A Patient's Last Breath: An Analysis of Hospice Clinical vs. Hospice Simulation Experiences

2.50
Hdl Handle:
http://hdl.handle.net/10755/621473
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
A Patient's Last Breath: An Analysis of Hospice Clinical vs. Hospice Simulation Experiences
Other Titles:
Palliative Care Simulation
Author(s):
Jeffers, Stephanie M.
Lead Author STTI Affiliation:
Eta Beta
Author Details:
Stephanie M. Jeffers, PhD, MSN, BSN, RN, Professional Experience: 2012-present: Assistant Professor of Nursing, Widener University, Chester, PA 2006-2012: Adjunct Clinical Faculty, Villanova University, Villanova, PA 2008-2012: Staff Nurse, Oncology/Telemetry Unit, Paoli Hospital, Paoli, PA 2002-2008: Staff Nurse, Cardiopulmonary Unit, Taylor Hospital, Ridley Park, PA 1998-2002: Staff Nurse, Trauma/Orthopedic Unit, Crozer-Chester Medical Center, Chester, PA 1995-1998: Staff Nurse, Trauma/Orthopedic, Neurosurgical Unit, Medical College of PA Hospital, East Falls, PA 2011 National League for Nursing Jonas Scholar Principal Investigator four research studies Author of one research based publication, one innovative teaching strategy publication Numerous presentations at nursing research conferences Author Summary: Dr. Jeffers is an assistant professor of nursing at Widener University in Chester, Pennsylvania. She is also a scholar in Sigma Theta Tau’s Nurse Faculty Leadership Academy. The focus of her research is end-of-life nursing education, specifically focusing on pre-licensure students. Dr. Jeffers has presented on this topic at the international and national levels as well as published her research on end-of-life undergraduate education.
Abstract:

Purpose:

The literature has shown that registered nurses continue to feel inadequately prepared to address end-of-life issues, due to a lack of education on the process of dying and how to manage patient symptoms, cultural considerations and an awareness of their own attitudes and values about death (Al Qadire, 2014; Cui, Shen, Ma, & Zhao, 2011). In addition, pre-licensure nursing programs have been slow to integrate end-of-life care into their curricula. In those pre-licensure nursing programs that do offer courses on end-of-life care, student outcomes include positive attitudes toward dying patients and a positive influence on the students regarding the philosophy of palliative care, as the teaching strategies of the courses were geared toward the affective domain. Students who completed courses on end-of-life care reported feeling increased sympathy and empathy towards their patients, and they found an end-of-life care course to be an essential part of the nursing curriculum (Hold, Blake, & Ward, 2015). In several studies, students noted that the curriculum contributed to their personal and professional development (Ballesteros, Centeno, & Arantzamendi, 2014; Conner, Loerzel, & Uddin, 2014).

There is a dearth of research examining nursing students’ experiences in a hospice or palliative care unit. This may be due to several factors including barriers to acquiring hospice as a clinical site or assigning a dying patient to a student. These barriers may include staff, patient, family or faculty comfort level and/or lack of knowledge to teach end-of-life concepts (Doucette, et al., 2014; Jeffers, 2014).

This study had two purposes. The first was to compare two teaching strategies, hospice simulation and hospice clinical, to outcomes resulting from teaching undergraduate nursing students about end-of-life nursing care. The second purpose of this study was to strengthen understanding of the attitudes and perceptions of nursing students caring for dying patients and their families in both simulated and hospice clinical settings.

Methods:

This investigator used both descriptive comparative and qualitative descriptive designs. Fourth year nursing students enrolled in a Medical-Surgical Nursing III course participated in the study (n=151). Prior to the study, Institutional Review Board approval was obtained from the university and participants were provided with an informed consent form detailing the purpose of the study.

Data collection involved three instruments. First, the investigator used a demographic questionnaire developed by the principal investigator for this study to collect information such as the participant's age, gender, experience with caring for dying patients in a clinical setting, experience with the loss of a family member or friend, ethnicity and religion. Second, to assess student attitudes about providing care, the investigator administered the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) as a pretest prior to the simulation or clinical and a posttest after simulation or clinical. Finally, the investigator used a third instrument, a reflection journal administered before and after the hospice simulation or clinical experience. This reflection journal provided qualitative data pertaining to students' feelings and experiences related to the assigned teaching strategy.

