profile analysis (LPA) was used to establish a latent profile model for death education needs among nursing interns in China. Binary logistic regression analysis was then performed to examine the predictors of high death education needs based on the different latent profiles.

RESULTS

Nursing interns' death education needs could be categorized into two latent groups: a "Low-level needs-higher views of death" group (26.2 %) and a "High-level needs" group (73.8 %). Binary logistic regression analysis, with the Low-level needs-higher views of death as the reference, revealed that educational level, experience of bereavement, occasional opportunities to care for the dying, and attitudes toward hospice care were significant predictors of nursing interns' death education needs.

CONCLUSIONS

Death education needs among nursing interns in China exhibit distinct profiling characteristics. Nursing interns with higher educational levels, experience of bereavement, opportunities to care for the dying, and positive attitudes toward hospice care are more likely to fall into the "High-level needs" group. These findings provide valuable insights for the development of future death education training models.

The need for culturally responsive teaching in death education: a call to action

With an aging population growing in size and diversity, more older adults will need support from the future geriatric workforce. Professional services will face issues related to end-of-life, making knowledge about death, grief, and loss essential. Most, however, report inadequate access to gerontological, geriatrics, or death education, particularly delivered with cultural humility. Colleges/universities can help fill this gap through formal death-and-dying-curricula, but faculty often feel unprepared to teach these sensitive topics. This study explored the experiences (e.g. lessons learned, best practices) of 27 instructors teaching death-related courses via semi-structured interviews. A consistent concern emerged among faculty regarding limited resources on cultural diversity. This prompted a post-hoc analysis of the existing data via a deductive content analytic approach to explore how a culturally responsive-sustaining (CR-S) education framework could inform future work. Evidence to support all four principles of CR-S emerged and three additional principles were identified that may build on the CR-S framework. Findings emphasize the need for more culturally relevant materials and multidisciplinary course delivery. We offer actionable suggestions for integrating cultural humility into death education and advocate for amplifying diverse voices in the field.

Efficiency of a palliative education programme for nursing students

BACKGROUND

Many nursing students are ill-prepared to care for patients nearing the end of their lives and lack knowledge about palliative care. A focused teaching strategy could help students better understand their own feelings and conduct. It could also foster positive attitudes that make it easier to provide outstanding care.

OBJECTIVE

To evaluate the efficiency of palliative education programme for nursing students caring for patients at the end of life.

METHODS

A quasi-experimental study was carried out with 216 nursing students from Prince Sattam Bin Abdulaziz University in Alkharj, Saudi Arabia, using a proportionate stratified random sampling approach. The educational intervention consisted of three key modules: bereavement support, understanding the dying process and specialised palliative nursing care. Students engaged with 60 video segments through the Blackboard platform, available on a smartphone or tablet. Data collection involved four questionnaires: (a) a demographic survey, (b) the Palliative Care Quiz for Nursing, (c) the Frommelt Attitudes Towards Care of the Dying Scale, and (d) the Death Attitude Profile-Revised.

RESULTS

Slightly over half of the nursing students (51.9%) were younger than 20 years, with a mean age of 22.8±13.5 years, and 51.4% were female. The vast majority of participants in this study (86.6%) had no prior education or training in palliative care. After participating in the palliative education programme, students showed significant improvements in their overall knowledge, Frommelt Attitudes and Death Attitude Profile-Revised scores in the post-test assessment. These results highlight the programme's effectiveness in enhancing nursing students' comprehension and attitudes toward palliative care.

CONCLUSION

A palliative care education programme can improve nursing students' knowledge and attitudes toward caring for patients at the end of life and supporting their families. Therefore, it is recommended that a palliative care course should be a mandatory part of nursing curricula. This course should incorporate experiential learning activities, including postmortem care, small group reflections and simulation-based training. To provide a well-rounded educational experience, these practical components should be reinforced with theoretical lectures.

RECOMMENDATIONS

Changing nurses' perceptions of mortality requires specialised training, and this should be prioritised in Saudi Arabia.

End-Of-Life Simulation in Undergraduate Nursing Curricula: A Cross-Sectional Survey

AIM

The aim of this study was to explore end-of-life simulation in undergraduate nursing curricula in Australian and New Zealand institutions.

