Journal of Nursing Education

Major Article 

Teaching Methodologies for End-of-Life Care in Undergraduate Nursing Students

Jennifer N. Carmack, MSN, RN; Stephanie Kemery, MSN, RN, CMSRN

Abstract

Background:

The purpose of this literature review was to explore methodologies for teaching end-of-life (EOL) care to undergraduate nursing students.

Method:

Articles were retrieved by searching CINAHL, Academic Search Complete, and MEDLINE databases using the terms terminal care, palliative care, end of life care, undergraduate nurs*, hospice care, baccalaureate nurs*, prelicensure nurs*, palliative nurs*, training, and undergraduate education. A total of 728 articles were preliminarily evaluated for inclusion, with 22 relevant to this literature review.

Results:

A variety of teaching methods have been studied for efficacy in undergraduate nursing education.

Conclusion:

Comparisons are limited by inconsistencies in instrumentation and the use of multiple teaching strategies in individual studies. More information is needed regarding the effect of interventions on clinical practice. Educational activities should be integrated throughout the learning experience and include elements of didactic teaching, clinical experiences, and application in simulation, including a focus on interprofessional education. [J Nurs Educ. 2018;57(2):96–100.]

Abstract

Background:

The purpose of this literature review was to explore methodologies for teaching end-of-life (EOL) care to undergraduate nursing students.

Method:

Articles were retrieved by searching CINAHL, Academic Search Complete, and MEDLINE databases using the terms terminal care, palliative care, end of life care, undergraduate nurs*, hospice care, baccalaureate nurs*, prelicensure nurs*, palliative nurs*, training, and undergraduate education. A total of 728 articles were preliminarily evaluated for inclusion, with 22 relevant to this literature review.

Results:

A variety of teaching methods have been studied for efficacy in undergraduate nursing education.

Conclusion:

Comparisons are limited by inconsistencies in instrumentation and the use of multiple teaching strategies in individual studies. More information is needed regarding the effect of interventions on clinical practice. Educational activities should be integrated throughout the learning experience and include elements of didactic teaching, clinical experiences, and application in simulation, including a focus on interprofessional education. [J Nurs Educ. 2018;57(2):96–100.]

In January 2016, the American Association of Colleges of Nursing (AACN) published recommendations for integrating palliative and end-of-life (EOL) care throughout the undergraduate nursing curriculum. This document provided guidance for curriculum planning to incorporate EOL care concepts in a variety of course topics, including fundamentals, mental health, community health, and nursing management (AACN, 2016), but no recommendations were made regarding specific teaching and learning strategies. A review of the literature was conducted to examine published reports of various instructional methodologies in delivering EOL content.

Although the need for instruction in EOL care has been recognized for some time (AACN, 1997), significant improvement is still needed. Ferrell, Malloy, Mazanec, and Virani (2016) noted that although the proportion of textbook content related to palliative care (a significant component of EOL care) has increased by approximately 16% since 1998, faculty still note deficiencies in student preparation related to curriculum time constraints and faculty comfort with palliative care concepts. Ferrell et al. (2016) also cited a survey of novice nurses and midlevel nursing leaders that discovered respondents did not consider “psychosocial and spiritual care and care at the time of death” to be important in EOL care (p. 329). Concerns about undergraduate EOL education are not limited to the United States. Adesina, DeBellis, and Zannettino (2014) found that more than half of Australian nursing students surveyed did not report being adequately trained to care for EOL patients. Students in the United Kingdom reported feeling similarly underprepared to care for dying individuals due to limited content during career preparation (Caveye & Watts, 2014).

Given the call to improve education on providing EOL care, new methodologies of integrating content into the undergraduate nursing curriculum should be explored. Although previous literature reviews have been published on EOL teaching (Gillan, Van der Riet, & Jeong, 2013; Lippe & Carter, 2015), new variations on teaching methodologies are being published regularly. Thus, the aim of this literature review was to explore current strategies, compare findings to that of previously published results, and determine whether progress has been made in the interim.

