Implementation and Evaluation of an End-of-Life Standardized Participant Simulation in an Adult/Gerontology Acute Care Nurse Practitioner Program

This episode of NLN Nursing EDge Unscripted features guests Shannon Daly, Sterling Roberts, and Lawanda Greene. Learn more about their work, “Implementation and Evaluation of an End-of-Life Standardized Participant Simulation in an Adult/Gerontology Acute Care Nurse Practitioner Program.”

Daly, Shannon; Roberts, Sterling; Winn, Sheryl; Greene, Lawanda. Implementation and Evaluation of an End-of-Life Standardized Participant Simulation in an Adult/Gerontology Acute Care Nurse Practitioner Program. Nursing Education Perspectives 45(3):p 172-173, 5/6 2024. | DOI: 10.1097/01.NEP.0000000000001167

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Transcript

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Welcome to this episode of the NLN podcast Nursing EDge Unscripted. I'm your host,  Dr. Steven Palazzo, a member of the NLN editorial board for the Nursing Education Perspectives  journal. In this episode we will discuss the impact of an end-of-life simulation on graduate  students anxiety and self-confidence. The article we will be discussing is titled "Implementation  and Evaluation of an End-of-Life Standardized Participant Simulation in Adult Gerontology Acute  Care Nursing Practitioner Program." The article can be found in the May-June issue of Nursing  Education Perspectives. The authors of the article are joining us for today's discussion. Dr. Shannon  Daly, associate professor of nursing at Middle Georgia State University. Dr. Sterling Roberts,  associate professor nursing and director of the Simulation and Translational Research Center at  Georgia College at State University. Dr. Lawanda Greene, director nursing at the Fort Valley State  University. Welcome all of you. Thank you. Well let's, you're welcome. Let's get right into the  article. So tell us a little bit about what got you interested in this topic and how it led to  your study. So I have always had a passion for end-of-life and palliative care as it relates  to patients and family members and I'm also aware that as a nurse I was aware of my lack  of comfort when handling situations that related to terminal illness and communicating to patients  about that. And so my goal was to work with an institution that would allow me to incorporate  those concepts into the into their curriculum and so Dr. Lawanda Greene, who at the time was the  program chair of an adult gerontology acute care nurse practitioner program. She recognized that  there was a gap in the graduate curriculum in her program and there was also a need to meet  that accreditation requirement. And so from there we just began to fill that gap that we  identified in the curriculum. And that's what led us to implementing that end-of-life simulation  program into the adult gerontology acute care nurse practitioner program. That's great. Tell  us a little bit about the study specifics. Okay. So a little overview. Yeah or the methodology. So what we did was we actually the study was actually conducted at a university in the  southeast here in Georgia and we identified that there was a need. And so our steps were to one,  implement an end of life simulation into the program and we wanted to use standardized  patients. This was my doctoral project and so I could have paid for actors but instead I recruited  undergraduate nursing students because that was also going to be an opportunity for them to learn.  Oh that's great. And so we recruited undergraduate nursing students to be those standardized actors  and we put them through a standardized participant training for them to be prepared for that process.  And so we prepared our standardized patients which were the undergraduate nursing students  and we had our students actually participate in one group, they participated in a pre-test  and post-test study that evaluated their comfort levels when incorporating or when participating  in that simulation. That's great, thank you. Can you guys discuss why you chose the end-of-life  nursing education consortium curriculum as the intervention and the nursing anxiety and  self-confidence with clinical decision-making scale to measure impact? Okay, We're trying  to explore using psychometrics and tools more too so I thought this was a great opportunity,  this article, to kind of discuss that. All right, sure. So I was Dr. Daly's chair and  when she brought this idea that her and Dr. Greene had, we wanted to do it off of a program that was  already well established, well-founded. So ELNEC answered that call. You know,  it's been around since 2000 Dr. Betty Ferrell and her colleagues with the City of Hope originally  developed this for the health care professionals that are already out there practicing  but however it formulated over time and expanded into academia and supporting the educational  efforts of nursing students at various degree levels. So that is where we started out with okay  ELNAC, this is going to really fit what we're trying to establish here. It's a six module  program. It touches on all those things that Dr. Daly has talked about that are really hard to  deal with when you have a patient that's dying with palliative care. The symptom management,  the ethical-legal dilemmas that come along, cultural considerations that vary between  patients and communicating and dealing with the grief process not only the patient but their  significant others as well. So it was a very robust program training program and Dr. Daly  was very committed to it and she went through the program herself and became the train the trainer  so she was in the perfect position to pass this education on to her students. That's wonderful.  And the tool to measure? So the nursing anxiety and self-confidence with clinical decision-making  tool I did discover, well, I will say that when you think about your project you ask yourself,  what what do I want to get out of this? Snd I did want to see if that ELNEC portion of  communication, if that portion of didactic would be effective and what an impact learning about communication would have as it relates to anxiety and self-confidence. And so Dr. Krista White,  who actually she developed this tool from Georgetown University's School  of Nursing and Health Sciences and I did get her permission to use it but it was the perfect tool to utilize when trying to determine, hey, are students comfortable when communicating  with patients about terminal illness? Do they have the self-confidence and will it change and make an impact in their anxiety levels? So it was the perfect tool to measure what we were trying  to discover. And you didn't find any changes in anxiety levels or correlation between years  of experience and self-confidence. Do you have any explanation for why you didn't see that or  why that may be? I thought it was curious. Yeah. Well I will say that what the study identified  was I think what we all kind of understood that there is a certain level of anxiety that one may  experience when they're discussing terminal illness and end of life to patients. So to  not have a change in their anxiety levels, it made sense to us. We understood that finding. We also were able to identify that this just goes along with our purpose here that there needs to  be more training. And not just graduate