DESIGN

A cross-sectional descriptive research design was employed. The study is reported using the CROSS checklist.

METHODS

A survey was distributed to 45 institutions with an accredited Bachelor of Nursing programme in Australia or New Zealand. The instrument comprised eight domains: simulation orientation, simulator type, simulation environment, instructional design, simulation event, pre-brief, debrief, and facilitation preparation and requirements.

RESULTS

Thirty institutions responded to the survey, with 25 suitable for data analysis. Eleven institutions included end-of-life simulation in their curriculum. The dominant modality used in the end-of-life simulation was high-technology manikins. All institutions used a validated approach to conducting the pre-brief and debrief. Variations were reported in the skill and clinical expertise required of end-of-life simulation facilitators and the approaches and modalities used in end-of-life simulations across institutions.

CONCLUSION

A small number of institutions reported including end-of-life simulations in their undergraduate nursing curriculum. This study found the end-of-life simulations integrated into undergraduate nursing curricula in Australia and New Zealand align with many elements of the Healthcare Simulation Standards of Best Practice. There were variations in the simulation modality and facilitation style used to deliver end-of-life simulations across institutions. While a pre-brief session was included, the elements covered and information conveyed to participants varied across institutions. Additionally, the content expertise required of simulation facilitators lacked clarity.

RECOMMENDATION FOR FUTURE RESEARCH

The influence the pre-brief has on the student learning experience requires further research. Moreover, the learning experiences of the participants in various simulation modalities, including the influence of SPs and debriefing approaches, warrant investigation. The role and impact of professional development and facilitator requirements, such as skills and clinical expertise, on the student learning experiences and outcomes in EOL simulation offer opportunities for further research.

PATIENT OR PUBLIC CONTRIBUTION

There were no patient or public contributions in this study.

Journey of touching death, nursing undergraduates' experiences in the simulated death graded exposure Programme: A qualitative descriptive study in China

BACKGROUND

Nursing undergraduates receive inadequate training in death and end-of-life care within the education system, resulting in feelings of unpreparedness and inadequacy when confronted with their first death event in clinical practice, as well as a low willingness to engage in end-of-life care.

OBJECTIVE

To explore the cognitive and emotional experiences of nursing undergraduate students participating in the simulated death graded exposure programme, and to evaluate the educational significance of the programme.

DESIGN

A qualitative descriptive study design.

SETTING

A comprehensive university in Jiangsu Province, China.

PARTICIPANTS

In October 2023, twenty-eight (age range, 19-21 years; 21 [75 %] female;) first-year nursing undergraduates were recruited to participate in the simulated death graded exposure programme.

METHODS

The research team developed and implemented a systematic simulated death graded exposure programme, consisting of four parts: end-of-life farewell role-playing, simulated funeral experience, post-simulation recovery and death reflection. Semi-structured interviews were conducted after the experience, and the interview data were analysed using content analysis.

RESULTS

The nursing students' experiences in the simulated death graded exposure programme could be divided into three phases through a longitudinal process: approaching death (dying), immersing in the world of death (death), and initiating the transformation of life's meaning (rebirth). In the first phase, participants felt integrated into the simulated roles, experienced the complex emotions of approaching death, and ultimately accepted the declaration of death. In the second phase, participants experienced a highly realistic simulation of death, guiding physical symptoms and emotional reactions. Additionally, their awareness of death began to awaken and disperse, leading to profound reflections on death. In the third phase, participants engaged in a process of self-examination which culminated in a self-proclaimed healing process from the experience of the simulated death. Through deep reflection, they were reacquainted with their values and professional mission.

CONCLUSIONS

The simulated death graded exposure programme enhances nursing students' psychological preparedness and emotional adjustment helping to prepare them for experiencing death in a clinical context, and deepens their understanding of life and death. This programme provides a practical example of nursing professionals' training and education in end-of-life care.

Knowledge, Self-Efficacy, and Correlates in Palliative and End-of-Life Care: Quantitative Insights from Final-Year Nursing and Medical Students in a Mixed-Methods Study

Introduction

About a decade after the introduction of palliative care teaching for undergraduate nurses and medical students in Uganda, no research has examined students' knowledge and self-efficacy to provide palliative and end-of-life care and their correlates.