Students were randomly divided into two groups: hospice simulation and hospice clinical. The students assigned to simulation participated in a scenario about an actively dying man in hospice. After the simulation, students were debriefed, explored their perceptions of end-of-life care and discussed their feelings regarding the simulation.

Participants in the hospice clinical experience attended a hospice clinical site, with an adjunct clinical instructor. The students participated in family planning meetings with the interdisciplinary team, communicated with patient, family and interdisciplinary team, and provided care for the dying patient as needed. The students debriefed about the experience in clinical post-conference.

Quantitative data analysis was conducted using descriptive statistics, including independent and paired t-tests. Thematic analysis of the reflection journals was conducted. Key phrases and themes were identified and the major themes were described.

Results:

Findings include changes in student attitudes towards the dying patient and end-of-life care, in both groups. Prior to the hospice simulation or clinical experience, students reported feeling anxious caring for a dying patient or a patient who has just died. After the hospice simulation or clinical, students reported feeling more comfortable discussing end-of-life preferences with the patient and interdisciplinary team. Thematic analysis of the qualitative data offers student insights about the care of a dying patient in both a clinical setting and a simulation setting.

Conclusion:

The results of this study demonstrate the benefit of a hospice clinical experience for pre-licensure nursing students which is supported by the literature (Chmura, 2016; Spicer, Heller, & Troth, 2015). The data support an improvement in overall attitudes towards the dying patient in both clinical and simulation settings. Students in both groups reported a preference for learning about end-of-life care in a clinical setting, rather than in a simulation. This study contributes to the advancement of nursing science and improvement of end-of-life care by highlighting an additional teaching strategy for end-of-life education. Further research is needed on the inclusion of hospice clinical settings for pre-licensure nursing students.

