A mixed-methods, multimodal approach was used to assess an undergraduate nursing students\u27 attitude towards the dying using a specifically designed lecture developed using the End-of-Life Nursing Education Consortium (ELNEC) competencies and an NLN ACE-s unfolding case study in simulation

Blumenfeld, Stephanie

Byrne, Deborah

Czekanski, Kathleen

Laske, Rita Ann

Overbaugh, Kristen J.

Wilby, Mary L.

English

Sigma Repository

45th Biennial Convention (16-20 November 2019)  Assessing Undergraduate Nursing Students' Attitude Toward the Dying Using an ACE-S Case Study in Simulation  Deborah Byrne, PhD, RN, CNE1 Kristen J. Overbaugh, PhD, RN, ACNS-BC, CHPN2 Rita A. Laske, EdD, MSN, BSN, RN, CNE3 Mary L. Wilby, PhD, RN, CRNP, ANP-BC3 Kathleen Czekanski, PhD, RN,CNE4 Stepahnie Blumenfeld, MSN, RN, CHsE3 (1)School of Nursing and Health Sciences, La Salle University, Philadlephia, PA, USA (2)School of Nursing, LaSalle University, Philadelphia, PA, USA (3)School of Nursing and Health Sciences, La Salle University, Philadelphia, PA, USA (4)School of Nursing and Health Sciences, LaSalle University, Philadelphia, PA, USA  Introduction Death is an inevitable part of life and nurses are frequently called upon to perform end-of-life (EOL) care. The American Association of Colleges of Nursing (AACN, 2016), National League of Nursing (NLN, n.d.), American Nurses Association (ANA, 2016), and the Institute of Medicine (IOM, 2008) agree that nursing education should prepare nursing students to manage and perform EOL care. Therefore, EOL education is imperative for undergraduate nursing students. The End-of-Life Nursing Education Consortium (ELNEC) was formed in 2000 to address deficits in nursing education concerning EOL. ELNEC has identified 15 competencies that are essential for undergraduate nursing students to achieve in order to provide quality care to the dying client (AACN, 2017). In 2017, the ANA and Hospice and Palliative Nurses Association published a Call for Action: Nurses Lead and Transform Palliative Care which recommended that ELNEC curricula be adopted as the standard for primary palliative care education for pre-licensure nurses. Primary palliative care includes care for the dying and support for grieving loved ones. Nurse educators need to identify effective strategies to integrate this content into existing undergraduate nursing courses. The use of simulation with standardized patients (SPs) and a high-fidelity mannequin is an effective strategy that could be integrated throughout the curricula to evaluate a student’s EOL skills (Jeffries, 2012). The purpose of this study was to examine differences in attitudes of sophomore level undergraduate nursing students in caring for a dying patient before and after a multimodal educational experience consisting of lecture and an unfolding case study presented as part of a simulation experience. Methods A quasi-experimental, pretest/posttest design with a convenience sample was used for this study. The study was conducted as part of a Foundations of Professional Nursing course taught in the second semester of sophomore year at a private university in the eastern region of the United States. Students were required to participate in a lecture and simulation as part of the course and clinical requirements. Participation in the study was voluntary. Of the 58 students enrolled in this cohort, 54 students agreed to participate in the study. The study was reviewed by the university’s institutional review board. Frommelt’s Attitudes Towards Care of the Dying (FATCOD) version A was used to measure attitudes towards care of the dying patient pre and post educational intervention. A Cronbach α co-efficient of .79 on the pretest and .84 on posttest suggests good internal consistency for this instrument. In addition to quantitative measurement of attitudes, qualitative measurement was obtained through analysis of three open-ended questions completed by participants. The three questions included: How did the educational experience prepare you for caring for a dying client?; What part of the experience had the greatest impact on you?; and What else do you feel you need to help you become more confident in caring for a dying client and their family? Content analysis was conducted by two members of the research team. Data were read several times by each researcher to ascertain patterns of ideas. The two researchers worked independently to develop codes and to the development of themes. Researchers participated in consensus procedures throughout this process to clarify discrepancies and facilitate accurate interpretation of data. Procedure Students participated in an interactive lecture which incorporated content from the ELNEC modules that addressed hospice and palliative care, caring for the dying patient, grief loss, and bereavement, and communication. Faculty presenters had expertise in palliative and hospice care and had received training to facilitate ELNEC courses. Prior to this lecture, students received information about the study and had an opportunity to review the informed consent form. Students were informed that while the participation in the lecture and simulation was a course requirement, participation in the study was voluntary. Over the remaining weeks of the course, students