Effect of end-of-life care education on nursing students' knowledge, attitude, and self-efficacy

Abstract

Purpose Nurses experience insufficient preparation for dealing with the death of their patients (Ferguson & Cosby, 2017). For proper learning, it is necessary for them to expose to the clinical environment during end-of-life care education. However, It is difficult for students to have sufficient end-of-life care training during the clinical training period because of short clinical practice hours, difficulty to access to patients or caregivers in the dying situation, and hardship to guarantee opportunities to experience dying situations (Randall et al., 2018; Smith et al., 2018). Thus, this study aims to confirm the effects of an integrated end-of-life education program for nursing students. Methods This is a nonequivalent control group pre-posttest design study. The intervention group received both the web-based virtual simulation and a clinical case study seminar on end-of-life care, while the control group received only the web-based virtual simulation. In order to confirm the effect of the educational program, nursing students’ end-of-life care knowledge, attitude toward end-of-life care, and educational self-efficacy were measured and compared through a survey which conducted before and after the program. The analysis included a paired T-test, an independent T-test and a Spearman’s rank correlation test in order to compare changes in knowledge, attitude, and self-efficacy of the nursing students. Results and  Discussion The mean age of participants was 21.73 (SD=1.57), of which 86.7% were women. The satisfaction with the educational program was 3.93 (SD=0.73) in the intervention group and 3.75 (SD=0.86) in the control group. There were significant changes in the end-of-life care knowledge (p=0.003) and attitude (p≤0.001) toward end-of-life care in the intervention group. There was a significant difference only in end-of-life care knowledge (p=0.037) in the control group. Self-efficacy did not change significantly in either group, and each change did not show a significant correlation with satisfaction. Also, among each change, only the change in the end-of-life care attitude showed a significant difference between groups, and there was no significant difference in changes of end-of-life care knowledge and educational self-efficacy between both groups. The findings indicate that web-based virtual simulation alone may improve nursing students’ knowledge. However, it is not enough to bring changes in nursing students’ attitude out. Therefore, an integrated program that includes clinical components such as case studies may be necessary to improve nursing students’ knowledge, attitude toward end-of-life care and self-efficacy in providing care in clinical settings.