Hospice: Dying at Home an Undergraduate Nursing Simulation

Abstract

Topic: The Hospice: Dying at Home simulation addressed a gap in undergraduate nursing student education, regarding end-of-life care. During the simulation, nursing students demonstrated novice level skills in caring for clients who were near the end-of-life or actively dying. The simulation promoted the utilization of therapeutic communication and critical thinking skills needed to assess, plan, implement, and evaluate nursing care given to clients and families during the end of life. Context: The simulation was implemented as a final project in a senior nursing course focusing on the care of adults living with chronic illness. Students were required to demonstrate overarching concepts taught throughout the course such as: self-management, uncertainty, spirituality, transitions in care, chronic pain, palliative care, hospice, and death. A checklist of required skills and activities to be utilized was provided for student review and included specific objectives such as performing a head to toe assessment and providing education on the hospice experience. The simulation was held in the Minka, a compact home on the University of Southern Indiana campus, to give students a realistic experience. Grounding: End-of-life simulation addresses a gap in undergraduate nursing education. Time allotted for clinical hours and availability of clinical settings limits nursing students experience of caring for clients and families near the end-of-life (Smith, et al., 2018). The Hospice: Dying at Home simulation gives a large cohort of nursing students the opportunity to care for a client and family near the end-of-life. This simulation provides a basis for how nurses care for and use therapeutic communication. When education on death and dying is minimized in undergraduate nursing programs, nursing students are left unprepared to care for clients and families near the end-of-life (Hjelmfors, Stromberg, Karlsson, Olsson, Jaarsma, 2016). Approach: The simulation took place in two 20-minute parts, first covering admission into home hospice, and subsequently addressing care of the actively dying client. Students were given one week to prepare for the simulation by accessing the academic electronic health record, reading assigned documents, and reviewing the simulation checklist. On the day of the simulation, three students were randomly chosen to participate in each part, assuming the roles of nurse and family members. The remaining students observed the live-streamed simulation from a classroom. The large group met to debrief after each part. In addition to peer and faculty comments, a practicing hospice nurse was on-hand to observe, answer questions, and offer feedback. Discussion: The Hospice: Dying at Home simulation positively impacted student learning by providing a comprehensive end-of-life experience for undergraduate nursing students. Overall, students indicated that the simulation was realistic, the debrief process was engaging, and the educational objectives were met. This simulation could be adapted to a variety of clinical settings including residential and acute care. If live-stream capabilities are not available, the class could be broken down into smaller sections with staggered starts. Caring for clients at the end-of-life is essential; simulation provides an effective method for students to practice this nursing responsibility. References Smith, M.B., Mecieira, T.G.R., Bumbach, M.D., Garbutt, S.J., Citty, S.W., Stephen, A., Keenan, G. (2018). The use of simulation to teach nursing students and clinicians palliative care and end of life communication: A systematic review. American Journal of Hospice and Palliative Medicine. 35(8), 1140-1154. doi: 10.1177/10499091 Hjelmfors, L., Strombert, A., Karlsson, K., Olsson, L., Jaarsma, L. (2016). Simulation to teach nursing students about end-of-life care. Journal of Hospice and Palliative Nursing. 18(6), 512-518. doi: 10.1097/NJH.00000000000000279