programs, undergraduate programs and even when they become nurses to continue that training because regardless of the amount of years of  experience that you have there is a level of discomfort that you may have if you are not  comfortable or trained to communicate effectively with those family members and patients. Yeah,  I enjoyed that statistic, thinking that with more experience perhaps maybe there was more comfort  or less anxiety and when you're dealing with something like end of life it seems that there's  still some discomfort there even those who may be seasoned or experienced in this area. And is it  the nature of the environment they're working in or is it because they still maybe this training  that you were talking about would be helpful. I would say when we looked at the participants and  where they worked a lot of them were emergency room nurses or ICU nurses and still they felt  a sense of anxiety and they felt a sense of discomfort. And so that again shows that that  environment is known to have an increased possible level of ... they experience terminal illness or  death a little bit more frequently than someone who may work in a different setting. And they  too still were uncomfortable with the topic. What are your next steps? So actually and Dr. Greene  can talk more on this, although this study was done with graduate nurse practitioner students,  Dr. Greene and I have actually been working with her undergraduate nursing students at Fort Valley  implementing end of life standardized participant simulations into her curriculum. And I think that  when we first started talking about this I knew that this was a big deal because we were looking  at the competencies for adult gerontology care nurse practitioners who primarily work in the  acute care setting, critical care, and they see a lot of death and dying. But that like Dr. Daly was  saying, the comfort with talking to people about end of life care and who should do it - should it  be a chaplain talking to the family, should it be the nurse, should it be the physician, the nurse  practitioner? And these students need that type, like we would saying, that type of training. I  feel like it needs to start at the undergraduate level. When we did an initial run with this a  couple months ago with our BSN students we had one students say, well, we usually have a nurse to do  this. I'm like, that's the role you're stepping into! Yes. And whether you like it or not,  you're gonna see a lot of death and dying with all these different disease processes that are going  on in the light of Covid it's ... you're going to see it and it's just a matter of time when you see  it. so being prepared to talk to families and to just they say more than I understand because  you really don't. You don't understand. You may can sympathize with them if you've been through  similar situations but you don't understand where they're coming from. so that listening,  being empathetic, and knowing what not to say that may trigger somebody to go into a tail spin is a  big deal. starting early and getting them on board with this would be great. I think that's  wonderful. I think all undergraduate programs should have some simulation built in that's  about end of life or palliative care. I think it's very helpful for the students. We used to do it at  a university I worked at previously and I know we're talking about doing something like that in  our new undergraduate curriculum that's beginning this fall. So go ahead. I was just gonna say also  I'm doing a interdisciplinary collaboration project with the respiratory therapy program  and we're going to actually try, we are going to actually implement terminal weaning with our  respiratory students and incorporating the role that nurses have and getting them comfortable with  collaborating during that end of life process and so I'm excited about that as well. It just shows  the passion that we all have when it comes to end of life. Dr. Roberts and her simulation experience  giving us the guidance to follow the simulation guidelines accurately to make sure we meet our  outcomes. We definitely have a desire to implement this in our own individual programs and let it be  something that's continuous. As Dr. Greene stated, it has to start with our undergraduate students,  making sure that they're comfortable and they we start with simulation because that's  a safe environment for them to begin with such a difficult situation and difficult conversation. So  is it accurate to say we should be expecting some new research data to come out from  your team? It's accurate to say you'll see one our names, each of our names on some form of research  related to either end of life simulation or palliative care. That is true. Great. I'm  looking forward to that. What's your takeaway messages you want to leave the audience with?  I definitely will highly encourage all nursing institutions, nursing schools to implement end  of life and palliative care into their curriculum somehow. ELNEC was the perfect way to do that. It  covers six domains related to end of life nursing education consortium and I just highly recommend  all programs to find a way to implement end of life into the curriculum and add simulation to  give that real world safe experience on how to effectively communicate during those difficult  times. And another component to that is looking at spirituality and how that plays a role into this  as well because a lot of people depend on their spirituality. I don't like to  use religion because religion is just a set of principles that a group of people follow,  but everybody has some type of spirituality so that needs to be incorporated as well and how  it plays a role into end of life care, advanced care planning, palliative care, so that's what  I'm working on right now. So hopefully that will be something that will be up and coming and that  we're going to incorporate in this curriculum here at Fort Valley State as well. We have  in the life one two and three so we're going from med-surg one to med-surg three with some  component of end of life. Oh that's really good. And might I add diversity and inclusion because  in our study we actually had the standardized participants, which were our undergraduate  students, we based on how many participants we had and with their permission the participants  were either a male and female or female male and female and so that diversity and inclusion to give  them comfort about end of life and dealing with different family dynamics that was really a good  aspect of the study as well. Simulation is so rich in enabling us to all offer multiple perspectives  and be very dynamic in you know our scenarios which is just great. Well I want to thank you  all for joining us for this really interesting and very important I think conversation.  I appreciate your time and your expertise in helping us better understand your research  and this topic. And to our listeners, if you have not had the opportunity,  please look for this article in the May-June issue of Nursing Education Perspectives, "Implementation  and Evaluation of an End-of-Life Standardized Participant Simulation in an Adult Gerontology  Acute Care Nursing Practitioner Program." I got it out almost in one breath. And again,  I want to thank you all for joining us. Very much appreciated. Thank you. Thank you. Thank you.[Music]