Graduation Year

2022

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Nursing

Major Professor

Laura Szalacha, EdD

Co-Major Professor

Hsiao-Lan Wang, PhD, RN, CMSRN, ACSM EP-C, FAAN

Committee Member

Harleah Buck, PhD, RN, EPCN, FAAN

Committee Member

Michelle Canale, DNP, CRNA, ARNP

Committee Member

Janet Roman, DNP, APRN, ACNP-BC, CHFN, ACHPN

Keywords

Debriefing, Emotional Competence, Experimental Learning, Healthcare Student, Palliative Care

Abstract

Dealing with dying patients or experiencing the death of a patient is one of the most challenging aspects for nursing students. When they enter the workforce, they will be confronted with emotional challenges when caring for terminally ill patients and the intense emotions of bereaved family members. The complexity of end-of-life (EOL) care, with patients and their families, requires emotional intelligence (EI). In EOL care, an emotional piece of information can act as an essential source of information. Simulation has been a successful teaching method to improve emotional learning outcomes among nursing students. The emotionally charged EOL care simulation, and the students’ raw emotions after being in the simulation, creates a suitable environment for emotional learning. It is there where they are prompted to explore their EI in order to display emotional competence. Self-reflection through debriefing, which is considered when most of the learning happens in a simulated experience, can improve EI abilities. The purpose of this research was to pilot-test the effectiveness of an EI-driven EOL care simulation (EI-EOL-SIM) that contained an EOL scenario, followed by debriefing with EI abilities. The first aim was to identify the current state of science in simulation intervention components and emotional outcomes in randomized controlled trials that use simulation to train health care professionals and students for EOL care. The second aim was to pilot-test the quantitative effects of an EI-EOL-SIM intervention on EI, empathy, and attitude toward care of the dying among undergrad nursing students. The third aim was to qualitatively examine undergraduate nursing students’ perceptions and experiences of participating in the EI-EOL-SIM intervention. In the literature review, Arksey and O’Malley’s (2005) framework and the preferred reporting items for scoping reviews were used. Eleven studies which included EOL care simulation interventions and outcomes for promoting emotional competence were identified. Gaps concerning the effectiveness of post-simulation debriefing and using theoretical models were discussed. The quantitative component used a one-group pretest–posttest design. Fifty-six nursing students participated in the study. The results of this pilot study confirmed that the EI-EOL-SIM intervention significantly improved the students’ levels of EI, empathy, and attitude toward care of the dying after the intervention. The study concludes that EOL care simulation should include content on EI to offer students the opportunity to improve their EI, empathy, and attitudes in EOL care. Giving students the opportunity to improve their EI can ensure not only the recruitment and retention in sensitive areas of nursing practice but also the quality of care delivered to patients and their family members at EOL. The study has implications for other nursing specialties, healthcare professionals, and clinical settings. The qualitative component used a qualitative descriptive design with a focus group method guided by semi-structured questions. Fifteen students participated in four focus groups. The following are some of the themes identified: a) caught me by surprise: unexpected/realistic; b) finding balance: physical needs vs. emotional needs; c) emotional fidelity: simulated patient vs. high-fidelity manikins; d) growing emotionally as a group; e) the four abilities of EI; f) being emotionally available; and g) compassion fatigue. Debriefing with EI abilities was perceived as a good practice to help nurses improve their EI and overcome compassion fatigue. Developing EI abilities among nursing students can ensure their readiness while improving their emotional competence, attitudes, and self-care behaviors. The study highlighted several simulation strategies to make the EI-driven EOL care simulation more effective. Understanding the role of emotions in EOL care at an early stage of nursing education is important for a healthy, sustainable workforce.

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