Aims

To: (1) estimate final-year undergraduate nursing and medical students' knowledge of and self-efficacy to provide palliative and end-of-life care, (2) identify correlates of knowledge and self-efficacy to provide palliative and end-of-life care.

Design

A multicentre cross-sectional quantitative study.

Setting/participants

Final-year undergraduate medical and nursing students in eight medical and nursing schools in Uganda. Instruments included biodata sheet, the Palliative Care Quiz for Nursing questionnaire and the Palliative Care Self-Efficacy scale. Statistical analyses were performed using STATA version 14.0.

Results

The mean age of the participants (n = 466) was 24.45 ± 3.31 years. Participants' knowledge of palliative care scores was low in all domains 'Philosophy and principles of palliative care' 1.46 ± 0.93 (range: 0-4), 'Psychosocial and spiritual care' 0.61 ± 0.73 (range: 0-3) and 'Management of pain and other symptoms' 6.32 ± 1.75 (range: 0-13). Predictors of knowledge were Gender (p = 0.0242), course of study (p = 0.0001) and religion (p = 0.0338). Participants had very low self-efficacy scores in the three domains of the Palliative Care Self-Efficacy scale.

Conclusion

Participants generally demonstrated limited knowledge and insufficient self-efficacy in providing palliative and end-of-life care. There is a need to integrate and strengthen practical, pedagogical and experiential teaching, review the palliative care curriculum. Future evaluative, longitudinal and interventional as well as qualitative studies are needed to gain deeper insights into this topic.

The utility and feasibility of incorporating death cafes in undergraduate education: A qualitative exploration of medical and nursing students' perspectives

BACKGROUND

The current medical and nursing curricula place little emphasis on palliative and end-of-life care. Consequently, students are less comfortable in communicating about topics related to death and dying when providing palliative and end-of-life care. Death cafés utilizes a facilitator-led small group to encourage conversations about death and dying to take place alongside food and beverages in a safe environment. In light of the presence of death taboos, there is a need to understand how medical and nursing students perceive the incorporation of a death café within the undergraduate program.

OBJECTIVES

This study aimed to explore the perceptions of medical and nursing students regarding the utility and feasibility of incorporating death cafés into their undergraduate education.

DESIGN

A qualitative study was conducted.

METHODS

This study was conducted in one medical school in a university in Singapore. Participants above the ages of 18 years, pursuing a full time undergraduate medical or nursing program were invited. A purposive sampling approach using the maximum variation sampling technique to enhance representativeness was used to select the participants based on their sociodemographic and academic variables. A total of 32 medical and nursing students were included in the study. Online individual interviews were conducted. The interviews were then transcribed and analyzed using qualitative content analysis.

RESULTS

Three main categories were developed from the content analysis: (1) Perceptions of death cafés, (2) Features of a death café, and (3) Contents of a death café conversation. Participants viewed the death café as a platform for conversations surrounding death and dying. Several features such as the presence of a facilitator and discussions to be held in small groups were surfaced. The proposed topics to be discussed ranged from communication skills, coping with death encounters, and understanding more about the concepts of palliative care.

CONCLUSION

Medical and nursing students view death cafes as a feasible and potential approach in learning pallative and end-of-life care. The use of a faciliator-guided small group discussion on topics such as coping with death, communication techniques and concepts of palliative care are proposed. Further work is needed to examine how the death café method can potentially impact students' confidence and skills in managing palliative and end-of-life care.

Fear and attitudes toward death in nursing students: A longitudinal study

BACKGROUND

Nurses are the most involved healthcare professionals in end-of-life care. Although scientific evidence has demonstrated the effectiveness of specific education in this aspect, the optimal timing of its delivery has not been identified.

AIM

To determine the characteristics of fear of death and attitudes toward end-of-life care among nursing students during academic education.

DESIGN

This longitudinal observational study was conducted between October 2019 and June 2023.

PARTICIPANTS

A total of 486 questionnaires were administered to nursing students from two Spanish faculties.

METHODS

A data collection sheet was developed to track various sociodemographic variables, which was distributed along with the Collett-Lester Fear of Death Scale and the Frommelt Attitude Toward Care of the Dying scale.