Method

Articles were retrieved by searching the Cumulative Index to Nursing and Allied Health Literature (CINAHL®), Academic Search Complete, and MEDLINE® databases for English language articles using the terms terminal care, palliative care, end of life care, undergraduate nurs*, hospice care, baccalaureate nurs*, prelicensure nurs*, palliative nurs*, training, and undergraduate education. Results were limited to those articles published since 2011 to focus on the most recent evidence. In addition, the table of contents for all issues of the Journal of Nursing Education and the Journal of Hospice and Palliative Nursing from January 2011 to May 2016 were reviewed for articles relevant to the topic. A total of 728 articles were preliminarily evaluated for inclusion from databases searches, with 40 articles selected for further screening from both the database searches and tables of content review based on titles and abstracts when available. Twenty-two articles were deemed relevant to the purpose of this review based on their discussion and evaluation of teaching methods. Articles were grouped according to primary teaching method: face-to-face instruction, clinical or practicum experience, online teaching, simulation, and interprofessional education (IPE). An overview of each article is presented within the appropriate teaching strategy subsection.

Face-to-Face Didactic Instruction

Several articles described a variety of didactic instruction methods in which students interact with the instructor face to face. Examples of the methods detailed include workshops, seminars, semester-long elective courses, guest speakers, and exploration of the liberal arts. Not all face-to-face offerings were required as part of the curriculum for the students. Details of each article can be found in Table A (available in the online version of this article).

Summary of Articles of InclusionSummary of Articles of InclusionSummary of Articles of InclusionSummary of Articles of InclusionSummary of Articles of InclusionSummary of Articles of InclusionSummary of Articles of InclusionSummary of Articles of InclusionSummary of Articles of Inclusion

Table A:

Summary of Articles of Inclusion

All the articles in this section detailed methods for face-to-face instruction with favorable evaluation data. Jackson and Motley (2014), Bailey and Hewison (2014), and Jo and An (2015) detail required curricula offerings spanning from less than a day to an entire course. Ballestros et al. (2014), Bush and Shahwan-Akl (2013), Hold et al. (2015), and Jafari et al. (2015) provided elective coursework options to supplement the required curriculum. A variety of teaching strategies were utilized, including lecture (Bailey & Hewison, 2014; Ballestros et al., 2014; Jackson & Motley, 2014; Jafari et al., 2015); guest speakers (Hold et al., 2015); videos (Jackson & Motley, 2014; Jafari et al., 2015); audio recordings (Ballestros et al., 2014; Jackson & Motley, 2014), discussion (Ballestros et al., 2014; Hold et al., 2015; Jackson & Motley, 2014; Jafari et al., 2015), journaling (Hold et al., 2015); case studies (Bailey & Hewison, 2014; Jackson & Motley, 2014); group work (Bailey & Hewison, 2014; Ballestros et al., 2014), and service-learning (Hold et al., 2015). Overall, it appears that these face-to-face offerings increased student confidence in caring for EOL patients, particularly in communication. Students in elective coursework generally felt that palliative care and EOL content should be mandated for all nursing students.

Unfortunately, it is difficult to compare results from study to study due to the lack of consistency in data collection. Of the seven articles reviewed in this section, only two used a common tool—the Frommelt Attitude Towards Care of the Dying Scale. The lack of standardization in measurement creates difficulty in making recommendations for incorporating specific teaching methodologies into face-to-face didactic coursework. In all courses for which teaching strategies were identified, more than one strategy was used. Therefore, isolating which face-to-face teaching strategies were most effective is challenging. In addition, much of the focus of the assessments conducted centered on the feelings of students completing the coursework, which may not translate into clinical practice.

