JOPHON NCPD (2024 May/Jun) Simulation, Storytelling, and Pediatric End of Life Care-JOPHON NCPD (2024 May/Jun) Simulation, Storytelling, and Pediatric End of Life Care

JOPHON NCPD (2024 May/Jun) Simulation, Storytelling, and Pediatric End of Life Care

Pdf Summary

This quality improvement project evaluated an evidence-based continuing professional development activity to better prepare newly licensed pediatric nurse residents to provide pediatric end-of-life (EOL) care, a role many feel unprepared for due to limited education and clinical exposure—especially in hematology/oncology settings.<br /><br />At a freestanding, magnet-recognized academic pediatric medical center in the northeastern United States, an interprofessional team embedded a high-fidelity EOL simulation module into a 12-month nurse residency program. The scenario involved a 5-year-old child with osteosarcoma nearing death, using a high-fidelity child mannequin and a standardized patient portraying the child’s mother. Learning goals included recognizing signs of imminent death, managing pain (including advocating for medication increases), communicating with and comforting the parent, and understanding postmortem nursing responsibilities. The module was structured as prebrief–simulation–debrief, with strong integration of storytelling and facilitated discussion informed by ELNEC pediatric curriculum principles.<br /><br />Thirteen nurse residents (within their first 6 months of practice) participated. Because residents were highly anxious and reluctant to volunteer for active roles, facilitators adapted the plan by expanding the prebrief into a broader educational session (lecture, Q&A, and storytelling). One resident performed the nurse role while others observed and contributed suggestions (“engaged observation”).<br /><br />Outcomes were measured using an author-developed knowledge/comfort tool (administered pre, immediately post, and 2 months post) and the Frommelt Attitudes Toward Care of the Dying (FATCOD) scale. Results showed improved EOL knowledge after the module, with some decline by 2 months. Comfort improved slightly on the project-specific tool, but overall attitudes/comfort measured by FATCOD remained essentially unchanged. Persistent challenges included talking about impending death and comforting family members.<br /><br />Participants reported positive perceptions of the simulation and desired more EOL education. The authors conclude that simulation paired with storytelling is valuable for teaching pediatric EOL care, but additional strategies and research are needed to meaningfully increase novice nurses’ comfort in this emotionally complex context.

Keywords

pediatric end-of-life care

nurse residency program

high-fidelity simulation

pediatric oncology nursing

hematology oncology setting

ELNEC pediatric curriculum

interprofessional education

communication with families

pain management advocacy

FATCOD scale