RESULTS

In the Frommelt Attitude Toward Care of the Dying scale, the lowest score for Factor I was observed in the third year (F(3,228) = 153.5, p < 0.001) and for Factor II in the second year (χ2(3) = 186.45, p < 0.001). The best attitude was demonstrated in the final academic year, with statistically significant differences. On the Collett-Lester Fear of Death Scale, the highest fear, both in the overall score and in all four factors, was noted in the first year and the lowest in the final year. We found a significant effect of time on the total score (F(3,300) = 7.43, p < 0.001), with differences observed between the first and other years (p < 0.001). The same pattern was found in Factor 3, fear of the death of others (F(3,300) = 18.7, p < 0.001), and in Factor 4, fear of dying of others.

CONCLUSIONS

It is suggested that education be provided on fear of death in the first year, person- and family-centered care in the second year, and end-of-life care in the third year, with interventions lasting more than two months.

Information needs for cancer screening and associated factors of information-seeking behaviour: a qualitative systematic review

BACKGROUND

At present, the participation rate in cancer screening is still not ideal, and the lack of screening information or misunderstanding of information is an important factor hindering cancer screening behaviour. Therefore, a systematic synthesis of information needs related to cancer screening is critical.

METHODS

On July 23, 2024, we searched the Cochrane Library, MEDLINE (Ovid), Embase, EBSCO, PsycINFO, Scopus, ProQuest, PubMed, Web of Science, and CINAHL to collect qualitative or mixed-methods studies on information needs of cancer screening. We also searched for grey literature on OpenGrey and Google websites. Data were synthesised using Sandelowski and Barroso's framework. A top-down approach was adopted to group and synthesise the encodes and then generate analytical themes.

RESULTS

A total of 37 studies were included. The results of the analysis of cancer screening-related information needs content, cancer-specific information needs content, requirements and preferences for information, and associated factors of information-seeking behaviour were reported. Based on the event timeline, we summarised the information needs of the screening demand side into four themes. Their information needs focus on disease risk factors, signs and symptoms, the importance of screening, the benefits and harms of screening, the detailed screening process, and screening results and explanations. Regarding cancer-specific information needs content, we summarised the specific information needs of cervical, breast, colorectal, and lung cancer. By referring to relevant concepts in the Comprehensive Model of Information Seeking, we synthesised the requirements and preferences for information according to the themes of editorial tone, communication potential, recommended information channels, and recommended source place. The information-seeking behaviours of the screening demanders are mainly passive attention and active searching. The common factors leading to the passive attention of screening demanders are demographic factors and fear of cancer. The most common reason for them to actively search information is lack of information.

CONCLUSIONS

The list of information needs identified in this review can serve as a reference for health professionals and information service providers before carrying out screening-related work to help the cancer screening participants obtain valuable information.

The mediating effects of death reflection on death literacy and death anxiety among Chinese nurses: a cross-sectional study

The purpose of this study was to investigate the mediating effect of death reflection on death literacy and death anxiety in clinical nurses. A sample of 2,882 nurses in China were selected by convenience sampling. A socio-demographic questionnaire, a death literacy scale, a death reflection scale, and a death anxiety scale were used to investigate. The results showed that death literacy was positively correlated with death reflection, but was negatively correlated with death anxiety. Furthermore, death literacy can influence death anxiety through the mediating effect of death reflection. We therefore suggest that relevant departments and institutions should seek optimal strategies to strengthen nurses' death literacy training and promote death reflection in order to improve their death anxiety.

A 'good death' needs good cooperation with health care professionals - a qualitative focus group study with seniors, physicians and nurses in Germany

BACKGROUND

Studies investigating notions of a 'good death' tend to focus on specific medical conditions and specific groups of people. Therefore, their results are often poorly comparable, making it difficult to anticipate potential points of conflict in practice. Consequently, the study explores how to achieve a good death from the perspective and experience of physicians, nursing staff, and seniors. The aim of this study is to identify comparable notions of a good death among the participants and to determine factors that may promote or prevent a good death, including those that may lead to futile care.

METHODS

The study used a qualitative design with a total of 16 focus group discussions, 5 each with physicians and nursing staff, and 6 with seniors at least 75 years old. The group size ranged between 3 and 9 participants. Analysis was carried out using Qualitative Content Analysis.

