The impact of a simulated intervention on attitudes of undergraduate nursing and medical students towards end of life care provision

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Abstract

Background

The concerns of undergraduate nursing and medical students’ regarding end of life care are well documented. Many report feelings of emotional distress, anxiety and a lack of preparation to provide care to patients at end of life and their families. Evidence suggests that increased exposure to patients who are dying and their families can improve attitudes toward end of life care. In the absence of such clinical exposure, simulation provides experiential learning with outcomes comparable to that of clinical practice. The aim of this study was therefore to assess the impact of a simulated intervention on the attitudes of undergraduate nursing and medical students towards end of life care.

Methods

A pilot quasi-experimental, pretest-posttest design. Attitudes towards end of life care were measured using the Frommelt Attitudes Towards Care of the Dying Part B Scale which was administered pre and post a simulated clinical scenario. 19 undergraduate nursing and medical students were recruited from one large Higher Education Institution in the United Kingdom.

Results

The results of this pilot study confirm that a simulated end of life care intervention has a positive impact on the attitudes of undergraduate nursing and medical students towards end of life care ( p < 0.001).

Conclusions

Active, experiential learning in the form of simulation teaching helps improve attitudes of undergraduate nursing and medical students towards end of life. In the absence of clinical exposure, simulation is a viable alternative to help prepare students for their professional role regarding end of life care.

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Most cited references 21

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Assessing nurses' attitudes toward death and caring for dying patients in a comprehensive cancer center.

Ethan Lange, Joel Kline, B Thom (2008)

To assess how nurses employed in a comprehensive cancer center feel about death and caring for dying patients and examine any relationships between their attitudes and demographic factors. Descriptive quantitative. A 432-bed comprehensive cancer center in New York, NY. A convenience sample of 355 inpatient and outpatient oncology nurses. Voluntary and anonymous completion of the Frommelt Attitude Toward Care of the Dying (FATCOD), the Death Attitude Profile-Revised (DAP-R), and a demographic questionnaire. Years of total nursing experience, years employed at the cancer center, previous experience with caring for dying patients, age, gender, and attitudes toward death and caring for dying patients. Statistically significant relationships were noted among age, nursing experience, previous experience with caring for terminally ill patients, and scores on the FATCOD and DAP-R. Nursing experience and age were the variables most likely to predict nurses' attitudes toward death and caring for dying patients. RNs with more work experience tended to have more positive attitudes toward death and caring for dying patients. Based on the data collected in the study, less experienced oncology nurses will most likely benefit from increased education, training, and exposure to providing and coping effectively with end-of-life care.

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Exposure to death is associated with positive attitudes and higher knowledge about end-of-life care in graduating medical students.

N Barnard, James E. Bost, J. Williams … (2008)

To examine the relationship between exposure to death and attitudes and knowledge about end-of-life care in graduating medical students. Survey of students graduating from the University of Pittsburgh School of Medicine between 2001 and 2006. Students reported their personal experience with death and their exposure to death and dying patients during medical school. They rated their agreement, on a 4-point Likert scale, with 8 attitude items that were previously used in a national survey. Knowledge about end-of-life care was assessed with a 15-item test about pain and symptom management, ethics, treatment appropriateness, and hospice. Three hundred and eighty students completed the survey; the response rate was 47%. Seventy-six percent of students reported personal experience with death, and 73% reported caring for dying patients or witnessing a patient's death during their third-year clerkships. Students had positive attitudes about physicians' responsibility and ability to help dying patients and their families, but reported negative emotional reactions to end-of-life care. Students who reported personal or professional experience with death had more positive attitudes and higher knowledge scores than those who did not, p = 0.05. Educational initiatives should maximize the time medical students spend caring for dying patients. Teaching students end-of-life care during the course of their clinical clerkships is an effective way to improve attitudes about end-of-life care. Schools should focus on developing emotionally supportive settings in which to teach students about death and dying.

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Medical students' first clinical experiences of death.

E Kelly, Jeff Nisker (2010)

Many medical students feel inadequately prepared to address end-of-life issues, including patient death. This study aimed to examine medical students' first experiences of the deaths of patients in their care. Final-year medical students at the Schulich School of Medicine & Dentistry, University of Western Ontario were invited to share their first experience of the death of a patient in their care. The students could choose to participate through telephone interviews, focus groups or e-mail. All responses were audiotaped, transcribed verbatim and analysed using a grounded theory approach. Twenty-nine students reported experiencing the death of a patient in their care. Of these, 20 chose to participate in an interview, five in a focus group and four through e-mail. The issues that emerged were organised under the overlying themes of 'young', 'old' or 'unexpected' deaths and covered seven major themes: (i) preparation; (ii) the death event; (iii) feelings; (iv) the role of the clinical clerk; (v) differential factors between deaths; (vi) closure, and (vii) relationships. These themes generated a five-stage cyclical model of students' experiences of death, consisting of: (i) preparation; (ii) the event itself; (iii) the crisis; (iv) the resolution, and (v) the lessons learned. 'Preparation' touches on personal experience and pre-clinical instruction. 'The event itself' could be categorised as referring to a 'young' patient, an 'old' patient or a patient in whom death was 'unexpected'. In the 'resolution' phase, coping mechanisms included rationalisation, contemplation and learning. The 'lessons learned' shape medical students' experiences of future patient deaths and their professional identity. A tension between emotional concern and professional detachment was pervasive among medical students undergoing their first experience of the death of a patient in their care. How this tension was negotiated depended on the patient's clinical circumstances, supervisor role-modelling and, most importantly, the support of supervisors and peers, including debriefing opportunities. Faculty members and residents should be made aware of the complexities of a medical student's first experience of patient death and be educated regarding sympathetic debriefing.

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Author and article information

Contributors

Claire Lewis: Claire.lewis@qub.ac.uk

Journal

Journal ID (nlm-ta): BMC Palliat Care

Journal ID (iso-abbrev): BMC Palliat Care

Title: BMC Palliative Care

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-684X

Publication date (Electronic): 2 August 2016

Publication date PMC-release: 2 August 2016

Publication date Collection: 2016

Volume: 15

Electronic Location Identifier: 67

Affiliations

[1 ]Northern Ireland Biobank, Queen’s University Belfast, Belfast, UK

[2 ]School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK

[3 ]School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK

Article

Publisher ID: 143

DOI: 10.1186/s12904-016-0143-2

PMC ID: 4969641

PubMed ID: 27484321

SO-VID: 2d0c2755-0fca-400a-9450-12dfc33f9090

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 9 February 2016

Date accepted : 27 July 2016

Custom metadata

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: nursing students,medical students,undergraduate,simulation,end of life,intervention,attitudes

Data availability:

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: nursing students, medical students, undergraduate, simulation, end of life, intervention, attitudes

The impact of a simulated intervention on attitudes of undergraduate nursing and medical students towards end of life care provision

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Background

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Conclusions

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Irish Journal of Paramedicine

Most cited references 21

Assessing nurses' attitudes toward death and caring for dying patients in a comprehensive cancer center.

Exposure to death is associated with positive attitudes and higher knowledge about end-of-life care in graduating medical students.

Medical students' first clinical experiences of death.

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