Simulating end-of-life scenarios in teaching nursing students care of the dying patient

Barbara Young, MN, MHP, RN, Sharon Wallace, PhD, RN, CCRN,

Cassey Jankowiak, ADN, RN, ELNEC, BS-PhD student

Introduction• The need for learning to communicate a difficult diagnosis and to

help a patient and family cope with end-of-life care came as a request from community college nursing students.

• End-of-life care was not included in the curriculum prior to developing a simulation titled, Breaking Bad News.

• Faculty collaborated to plan and debrief each scenario. Photograph and video release forms were obtained. Campus media videotaped scenarios for discussion.

• Dramatic presentation of well known plays, improvisation, and simulation of scenarios written by nursing students and Cassey Jankowiak, an RN of Navajo heritage, were implemented with nursing and drama students under the direction of both nursing and drama faculty.

Learning Objectives

• Develop interdisciplinary collaboration with nursing and drama students to simulate end-of-life care.

• Discuss effectiveness of simulating end-of-life scenarios for teaching and learning care of the dying patient.

Method• Morning interactive classroom sessions were scheduled to explore

concepts of vigilance, compassion, fallibility of certainty, and nurse resilience and self care. Professional and personal stories were shared. A post mortem kit and low fidelity mannequin were available for students to simulate post mortem care.

• Afternoon sessions were held in the Black Box Theatre of the drama department and the simulation lab within the Nursing Program. Drama students portrayed scenes from plays that depicted a dying patient or a family coping with the death of a child. Improvisation of scenarios provided an opportunity for nursing students to interact with dying patients and their families.

Results

To determine effectiveness, we asked students of both disciplines to provide feedback. Response to survey items follow:

What one word would describe your experience today?

Refreshing. Great. Sad. Enlightening . Educational. Wonderful. Eye-opening. Complete. Informative.

Experimental. Fun. Exploration. Interesting. Different.

ResultsWhat did you learn?

How to tackle death and dying.Coping with death. How there are many perspectives to one story. There are so many ways to handle asituation. There are always new things to learn.How to deal with struggles of patients/family regarding death/dying.About encountering patients that are dying and their families – ethical and moraldilemmas. About relationships between dying patients and their caretakers.This helped me evaluate my views and feelings on death and dying.Death is nothing to be afraid of.To continue my education on grief/bereavement.Enjoyed Sharon’s sharing of personal nursing experiences in less-stressful environment thanclass.Lots of things on how to deal with end-of-life care.Death is a good experience if given dignity.

Results

What was most important to your learning?

InteractionsSharing of experiences from experienced nurses.How I as a nurse will need to learn how to face patients and their families with thedying process.Cassey’s lecture, skits, how to deal with end-of-life.To be more sensitive to caring for the dying person.How end-of-life effects everyone involved, not just the person that is sick.How a nurse should deal with this situation.Interacting with the nursing students.Death is nothing to be afraid of.Navajo’s refusing to acknowledge death.

Conclusion

• Nursing students affirmed need to include end-of-life care in nursing curriculum.

• Nursing and drama students expressed the value of collaborative learning.

• Students benefitted from exploring the scenarios of death and dying from the perspective of a different discipline.

• The interaction and collaboration of nursing and drama departments made for a richness of perspectives and exchange among the students of both disciplines.

Recommendations

• End-of-life care of patients and family members needs to be included in nursing curriculum.

• Interdisciplinary collaboration can be used to provide a broad exploration of concepts related to death and dying.

• Simulation can be used as a method to increase nursing students’ sensitivity to cultural differences in end-of-life care.

Jack Edwards ScenarioAuthor: Rebecca Edwards, Nursing Student

Navajo Cultural Perspective ScenarioAuthor: Cassey Jankowiak, RN

Navajo Cultural Perspective ScenarioAuthor: Cassey Jankowiak, Rn

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