RESULTS

Three major aspects affect the quality of death: (1) good communication and successful cooperation, (2) avoidance of death, and (3) acceptance of death. While successful communication and acceptance of death reinforce each other, successful communication counters avoidance of death and vice versa. Acceptance and avoidance of death are in constant tension. Additionally, the role of family and loved ones has been shown to be crucial in the organization of dying (e.g. communicating the patient's wishes to health care professionals).

CONCLUSIONS

Communication and cooperation between patients and all involved caretakers determines quality of death. However, communication depends on several individual and organizational factors such as the personal level of acceptance or avoidance of death and the availability of institutionalized communication channels crossing professional and organizational boundaries. Furthermore, treatment cultures and organizational structures in hospitals and nursing homes often default towards life prolongation. This carries significant potential for problems, particularly because physicians emphasized the need to prevent hospital admissions when no further life-sustaining treatment is desired. In contrast, nurses and seniors were less aware that hospitals may not be the most suitable place for end-of-life care. This, along with the ambivalent role of nursing homes as places of death, holds potential for conflict.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00027076, 05/11/2021.

Experiences and attitudes of nurses with the legislation on assisted suicide in Austria

OBJECTIVES

In 2022, assisted suicide (AS) was legalized in Austria. We aimed to investigate the experiences and attitudes of palliative care (PC) and hospice nurses toward AS in Austria after the first year of implementation of the new law.

METHODS

A cross-sectional survey was distributed online to nurses in every known specialized and general hospice and PC units in Austria (n = 255 units). The questionnaire included sociodemographic characteristics, the Assisted Suicide Attitude Scale, the Comfort Discussing Assisted Suicide Scale, and questions on recent experiences with AS requests. We used Spearman's correlation coefficient for determining associations between sociodemographic characteristics and attitudes toward AS, as well as comfort discussing AS. For comparison of frequencies, we applied ꭓ2 tests. We computed a linear regression model to examine predictors for attitudes toward AS.

RESULTS

The total sample were N = 280 nurses. More than half (61.2%) indicated that they had cared for a patient who expressed a wish for AS within the first year of implementation. Though responses varied widely, more nurses expressed support for AS than those were opposed (50.36% and 31.75%, respectively). Factors that statistically contributed to more reluctance toward AS in the regression model were older age, religiousness, and experience of working with patients expressing a wish for AS.

SIGNIFICANCE OF RESULTS

This work provides valuable insight into nurses' perceptions toward the legislation of AS in the first year since the new law was passed. The results can inform the future development of the AS system and support for nurses in end-of-life care, and critically contribute to international discussions on this controversial topic.

Self-Perceived Competencies and Attitudes on Palliative Care in Undergraduate Nursing Students: A Multicenter Descriptive Study

Introduction: Caring for the dying can generate anxiety and emotional distress, particularly in nursing students, and perceived competence could play a crucial role in enabling nurses to perform their duties with greater confidence. Unfortunately, few studies describe the relationship between students' nursing attitudes and perceived self-efficacy in palliative care (PC). To overcome this gap, this survey aimed to assess the attitudes towards dying patients and the perceived competence of nursing students in palliative care at different universities in the south of Italy. Methods: A cross-sectional study was conducted from September 2022 to March 2023 involving nursing students from the three major Sicilian universities (Italy). The study included a survey investigating socio-demographic characteristics, palliative care training, knowledge about pain management, and previous experience with dying. Moreover, the Professional Competence of the Core Curriculum in Palliative Care Nursing (CCPCN) questionnaire and the Frommelt Attitudes Toward Care of the Dying-B Italian version (FATCOD-B-I) assessed competencies and emotional attitudes. Results: A total of 1913 nursing students were recruited, of which 71.3% were females, and 53.9% were in the age range of 18 to 21 years. In the multivariable analysis, practical PC training was a substantial factor in enhancing competencies (Adj-OR 2.78 [95% CI = 2.12-3.65]). Male students had higher competence odds (Adj-OR 1.38 [95% CI = 1.14-1.66]), and perceived knowledge strongly correlated with self-assessed competence. Advancement in academic years also positively influenced competence self-assessment (Adj-OR 1.98 [95% CI = 1.75-2.24]). Regarding emotional attitudes, a per-quartile increase in competence score was found to improve the attitude score (Adj-OR 1.24 [95% CI = 1.13-1.35]). Conclusions: Nursing students gain valuable experience during clinical experience. PC training and perceived knowledge of PC significantly increase nurses' competencies, and the latter seem to be strongly associated with attitudes. Thus, introducing palliative care education into nurses' core curricula could be a way to reduce anxiety and emotional distress in young students.