Clinical Experience

Clinical experiences have long been a foundation of undergraduate nursing education; however, studies by Jeffers (2014), Colley (2016), and Ek (2014) have demonstrated there is room for improvement to maximize the benefits of this strategy in educating students on EOL care. Jeffers (2014) found that clinical faculty perceive nursing students as devaluing EOL care as meaningful work due to the limited amount of psychomotor and technical skills involved with this vulnerable population and their families. Clinical faculty also noted that unit nurses were reluctant to involve students in EOL care, thus decreasing opportunities for exposure and learning (Jeffers, 2014). Colley's (2016) findings echo those of Jeffers—students had no issues providing mouth care to these patients, but they avoided interacting with the families due to the sensitive topic of death. Colley recommended more positive opportunities for students to build on these skills and knowledge to build confidence for the future. The qualitative work of Ek et al. (2014) with students further highlights the importance of a positive clinical experience, with students reporting that caring for a dying patient is less intimidating than anticipated prior to the experience. Three articles returned in the literature review discussed methods for improving the clinical experience (Gilliland, 2015; Heise & Gilpin, 2016; Ka Yee Chow, Wong, Yik Kam, & Tin Yu, 2014).

Two of the three studies included in this section were nonexperimental, making a determination of cause and effect difficult (Table A). Further, the use of relatively small sample sizes and convenience sampling limits the generalizability of the results. It is recommended that future studies incorporate a clinical intervention specific to palliative care, ideally with a control or comparison group to isolate the effects of intentional clinical experiences and measurement of student outcomes.

Although limited in number, these studies support the inclusion of intentional experiences in providing EOL care in the clinical setting. Exposure to death and dying in a supervised environment may provide a foundation for positive attitudes toward providing EOL care to future patients. Clinical faculty must be intentional about seeking out these experiences within regular clinical assignments and provide support for the student's need to participate in direct care of the dying patient, including advocating with unit staff. In addition, clinical faculty should be mindful of the emotional implications of providing EOL care and engage the student in a debriefing process to explore emotional reactions.

Online Format

Technology development offers many new avenues for obtaining a nursing degree and pushes nursing programs to be innovative in delivery methods in attracting students. This process also includes faculty being creative in the approach and teaching of their materials in a learning conducive manner that will be productive and meaningful to the student. EOL care is no exception to this initiative and must find ways to prevail. Two articles were found that explored options for incorporating EOL care into an online format (Table A).

After searching for articles that provide online learning experiences in EOL care, it is noted that there is a dearth of literature addressing the efficacy of online coursework. The articles reviewed for online interventions detailed vastly different approaches to teaching, and only one (Conner, Loerzel, & Uddin, 2014) used a nonexperimental comparison group. The evidence supporting online instruction in EOL care lags behind that of the traditional face-to-face didactic model. Further research is needed to establish whether students benefit from instruction in EOL topics via nontraditional modalities.

Simulation

Simulation has long been used in nursing education to provide a safe environment to assess and improve the clinical skills necessary to become a competent nurse. Given that EOL is a high-stakes area with a need for increased sensitivity, incorporating simulation to enhance the best practices and techniques to deliver exceptional care may provide a useful educational format. In the literature review, it was evident that simulation has been frequently included in EOL instruction, as nine studies were returned that focused on the applicability the method (Table A).

All the studies reviewed that incorporated simulation included debriefing sessions after the conclusion of the scenario. Debriefing has been found to be a critical component of simulation, providing greater knowledge attainment for students (Shinnick, Woo, Horwich, & Steadman, 2011). Generally, gains were noted in student knowledge and attitudes after simulation, although some students reported feeling unprepared for the scenario encountered. Many, but not all, of the simulation studies included a presimulation assignment intended to prepare students for the scenario. Future studies examining the efficacy of presimulation assignments in undergraduate EOL instruction are recommended.

Studies related to simulation generally experienced the same limitations noted in previous sections: a lack of consistency in evaluation tools, and a focus on student attitudes and feelings regarding EOL care. Issues with tool consistency are evident in the wide variety of tools used, particularly in studies that included tools that had not been previously validated. Montgomery et al. (2016), Bobianski et al. (2016), and Moreland et al. (2012) collected quantitative data using various tools that were created or adapted for the purpose of their studies. Fabro et al. (2014) included instruments that had been previously developed and standardized.

