End-of-life Simulation

Submitter Information

Author: Carla Hunt, RN, MSN
Title: Clinical Instructor
Institution: Mercy College of Nursing Health Sciences Southwest Baptist University
Email: carla.hunt@mercy.net

Competency Category(s)
Patient-Centered Care, Safety, Teamwork and Collaboration

Learner Level(s)
Pre-Licensure ADN/Diploma

Learner Setting(s)
Skills or Simulation Laboratories

Strategy Type

Learning Objectives

At the completion of this end-of-life simulation, the learner will be able to:
1. Perform a physical assessment and analyze the findings to manage end-of-life symptoms;
2. Practice therapeutic support and compassionate end-of-life communication;
3. Assess spiritual needs and provide culturally sensitive nursing care;
4. Demonstrate a patient and family-centered approach to care;
5. Analyze the completed advanced directive and advocate to uphold the patient’s wishes;
6. Utilize nursing process to develop an individualized plan of care;
7. Evaluate personal beliefs and values that influence a nurse’s ability to provide care to the dying;
8. Perform the nurse-to-nurse death verification and death documentation utilizing a standardized expiration checklist.
9. Demonstrate post mortem care and safe handling precautions;
10. Practice interdisciplinary collaboration as death approaches and at the time of death.

Strategy Overview

The End-of-Life (EOL) simulation occurs in a simulation lab and is intended to facilitate clinical correlation to oncology, palliative, and end-of-life content presented in the third semester classroom. Required pre-assignments are EOL lecture attendance or power point review, completion of Caring Conversations of Young Adults (2012), and review of the journal article, Preparation and care at the time of death: Content of the ELNEC curriculum and teaching strategies by Sherman, Matzo, Ferrell, and Malloy (2005). In the EOL simulation, student groups of two rotate in and out of the simulation to perform a physical assessment, compassionate comfort care, effective communication, interdisciplinary collaboration, and post-mortem care. Students demonstrate physical assessment for a non-responsive patient and perform post mortem care on the female Sim Man manikin. Students demonstrate compassionate comfort care and effective communication through interaction with the Sim Man manikin and a live patient’s mother that is role played by a faculty member. Communication with the live patient’s mother is scripted to facilitate confidence and competence in EOL skills. Students demonstrate interdisciplinary collaboration through telephonic communication with a second faculty member acting out the role of interdisciplinary team members. An observer faculty member remains with the students to takes notes and be present for the debriefing session. The simulation is intended to run 45 minutes and then a 15 minute emotional break is provided before students proceed to the 60 minute debriefing session.

Submitted Materials

134.LIVING-WILL-DECLARATION-OF-Doris-Says.docx
134.Sim-Doris-Say.docx
134.Sim-Doris-Say-CAT-scan.docx
134.Sim-Doris-Say-H-and-P.docx

Additional Materials

Read the journal article: Sherman, D. W., Matzo, M. L., Pitorak, E., Ferrell, B. R., & Malloy, P. (2005). Preparation and care at the time of death: Content of the ELNEC curriculum and teaching strategies. Journal for Nurses in Staff Development, 21(3), 93-100.
Complete the Caring Conversations for Young Adults available via web link http://www.practicalbioethics.org
Read the Missouri Advance Directive available via web link http://www.caringinfo.org/files/public/ad/missouri.pdf

Evaluation Description

This simulation was utilized during the Spring 2013 semester with third semester students after presentation of the oncology course content. Nine clinical groups participated in the EOL simulation. Student feedback indicated the simulation fostered a positive learning experience through an interactive approach to EOL communication. A live faculty member used to role play a grieving mother was positively received by students. Faculty observers and the debriefing faculty member reported the simulation was well organized, had good flow, and facilitated the necessary end-of-life competencies. The final page of the simulation includes an evaluation tool for students to complete following the simulation.