Changes Due to Patient Deaths: Medical Students' Expectations vs. Health Professionals' Experiences

CONTEXT

Preparing healthcare professionals for inevitable encounters with patient deaths is crucial to preventing maladaptive professional bereavement outcomes.

OBJECTIVES

This study aimed to explore the discrepancies between medical students' pre-patient death expectations and healthcare professionals' post-patient death experiences regarding accumulated global changes due to patient deaths (AGC), identify heterogeneous expectation patterns among students, and reveal risk factors for worthy-of-concern expectation patterns.

METHODS

Cross-sectional survey data from 231 professional caregivers and 405 medical and nursing students were used. Independent t tests and analyses of covariance were run for staff-student AGC comparisons. Latent profile analysis (LPA) among students was followed by logistic regression.

RESULTS

The students scored higher than did the staff in two AGC factors: more acceptance of limitations and more death-related anxiety. LPA identified four latent expectation patterns, with the "overoptimistic" (27.8%) group being worthy of concern, as students overestimated positive changes and underestimated negative changes. The overoptimistic pattern was predicted by students' motivations to study medicine, which were driven by "interests," "career opportunities," and "improving medical services in the hometown," rather than "by chance," and higher scores on the death attitude of "neutral acceptance."

CONCLUSION

In general, students tend to overestimate the long-term impacts of patient deaths. However, approximately 1/4 of students hold overly optimistic expectations, which are predicted by motivations to study medicine and death attitudes.

Stillbirth Simulation for Nursing and Midwifery

Collaboration is necessary to design and execute a nursing simulation that meets undergraduate and graduate competency expectations for communication, effective relationships, and stillbirth care. This simulation plan aligns with the ten international healthcare simulation standards published by the International Nursing Association for Clinical Simulation and Learning (INACSL). Course faculty work with simulation faculty, staff, and volunteer actors to plan and implement a consistent experience for pre-licensure and or graduate nursing students to develop critical clinical skills and attitudes across spheres of care while caring for parents experiencing pregnancy loss.

Effective use of role-modeling videos for end-of-life education

BACKGROUND

Role-modeling videos portray how to complete a task or behave in a situation. As posited by Social Learning Theory and the Model of Transformational Learning, role-modeling videos used in the Catalyzing Relationships at the End-of-Life Program (CAREol Program©) were developed to engage and transform student learning.

PURPOSE

The purpose of the study was to understand how role-modeling videos about difficult family relationships at the end of life enhance preparation of nursing and medical students for clinical practice.

METHODS

A descriptive qualitative analysis was used to explore the understanding of 156 nursing and medical students' knowledge of end-of-life care expressed through journal reflections after experiencing a role-modeling video.

RESULTS

Four themes emerged from the qualitative descriptive analysis: comfort, communication, time together, and forgiveness/reconciliation.

CONCLUSION

Through the lens of Social Learning Theory and the Model of Transformational Learning, students learn about the importance of comfort, communication, time together, and forgiveness in family relationships at the end of life.

The impact of a student death doula service-learning experience in palliative care settings on nursing students: A pilot mixed-methods study

Through a mixed-methods approach (randomized controlled trial and thematic analysis of pre and post-service-learning reflections), this study evaluated the impact of a student death doula service-learning experience on nursing students' palliative competencies and learning experiences. The intervention group underwent a 2-day student death doula training workshop followed by a 6-month service-learning experience, while the control group received standard palliative care education. Attitudes toward the care of the dying significantly improved for the intervention group but not for compassion competence and palliative care knowledge. Six themes were developed: (1) Motivations for being a student death doula, (2) Improved perceptions of palliative care patients, (3) Perceptions of a good death, (4) Confidence in caring for palliative care patients, (5) Understanding the multifaceted nature of palliative care, and (6) Joys and challenges during service-learning. Service-learning helped students to understand palliative care patients and acquire confidence in engaging with them.