Lippe and Becker (2015) and Fluharty et al. (2012) used a combination of previously validated instruments and tools modified or created specifically for their study. Consistency in instrumentation would assist in comparing outcomes among simulation studies.

All the studies included in this section were found to focus on the aspect of attitudes toward EOL care or satisfaction with teaching methodologies. Two of the studies also incorporated knowledge growth data (Fluharty et al., 2012; Moreland et al., 2012). Although it is certainly important to improve students' attitudes and feelings of self-confidence regarding caring for dying patients, a positive attitude does not necessarily translate into improved patient care. Further research is needed regarding clinical practice outcomes related to the use of simulation in training students for EOL patient care.

Interprofessional Education

IPE is a hot topic in health care, not just in the education setting but also in the practice setting. This concept fits well with EOL due to the multiple disciplines involved in the care for these individuals. Despite the potential benefits of interprofessional collaboration and education, only one article was located about IPE. In that article (Sinha et al., 2015), the authors described the development of a 3-day workshop incorporating the interprofessional concept with EOL care and challenging medical and nursing students in their third and fourth years to utilize art, science, and care techniques to emphasize the importance of EOL care as a health care team. The results showed an improvement in overall scores from preintervention to postintervention (at both the 6-month and 1-year mark) and did not show any statistically significant differences between the disciplines (Sinha et al., 2015). This suggests that this workshop was beneficial in improving the students' attitudes toward EOL care while allowing the students exposure to an interprofessional experience.

Discussion and Recommendations

Holistic EOL concepts must be incorporated in undergraduate prelicensure nursing curriculum, and many of the studies presented in this review have demonstrated improvements in student attitudes toward EOL care. Unfortunately, the most effective manner to do so is unclear based on current evidence. Therefore, it is of great importance that nursing faculty who develop and implement these creative strategies to address deficiencies in the curriculum also conduct well-planned research into the efficacy of their teaching. Based on the gaps in evidence noted throughout this literature review, several recommendations are presented for future research.

The vast majority of research articles reviewed for this manuscript detailed efforts in face-to-face didactic offerings and simulation. Few articles examined the effects of online course-work, intentional clinical experiences, or IPE. Although it is recommended that ongoing research be conducted in face-to-face didactic strategies, and simulation, more attention should be paid to clinical and online education outcomes. The authors also note that, given the Institute of Medicine (2015) report calling for increased inclusion of IPE within the health professions, more literature is needed describing and evaluating new efforts toward incorporating interprofessional concepts into EOL teaching.

Future research into the efficacy of EOL teaching strategies should include an intervention, rather than rely for example upon surveys of students having the luck of being exposed to a particular clinical experience. Including an intervention, ideally with a control or comparison group, will allow for stronger evidence supporting the influence of teaching interventions on student outcomes. In addition, future studies should focus on a single intervention or include a sufficient number of comparison or intervention groups to isolate the effects of a specific intervention. In some studies included in this review, multiple didactic teaching strategies were utilized (e.g., lecture, discussion, case studies, and video clips), making it difficult to determine which strategies had the greatest effect on outcomes.

As noted previously, studies in this review tended to focus on student attitudes and feelings. Measurement of outcomes should extend beyond student attitudes toward EOL care and satisfaction with the teaching strategy used. Although changing attitudes toward EOL care is a noteworthy effort, and most of us would agree that we would like our students to enjoy learning, changed attitudes does not necessarily translate into improved care or patient outcomes. Future researchers are urged to include a component in their work measuring the effects of learning interventions on the care provided by students to EOL patients, particularly beyond the immediate effects of the intervention. Although engaging in longer-term follow up certainly adds more work and perhaps cost to a study, understanding the effects of teaching on eventual patient care is crucial to adequate evaluation.

