Utilizing high‐fidelity simulation to improve newly licensed pediatric intensive care unit nurses' experiences with end‐of‐life care

Abstract

Purpose: New pediatric intensive care unit (PICU) nurses face distinct challenges in transitioning from the protected world of academia to postlicensure clinical practice; one of their greatest challenges is how to support children and their caregivers at the end-of-life (EOL). The purpose of this quality improvement project was to create, implement, and assess the efficacy of a high-fidelity EOL simulation, utilizing the "Debriefing with Good Judgment" debriefing model. Design and methods: Participants were nurses with 4 years or less of PICU experience from a 404-bed quaternary care, free-standing children's hospital in the northeastern United States. Data were collected with the Simulation Effectiveness Tool-Modified (SET-M) and the PICU EOL Simulation Evaluation Survey.Results: Twenty-four nurses participated; the majority (54%) were 25-29 years of age. The SET-M results indicate that the EOL simulation was beneficial to their learning and increased nurse confidence in delivering EOL care. Responding to the EOL Simulation Survey, participants rated high levels of confidence with tasks such as utilizing unit and hospital-based supports, self-care, ability to listen and support families, and medicating their patients at the EOL.Practice implications: This high-fidelity EOL simulation is a robust teaching tool that serves to support the unmet needs of the PICU nurses who care for dying children.Nurse participants had a unique opportunity to practice procedural and communication skills without risk for patient or family harm. Findings from this project can serve to guide curriculum changes at the undergraduate level as well as provide direction for new nurse orientation classes.

Exploring intensive care nurses' perception of simulation‐based learning: A systematic review and meta‐synthesis

“…Regular SBL sessions were seen to improve nurses' readiness and proficiency (Ballangrud et al, 2014), with the desire for increased duration and frequency of training attributed to the positive learning experience nurses commonly described experiencing during SBL (Ballangrud et al, 2014;Dante et al, 2022;Karlsen et al, 2021;Leclair et al, 2018). This aligns with best practice in nursing education, which recognises that frequent exposure to high-fidelity simulation significantly improves nurses' skill acquisition and maintenance (Anderson et al, 2019;Boling & Hardin-Pierce, 2016;Hardenberg et al, 2019Hardenberg et al, , 2020Hillier et al, 2022;Jung et al, 2023;Karageorge et al, 2020).…”

Effect of the Postoperative Pain Management Model on the Psychological Status and Quality of Life of Patients in the Advanced Intensive Care Unit

“…In addition, pain also affects the psychological reaction of patients, and patients with gastric cancer have various degrees of anxiety, depression, irritability, and other negative emotions, which not only directly affect the QOL of patients but also have a negative impact on the recovery of the disease. Hillier et al (2022) [30] found that pain control in postoperative gastric cancer patients was affected by a variety of factors, including patients' emotions, analgesic methods, ward environment, and management level of medical staff. At the same time, patients' attitude and cognitive level toward pain and analgesic drugs directly affect patients' ability to control pain and the nal analgesic effect.…”

Assessment of an Instrument to Measure Interdisciplinary Staff Perceptions of Quality of Dying and Death in a Pediatric Cardiac Intensive Care Unit

“… 46 Simulation training may better prepare staff with effective communication and clinical skills. 49 Finally, nursing and allied health staff may experience frustration about their limited role and participation in end-of-life decision-making. 23 , 41 , 44 Interdisciplinary team support and institutional practices including joint approaches to symptom control, routine team meetings, ethical competency training, and robust discussions sharing perspectives may overcome these challenges.…”

“…In response, international nursing organizations have emphasized importance of robust palliative care instruction in curricula . Simulation training may better prepare staff with effective communication and clinical skills . Finally, nursing and allied health staff may experience frustration about their limited role and participation in end-of-life decision-making .…”