The experiences of nursing students participating in a student death doula service-learning program in palliative care settings: A qualitative study

Nursing students desire more training and experience in palliative care due to a need for more skills and knowledge. This descriptive qualitative study explored nursing students' experiences in participating in a student death doula service-learning program in palliative care settings. Fourteen final-year undergraduate nursing students participated in semi-structured focus group discussions via Zoom. Four focus group discussions were conducted. Six themes with 19 subthemes were developed: (1) initial feelings of fear and uncertainty, (2) death doula training and orientation, (3) palliative wards being a happier place than expected, (4) experience of watching their patients deteriorate over time, (5) benefits of participating in service-learning in palliative care settings, and (6) improving the service-learning experience. The program was well received by the nursing students, who recommended incorporating it into the nursing curriculum to enhance palliative nursing education. Additional refinements were proposed to better support nursing students during service-learning.

Nursing Students' Intention to Work in Hospice Care in the Future: A Cross-sectional Study

Studies reveal that nursing students rank hospice nursing among their least preferred career choices. The purpose of this study was to explore the association between nursing students' intention to work in hospice care in the future and their attitudes toward caring for dying patients, death anxiety, personal and/or professional experience of caring for dying patients, and type of nursing program studied. In this cross-sectional study, 200 nursing students completed an online survey based on the Frommelt Attitude Toward Care of the Dying Scale and the Turkish Death Anxiety Scale. Only 11% of the respondents were found to express interest in working in hospice care in the future. Studying in the accelerated program for nonnursing Bachelor of Arts graduates predicted a higher intention to work in hospice care in the future, than studying in the generic program (β = 0.27, P < .001). Completion of clinical experience in a medical ward predicted lower intention (β = -0.21, P < .01). These findings suggest that nursing students in the accelerated program for nonnursing Bachelor of Arts graduates should be provided with appropriate experience and support to maintain their interest in hospice nursing. Clinical experience in medical wards does not seem to be a good substitute for clinical experience in hospice care.

A Structured Home Health and Hospice Clinical Rotation and Onboarding Model to Address the Nursing Shortage

North Carolina home health and hospice agencies are experiencing serious shortages of registered nurses (RNs), particularly in rural areas. These shortages can negatively impact patients and families by delaying access to care and possibly resulting in avoidable hospitalizations/rehospitalizations. Many home health and hospice agencies do not hire newly graduated RNs due to limited patient care experience, limited or no opportunity for home health/hospice clinical rotations, and the autonomous nature of providing care in the home. The Hospice and Home Health Foundation of North Carolina was awarded a $468,196 3-year grant, and, in collaboration with key stakeholders, developed a model for clinical rotation experiences in home health and hospice settings for RN students as well as an onboarding model for newly graduated RNs. Seven home health and hospice project partner agencies were selected to pilot the models. This article describes program implementation and evaluation. We used a survey method and site visit interviews to assess program effectiveness. Students provided positive feedback about the clinical rotation and more than 80% indicated their clinical rotation met "most" or "almost all" of their learning needs. The focus group interviews provided substantive anecdotal examples to validate the survey results.

Nursing students' perspectives and learning experiences of participating in a palliative and end-of-life care simulation programme: A qualitative study

BACKGROUND

Simulation-based learning has become an integral part of the nursing curriculum, allowing students to acquire clinical knowledge and relevant skills and apply them to real-life clinical encounters. However, little is known about the best practices in palliative and end-of-life care simulations.

OBJECTIVE

To explore the perspectives and learning experiences of undergraduate nursing students participating in a newly developed advanced practice nurse-led palliative and end-of-life care simulation program.

DESIGN

A descriptive qualitative study based on focus group discussions.

SETTINGS

A healthcare simulation centre at a university in Singapore.

PARTICIPANTS

A purposive sample of 75 third-year undergraduate nursing students who had attended a palliative and end-of-life care simulation program.

METHODS

Eight face-to-face focus group discussions were conducted and audio recorded. Data were analysed using inductive thematic analysis.

RESULTS

Four themes encompassing 12 subthemes were derived: (1) Patient, family and caregiver needs during palliative and end-of-life care, (2) Nursing competencies in palliative and end-of-life care, (3) Experience of palliative and end-of-life care simulations and (4) Suggestions for future palliative and end-of-life simulations. The students expressed their support for including advanced practice nurses as facilitators and suggested the use of other simulation modalities such as virtual simulations to enable the participation of all students and provide a wider range of simulated scenarios.