The final recommendation is a call for the use of standardized tools in future research. Many tools used in these studies were created by the research team for that particular study and did not include information on reliability or validity. The use of standardized instrumentation that has been tested for reliability and validity will allow for comparison of results across interventions and settings, creating a body of knowledge that can be drawn on for the creation of high-quality educational offerings to enhance EOL nursing care.

Conclusion

A variety of teaching strategies aimed at improving outcomes related to EOL care were found in the literature. Nurse educators have detailed creative methods for incorporating EOL concepts into their classrooms. However, many of these methods are not sufficiently supported by research. Well-designed experimental or quasi-experimental studies are needed to determine the effects of education interventions on nursing care provided by students to patients at the end of life. The state of the science must advance in order to guide nursing faculty in developing coursework to prepare undergraduate prelicensure students to deliver holistic quality EOL services.

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Summary of Articles of Inclusion

StudyaNMethodsIntervention(s)Outcomes/Effectiveness
Face-to-face
Jackson, M.J., & Motley, C.J. (2014)106Qualitative/Quantitative - pre/post Tools: End of course survey created for this intervention & analysis of reflective essaysRequired half day seminar (case studies, video clips, audio recordings, lecture, and discussion)Students reported a desire for more information on various end-of-life (EOL) aspects of patient care (Do Not Resuscitate, ethical dilemmas, impaired patient communication), additional examples and resources for emotional support of patients and families, and role play. They also uncovered an understanding of the importance of emotional needs of patients and families
Bailey, C., & Hewison, A. (2014)21Quantitative/Qualitative-pre/post Quantitative tool-Frommelt Attitude Towards Care of the Dying ScaleOne day workshop on emotional aspect for patients' receiving EOL care, including case studies.Statistically significant difference noted in quantitative scores (greatest advances in students who had previous education about death and dying). Qualitative statements included appreciation for small group work and the applicability of the workshop.
Jo, K.-H., & An, G.-J. (2015)39Quantitative pre/post-test design compared experimental group with a control group that did not complete the course. Tools: Attitudes Toward Death, Death Anxiety Scale, & Communication Assessment ToolEOL course focused on the humanities in Korea, aimed to need for students to feel more prepared for these situations using ELNEC as a framework.Communication skills and students' attitudes toward the topic of death improved with the experimental group when compared with the control group; anxiety experienced by students associated with the topic of death did not differ between groups.
Ballesteros, M., Centeno, C., & Arantzamendi, M. (2014)236Qualitative-post onlyPalliative care course that was optional for students. The course utilized strategies of lecture, discussion, group work, and movie/audio clips.Students stated the course helped to understand the importance of placing the patient and family at the center of the care plan, allowed students to gain more experience with this population and improved confidence in the clinical setting. Improved communication and professional development were noted. The most knowledge gained was in pain management.
Bush, T., & Shahwan-Akl, L. (2013)51Qualitative/Quantitative-post Tool designed for this study measuring motivation for completing the elective coursework, the efficacy of teaching strategies utilized, and confidence in the ability to care for patients with a terminal diagnosisAn elective oncology and palliative care course for third year undergraduate students; Specific teaching strategies in the course were not provided;Students indicated that it would be beneficial to incorporate palliative care concepts as part of the required content for all students.
Hold, J., Blake, B., & Ward, E. (2015)19Qualitative-postElective palliative care course including apprenticeship, guest speakers, service learning at a hospice facility, and discussion/journalingStudents expressed appreciation in learning from other individuals and their stories; gained knowledge.