participated in a simulation experience focused on end of life care. The simulation was adapted from the National League of Nursing’s (NLN) Advanced Care Excellence for Seniors (ACE-S) simulation scenario on end of life care. The simulation was conducted in the university’s Interprofessional Simulation Center. The simulation focused on providing care and support to a dying female client and her partner. A high-fidelity simulator was used for the client and an SP played the role of the client’s partner. After the simulation, the participants were debriefed by the simulation coordinator and the SPs. Debriefing allows the participants the opportunity to reflect on their actions, feelings, and reactions to the experience (Dreifuerst, 2012). The students completed the demographic questionnaire, post-test instrument, and open-ended questionnaire after the debriefing. Results Descriptive statistics showed participants (N = 54) were between the ages of 18-27 years. Of the 54 subjects, the majority was female (42%), Catholic (64.7%), and most were Caucasian (74.5%). The FATCOD pretest mean was 118.23 (SD ± 9.9; range 30 – 150) and the posttest mean was 123.92 (SD ± 10.7; range 30-150). A paired t-test revealed a statistically significant difference between the pretest and posttest (p = .003), suggesting that students gained a more positive attitude towards caring for the dying client. Content analysis of the open-ended questions revealed three themes for the first question including: knowing what to say and how to offer presence, becoming emotionally prepared, and learning skills to comfort. The second question identified four elements of the study students felt had the greatest impact including: the crying family member (patient and/or family’s emotions), communicating death (to spouse or patient), debriefing, and consoling family. The third question revealed three things the students felt they would need to increase their confidence in caring for a dying patient including: more experience, practice caring in death and dying situations, and more EOL simulation. Discussion It is imperative that EOL care be integrated into undergraduate nursing education. Leading bodies of nursing have called for an increase in educating nursing students on EOL care. This study examined a multimodal approach to EOL care including a specifically designed lecture and simulation. Results of the study revealed a statistically significant increase in students’ attitudes towards caring for the dying client following lecture and simulation. In addition, qualitative results showed the positive impact students revealed following these educational strategies.   Title: Assessing Undergraduate Nursing Students' Attitude Toward the Dying Using an ACE-S Case Study in Simulation Keywords: End-of-life care, Nursing Education and Simulation References: American Association of Colleges of Nursing. (2016). CARES: Competencies and recommendations for educating undergraduate nursing students: Preparing nurses to care for the seriously ill and their families. Retrieved from http://www.aacnnursing.org/Portals/42/ELNEC/PDF/New-Palliative-Care-Competencies.pdf  American Association of Colleges of Nursing. (2017). End-of-Life nursing education consortium (ELNEC) fact sheet. Retrieved from https://www.aacnnursing.org/ELNEC/About  American Nurses Association. (2016). Nurses’ Roles and Responsibilities in Providing Nurses’ Providing Care and Support at the End of Life. Retrieved from https://www.scribd.com/document/366570957/EndofLife-PositionStatement-ANA  American Nurses Association. (2017). Call for Action: Nurses Lead and Transform Palliative Care. Retrieved from https://www.nursingworld.org/~497158/globalassets/practiceandpolicy/health-policy/palliativecareprofessionalissuespanelcallforaction.pdf   Dreifuerst, K.T. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, 6, 159 - 166.  Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Washington, DC: National Academies Press.  Jeffries, P. (2012). Simulation in nursing education: From conceptualization to evaluation. (2nd ed). New York, NY: National League of Nursing.   National League of Nursing (n.d.). NLN Advancing Care Excellence for Seniors. Retrieved from http://www.nln.org/professional-development-programs/teaching-resources/ace-s/development-history  Abstract Summary: A mixed-methods, multimodal approach was used to assess an undergraduate nursing students' attitude towards the dying using a specifically designed lecture developed using the End-of-Life Nursing Education Consortium (ELNEC) competencies and an NLN ACE-s unfolding case study in simulation.  Content Outline:  I. Introduction A. Importance of quality end-of-life (EOL) care B. Leading bodies of nursing position on EOL care in undergraduate nursing education. C. Purpose of the study - to examine differences in attitudes undergraduate nursing students in caring for a dying patient before and after a multimodal educational experience consisting of lecture and an unfolding case study presented as part of a simulation experience.  