CONCLUSIONS

Simulation-based learning plays a crucial role in the palliative care curriculum. Clinical experts should be involved as facilitators to provide essential insights. It is also vital to consider students' prior experiences with death and dying, which may positively or negatively influence their palliative and end-of-life care competencies.

RECOMMENDATIONS

Nursing schools should utilise clinical experts and other simulation modalities to improve students' learning experiences, provide more simulation experiences and overcome resource constraints such as limited curriculum time.

Using palliative and end-of-life simulation to enhance pre-licensure nursing students' emotional intelligence, palliative care knowledge and reflective abilities: A single group, pretest-posttest study

BACKGROUND

Nursing students have reported that they lack skills and knowledge in palliative and end-of-life care, and as a result, they faced numerous challenges caring for patients and families receiving palliative and end-of-life care during clinical attachments.

OBJECTIVES

To develop a palliative and end-of-life care simulation program and evaluate its effects on nursing students' emotional intelligence, palliative care knowledge and reflective abilities.

DESIGN

A single group, pretest-posttest quasi-experimental study.

SETTINGS

A simulation center in a Singapore university.

PARTICIPANTS

A convenience sample of 135 third-year undergraduate nursing students.

METHODS

Students attended a two-day simulation program consisting of four scenarios in total. Outcomes were measured before and after the study. Palliative care knowledge was measured using the Palliative Care Knowledge Test, emotional intelligence using the Trait Meta-Mood Scale-24, and reflective abilities using the Groningen Reflective Ability Scale. Outcome and demographic data were analyzed using descriptive and inferential statistics.

RESULTS

Total Palliative Care Knowledge Test scores (p = 0.003) and total Trait Meta-Mood Scale-24 scores (p < 0.001) improved significantly, but there was no significant change in Groningen Reflective Ability Scale scores (p = 0.650). Demographic characteristics did not significantly influence most outcome variables. Students' highest education level and experience with caring for a person receiving palliative or end-of-life care significantly affected the posttest scores of the Palliative Care Knowledge Test. Students with prior experience in caring for a person receiving palliative or end-of-life care scored significantly better in the Palliative Care Knowledge Test post-simulation compared to those who did not (p = 0.011).

CONCLUSIONS

The palliative and end-of-life simulation program significantly improved nursing students' emotional intelligence and palliative care knowledge. Further research is needed on developing a reliable tool to measure nursing students' palliative care knowledge. Future simulations should include structured and deliberate reflection features aside from debriefings to enhance reflective abilities, which is an important nursing competency. More research is needed on the effect of palliative and end-of-life care simulations on emotional intelligence and reflective abilities, and the influence of demographic variables on nursing students' outcomes.

Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews

OBJECTIVE

The COVID-19 pandemic has impacted the capacity for advance care planning (ACP) among patients, families and healthcare teams. We sought to identify and review the barriers to and facilitators of ACP implementation for medical staff in different settings (eg, hospitals, outpatient palliative care, nursing and care homes) during the pandemic.

DESIGN

This study employed an overview of reviews design. We searched the MEDLINE, CENTRAL, Web of Science and Embase databases for studies published between 8 December 2019 and 30 July 2023. We used AMSTAR 2 to assess the risk of bias.

RESULTS

We included seven reviews. Common barriers to ACP implementation included visitation restrictions, limited resources and personnel and a lack of coordination among healthcare professionals. In care and nursing homes, barriers included a dearth of palliative care physicians and the psychological burden on facility staff. Using telemedicine for information sharing was a common facilitator across settings. In hospitals, facilitators included short-term training in palliative care and palliative care physicians joining the acute care team. In care and nursing homes, facilitators included ACP education and emotional support for staff.

CONCLUSIONS

Visitation restrictions and limited resources during the pandemic posed obstacles; however, the implementation of ACP was further hindered by insufficient staff education on ACP in hospitals and facilities, as well as a scarcity of information sharing at the community level. These pre-existing issues were magnified by the pandemic, drawing attention to their significance. Short-term staff training programmes and immediate information sharing could better enable ACP.

PROSPERO REGISTRATION NUMBER

CRD42022351362.