Jafari, M., Rafiei, H., Nassehi, A., Soleimani, F., Arab, M., & Noormohammadi, M. (2015)30Quantitative-pre/post Tool: Frommelt Attitude Toward Care of Dying ScaleFour hours of lecture, the presentation of a film, and two days of group discussionSignificant positive change in attitudes on caring for patients at the end of life; all participants felt that instruction on end of life care was lacking in previous nursing instruction.
Clinical
Ka Yee Chow, S., Wong, L., Yik Kam, C., & Tin Yu, C. (2014)253Quantitative Tool-combination of questions developed for this study, American Association of Critical Care Nursing self-assessment tool, & an unnamed instrument from a previous studyNo specific study intervention-data collected on clinical experiences & personal experiencesClinical experience was a vital component to building competency and positive attitudes; instructor feedback is instrumental in improving student attitudes and self-confidence
Gilliland, I. (2015)61Qualitative-post Quantitative-pre/post Tools: Attitudes Toward Death, End-of-Life Competencies Survey, & student reflectionsTwo-day hospice rotationResults did show a significant improvement in the attitudes toward EOL care; students were more comfortable and empowered to learn more with EOL care. Competencies were also measured, but did not show significant difference when comparing the pre- post results.
Heise, B., & Gilpin, L. (2016)25Qualitative/Quantitative Tool created for this study examining experiences and debriefingNo specific study intervention-experiences of students who had participated in end of life care during a clinical rotationStudents reported feeling unprepared to communicate with family members of patients at the end of life. Debriefing after patient death in the clinical setting was inconsistently received.
Online
Conner, N., Loerzel, V., & Uddin, N. (2014)123Quantitative pre/post comparison of online group & students who did not take an EOL course Tools: Frommelt Attitude Toward Care of Dying Scale (FATCOD) & Death Attitude Profile-Revised (DAP-R)Online course with print and online readings, videos, discussion, reflection, and experiences designed to expose students to EOL and death planningStatistically significant improvement in attitudes towards caring for EOL patients in online group; students who did not participate in the course showed no change. A statistically significant difference was noted between the intervention and comparison groups on the FATCOD tool
Hall, N., & Grant, M. (2014)74Quantitative pre/post Tool: select items from Knowledge, Attitudes, and Experiential Survey on Advance DirectivesStudents in both online and face-to-face courses were required to fill out their own advance directivesSignificant increase in attitudes of the students following intervention; however, no distinction made between online and face-to-face students
Simulation
Montgomery, M., Cheshire, M., Johnson, P., & Beasley, A. (2016)∼90Qualitative/Quantitative post Tool: Internal instrumentRequired high-fidelity simulation with patient death & attendant family; lecture on hospice/EOL prior to simulationImprovement of communication skills with patient and family and increased knowledge of dying process
Bobianski, K., Aselton, P., & Cho, K. (2016)43Quantitative/Qualitative -post Tool: Evaluation survey developed for this study & postsimulation debriefing discussionRequired high-fidelity simulation in home care setting based on ELNEC case study with focus on cultural competency; preparation readings assigned beforehandStudents overwhelmingly reported positive experiences, including use of in home setting to promote focus on cultural competency in practice. Pre-simulation assignments beneficial.
Ladd, C., Grimley, K., Hickman, C., & Touchy, T. (2013)35Qualitative-pre/postInpatient hospice setting simulation with actively dying patient and attendant family members. Students viewed video on communication, were assigned material to view, and reflected on concerns and prior experiences with EOL before simulation.Findings were positive, with several themes: “avoiding the subjects, having witnessed tremendous pain and many other forms of suffering among those who are dying, and finding comfort in memories of good deaths” (p. 49). Some students recommended including the simulation prior to EOL clinical experiences, but others noted it was a good opportunity for reflection on clinical experiences. Individual growth in practice & ability to connect with family members was also noted.
Eaton, M., Floyd, K., & Brooks, S. (2012)30Qualitative-post simulation & post clinical rotationSimulation of dying patient in home health hospice followed by hospice practicum rotation. No information provided about pre-simulation preparation assignments.Themes: “experiential learning, affirmative outcomes, and family and client” (p. e239)
