Nursing students' perspectives and learning experiences of participating in a palliative and end-of-life care simulation programme: A qualitative study

Background: Simulation-based learning has become an integral part of the nursing curriculum, allowing students to acquire clinical knowledge and relevant skills and apply them to real-life clinical encounters. However, little is known about the best practices in palliative and end-of-life care simulations. Objective: To explore the perspectives and learning experiences of undergraduate nursing students participating in a newly developed advanced practice nurse-led palliative and end-of-life care simulation program. Design: A descriptive qualitative study based on focus group discussions. Settings: A healthcare simulation centre at a university in Singapore. Participants: A purposive sample of 75 third-year undergraduate nursing students who had attended a palliative and end-of-life care simulation program. Methods: Eight face-to-face focus group discussions were conducted and audio recorded. Data were analysed using inductive thematic analysis. Results: Four themes encompassing 12 subthemes were derived: (1) Patient, family and caregiver needs during palliative and end-of-life care, (2) Nursing competencies in palliative and end-of-life care, (3) Experience of palliative and end-of-life care simulations and (4) Suggestions for future palliative and end-of-life simulations. The students expressed their support for including advanced practice nurses as facilitators and suggested the use of other simulation modalities such as virtual simulations to enable the participation of all students and provide a wider range of simulated scenarios. Conclusions: Simulation-based learning plays a crucial role in the palliative care curriculum. Clinical experts should be involved as facilitators to provide essential insights. It is also vital to consider students' prior experiences with death and dying, which may positively or negatively influence their palliative and end-of-life care competencies. Recommendations: Nursing schools should utilise clinical experts and other simulation modalities to improve students' learning experiences, provide more simulation experiences and overcome resource constraints such as limited curriculum time.