II. Methods A. Mixed methods, quasi experimental, pretest/posttest design B. IRB approval C. Informed consent D. Tools a. Frommelt’s Attitudes Towards Care of the Dying (FATCOD) version A b. Open-ended survey c. Demographic questionnaire III Procedures A. Multi-modal approach a. A specifically designed lecture based on the End-of-Life Nursing Education Consortium (ELNEC) competencies. b. A simulation adapted from the National League of Nursing’s (NLN) Advanced Care Excellence for Seniors (ACE-S) simulation scenario on end of life care. IV. Results A. Demographic results a. Participants (N = 54) were between the ages of 18-27 years. Of the 54 subjects, the majority was female (42%), Catholic (64.7%), and most were Caucasian (74.5%). B. Statistical significance on the FATCOD questionnaire. a. A paired t-test revealed a statistically significant difference between the pretest and posttest (p = .003), suggesting that students gained a more positive attitude towards caring for the dying client. C. Content analysis on open-ended survey a. Various themes were revealed to show the positive impact of this multi-modal approach to EOL education. III. Discussion A. Limitations of the study a. Convenience sample b. Small sample size B. Significance of the results a. The benefit of a multi-modal approach to educating undergraduate students on EOL care. C. Future implications a. Seeking opportunities in undergraduate education to expose and educate students on EOL care.  First Primary Presenting Author Primary Presenting Author Deborah Byrne, PhD, RN, CNE La Salle University School of Nursing and Health Sciences Assistant Professor Philadelphia PA  USA  Author Summary: Deborah is an assistant professor at La Salle University teaching in the undergraduate nursing program. Deborah has been trained at Drexel University in simulation and is a strong advocate for simulation at La Salle University. Deborah teaches in introduction to nursing, fundamentals, and adult health nursing courses. Her research interests include: cultural competence, chronic illness, end-of-life care, caring, simulation, health disparities, and curriculum development. Second Secondary Presenting Author Corresponding Secondary Presenting Author Kristen J. Overbaugh, PhD, RN, ACNS-BC, CHPN LaSalle University School of Nursing Assistant Professor Philadelphia PA  USA  Author Summary: Dr. Kristen Overbaugh is an assistant professor of nursing at LaSalle University in Philadelphia, PA. She is board certified as an adult health clinical nurse specialist and as a hospice and palliative care nurse. She has over 20 years of experience working in practice, educator, and leadership roles. Her research focuses on heart failure, palliative care, caregiving, and improving psychosocial outcomes for individuals living with chronic illness and their family members. Third Author Rita A. Laske, EdD, MSN, BSN, RN, CNE La Salle University School of Nursing and Health Sciences Assistant Professor Philadelphia PA  USA  Author Summary: Rita Ann Laske has been a clinical educator for over 10 years. Her special areas of interest are clinical evaluation, camp nursing and adult medical surgical nursing. She currently is an assistant professor at La Salle University in Philadelphia, Pa. She teaches clinical, lab, and classroom for undergraduate nursing students. Fourth Author Mary L. Wilby, PhD, RN, CRNP, ANP-BC La Salle University School of Nursing and Health Sciences Assistant Professor Philadelphia PA  USA  Author Summary: Dr. Wilby is an Assistant Professor and coordinator of the Nurse Practitioner programs at La Salle University. Her interests promoting cultural diversity in nursing, qualitative research and the experiences of nursing students led to the study presented. Fifth Author Kathleen Czekanski, PhD, RN,CNE LaSalle University School of Nursing and Health Sciences Director, RN-BSN and Graduate Nursing Programs Philadelphia PA  USA  Author Summary: Dr. Kathleen Czekanski is an experienced educator who holds a PhD in Nursing from Duquesne University. She attended End-of-Life Nursing (ELNEC) training in 2000 and received the ELNEC Education Consortium Award from the AACN in November 2002 for acknowledgement of the creative and innovative implementation of the ELNEC curriculum. Dr. Czekanski has published in the areas of end of life care, strategies to improve the dementia caregiving experience, and educational strategies to improve curricular outcomes.  Sixth Author Stepahnie Blumenfeld, MSN, RN, CHsE La Salle University School of Nursing and Health Sciences Director, Interprofessional Simulation and Learnig Center Philadelphia PA  USA  Author Summary: Stephanie Blumenfeld is the Coordinator of the Interprofessional Simulation Center at La Salle. Stephanie has over 10 years of experience and works closely with course faculty to integrate Human Patient Simulators into the assessment processes throughout the curriculum. She supports the development of a research infrastructure in the Center. She holds a Master’s Degree in Nursing Administration from La Salle University, Certificate of Simulation from Drexel University,and Clinical Simulation Certification from University of Southern Indiana. 

Assessing undergraduate nursing students\u27 attitude toward the dying using an ACE-S case study in simulation

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Assessing undergraduate nursing students\u27 attitude toward the dying using an ACE-S case study in simulation

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