Lippe, M.P., & Becker, H. (2015)128Quantitative-pre/post Tools: Frommelt Attitude Toward Care of Dying Scale, Concerns About Dying Scale, & tool developed for the study (Perceived Competence in Meeting ELNEC Standards)Three-part clinical simulation caring for patient and family with acute exacerbation of heart failure leading to end of life care; debriefing occurred between each segment of simulation.Higher perceived competency in providing EOL care and statistically significant improvement in FATCOD scores, indicating positive gains in attitudes regarding caring for dying patients.
Fabro, K., Schaffer, M., & Scharton, J. (2014)21 (quantitative data); 18 (qualitative data)Quantitative/Qualitative - post Tools: Educational Practices Questionnaire, Student Satisfaction and Self-Confidence in Learning, & student reflectionsElective EOL course with two-part high-fidelity simulation designed to care for a dying patient and his family members Students in second cohort also received pre-simulation assignmentStudents experienced negative feelings related to being unprepared and uncomfortable during the simulation. Both instruments reflected positive outcomes in active learning, student satisfaction, and student confidence.
Fluharty, L., Hayes, A., Milgrom, L., Malarney, K., Smith, D., Reklau, A., . . . McNeilis, A. (2012)370Quantitative-pre/post Tools: adjusted Nurse Self-Concept Questionnaire focusing on self-confidence (post only), End-of-Life Communication Assessment Tool (post only), & faculty developed tools on knowledge (pre/post) and learning method satisfaction (post only)Elective simulation in unspecified hospice environment; recorded lecture from ELNEC trainer assigned beforehandIncrease in knowledge concerning end-of-life care, self-confidence pertaining to delivering care to these individuals, communication skills and an overall satisfaction with learning method
Moreland, S., Lemieux, M., & Myers, A. (2012)14Quantitative/Qualitative -pre/post Tools: Knowledge Assessment Instrument, Self Efficacy Assessment Instrument, & Student debriefing commentsElective High-fidelity simulation in unspecified EOL environmentSignificant improvement in knowledge; self-efficacy scores related to caring for EOL patients increased, however, decreases were noted on individual items related to the ability of the student to provide nursing care and student emotional responses. “(S)tudents expressed difficulty with changing perspectives from curing (task completion) to caring (just being there)” (p. 11).
Venkatasalu, M., Kelleher, M., & Chun Hua, S. (2015)12Qualitative-postComparison group received classroom instruction with videos, discussion and reflection; experimental group received high-fidelity simulation. However, there were inconsistencies in intervention time allotted to each group. All study participants were required to have experienced EOL care in the clinical setting.Themes: ability to recognize death and dying (improved with both methods, but higher with sim), transformation of knowledge (in sim, but not classroom), clinical preparation (both groups stated benefits however had participants in both that felt that no matter the teaching method, they would never feel prepared), emotionally prepared (both groups improved).
IPE
Sinha, P., Murphy, S., Becker, C., Poarch, H., Gade, K., Wolf, A., . . . Basher, V. (2015)38Quantitative data-pre/post/post Tool: developed for this studyThree-day interprofessional workshop with nursing and medical students. Day 1: use of art in EOL Day 2: shadowing practicing palliative care physician Day 3: Simulation utilizing standardized patientImprovement in overall scores from pre-intervention to post-intervention (at both the six months and one year mark), and did not show any statistically significant differences between the disciplines; suggesting this workshop was beneficial in improving the students' attitudes toward end-of-life care while allowing the students exposure to an interprofessional experience.
Authors

Ms. Carmack and Ms. Kemery are Assistant Professors, School of Nursing, University of Indianapolis, Indianapolis, Indiana.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Jennifer N. Carmack, MSN, RN, Assistant Professor, School of Nursing, University of Indianapolis, 1400 E. Hanna Ave., Indianapolis, IN 46227; e-mail: jncarmack@gmail.com.

Received: January 11, 2017
Accepted: August 23, 2017

10.3928/01484834-20180123-06

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