Keywords:
Clinical; End-of-Life; Simulation
Repository Posting Date:
12-Jun-2017
Date of Publication:
12-Jun-2017
Other Identifiers:
INRC17O11
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleA Patient's Last Breath: An Analysis of Hospice Clinical vs. Hospice Simulation Experiencesen_US
dc.title.alternativePalliative Care Simulationen
dc.contributor.authorJeffers, Stephanie M.en
dc.contributor.departmentEta Betaen
dc.author.detailsStephanie M. Jeffers, PhD, MSN, BSN, RN, Professional Experience: 2012-present: Assistant Professor of Nursing, Widener University, Chester, PA 2006-2012: Adjunct Clinical Faculty, Villanova University, Villanova, PA 2008-2012: Staff Nurse, Oncology/Telemetry Unit, Paoli Hospital, Paoli, PA 2002-2008: Staff Nurse, Cardiopulmonary Unit, Taylor Hospital, Ridley Park, PA 1998-2002: Staff Nurse, Trauma/Orthopedic Unit, Crozer-Chester Medical Center, Chester, PA 1995-1998: Staff Nurse, Trauma/Orthopedic, Neurosurgical Unit, Medical College of PA Hospital, East Falls, PA 2011 National League for Nursing Jonas Scholar Principal Investigator four research studies Author of one research based publication, one innovative teaching strategy publication Numerous presentations at nursing research conferences Author Summary: Dr. Jeffers is an assistant professor of nursing at Widener University in Chester, Pennsylvania. She is also a scholar in Sigma Theta Tau’s Nurse Faculty Leadership Academy. The focus of her research is end-of-life nursing education, specifically focusing on pre-licensure students. Dr. Jeffers has presented on this topic at the international and national levels as well as published her research on end-of-life undergraduate education.en
dc.identifier.urihttp://hdl.handle.net/10755/621473-
dc.description.abstract<p><strong>Purpose:</strong></p> <p>The literature has shown that registered nurses continue to feel inadequately prepared to address end-of-life issues, due to a lack of education on the process of dying and how to manage patient symptoms, cultural considerations and an awareness of their own attitudes and values about death (Al Qadire, 2014; Cui, Shen, Ma, & Zhao, 2011). In addition, pre-licensure nursing programs have been slow to integrate end-of-life care into their curricula. In those pre-licensure nursing programs that do offer courses on end-of-life care, student outcomes include positive attitudes toward dying patients and a positive influence on the students regarding the philosophy of palliative care, as the teaching strategies of the courses were geared toward the affective domain. Students who completed courses on end-of-life care reported feeling increased sympathy and empathy towards their patients, and they found an end-of-life care course to be an essential part of the nursing curriculum (Hold, Blake, & Ward, 2015). In several studies, students noted that the curriculum contributed to their personal and professional development (Ballesteros, Centeno, & Arantzamendi, 2014; Conner, Loerzel, & Uddin, 2014).</p> <p>There is a dearth of research examining nursing students’ experiences in a hospice or palliative care unit. This may be due to several factors including barriers to acquiring hospice as a clinical site or assigning a dying patient to a student. These barriers may include staff, patient, family or faculty comfort level and/or lack of knowledge to teach end-of-life concepts (Doucette, et al., 2014; Jeffers, 2014).</p> <p>This study had two purposes. The first was to compare two teaching strategies, hospice simulation and hospice clinical, to outcomes resulting from teaching undergraduate nursing students about end-of-life nursing care. The second purpose of this study was to strengthen understanding of the attitudes and perceptions of nursing students caring for dying patients and their families in both simulated and hospice clinical settings.</p> <p><strong>Methods:</strong></p> <p>This investigator used both descriptive comparative and qualitative descriptive designs. Fourth year nursing students enrolled in a Medical-Surgical Nursing III course participated in the study (n=151). Prior to the study, Institutional Review Board approval was obtained from the university and participants were provided with an informed consent form detailing the purpose of the study.</p> <p>Data collection involved three instruments. First, the investigator used a demographic questionnaire developed by the principal investigator for this study to collect information such as the participant's age, gender, experience with caring for dying patients in a clinical setting, experience with the loss of a family member or friend, ethnicity and religion. Second, to assess student attitudes about providing care, the investigator administered the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) as a pretest prior to the simulation or clinical and a posttest after simulation or clinical. Finally, the investigator used a third instrument, a reflection journal administered before and after the hospice simulation or clinical experience. This reflection journal provided qualitative data pertaining to students' feelings and experiences related to the assigned teaching strategy.</p> <p>Students were randomly divided into two groups: hospice simulation and hospice clinical. The students assigned to simulation participated in a scenario about an actively dying man in hospice. After the simulation, students were debriefed, explored their perceptions of end-of-life care and discussed their feelings regarding the simulation.</p> <p>Participants in the hospice clinical experience attended a hospice clinical site, with an adjunct clinical instructor. The students participated in family planning meetings with the interdisciplinary team, communicated with patient, family and interdisciplinary team, and provided care for the dying patient as needed. The students debriefed about the experience in clinical post-conference.</p> <p>Quantitative data analysis was conducted using descriptive statistics, including independent and paired t-tests. Thematic analysis of the reflection journals was conducted. Key phrases and themes were identified and the major themes were described.</p> <p><strong>Results:</strong></p> <p>Findings include changes in student attitudes towards the dying patient and end-of-life care, in both groups. Prior to the hospice simulation or clinical experience, students reported feeling anxious caring for a dying patient or a patient who has just died. After the hospice simulation or clinical, students reported feeling more comfortable discussing end-of-life preferences with the patient and interdisciplinary team. Thematic analysis of the qualitative data offers student insights about the care of a dying patient in both a clinical setting and a simulation setting.</p> <p><strong>Conclusion:</strong></p> <p>The results of this study demonstrate the benefit of a hospice clinical experience for pre-licensure nursing students which is supported by the literature (Chmura, 2016; Spicer, Heller, & Troth, 2015). The data support an improvement in overall attitudes towards the dying patient in both clinical and simulation settings. Students in both groups reported a preference for learning about end-of-life care in a clinical setting, rather than in a simulation. This study contributes to the advancement of nursing science and improvement of end-of-life care by highlighting an additional teaching strategy for end-of-life education. Further research is needed on the inclusion of hospice clinical settings for pre-licensure nursing students.</p>en
dc.subjectClinicalen
dc.subjectEnd-of-Lifeen
dc.subjectSimulationen
dc.date.available2017-06-12T19:35:01Z-
dc.date.issued2017-06-12-
dc.date.accessioned2017-06-12T19:35:01Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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