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In the past decade, innovative use of simulation has been transforming nursing education. Although simulation using human patient simulation (HPS) is a highly effective teaching strategy, gaps remain between the experiences that nursing education and simulation offer and what students and graduates encounter in the clinical environment. Nurse educators conducting research in simulation identified student-reported lack of preparation for end-of-life (EOL) care and patient deaths (Fluharty et al., 2012 ; Hamilton, 2010 ; Leighton, 2009 ; Leighton & Dubas, 2009 ; Robinson, 2004). A brief review of the recent simulation literature reveals multiple studies and reports of simulations in which the HPS dies in palliative care or hospice care, or scenarios in which the death is expected. The focus of these simulations is on assessment of the dying patient, comfort care, and therapeutic communication with the patient and family members. Leighton (2009) indicated that students express feelings of anxiety and lack of communication skills surrounding the death of a patient. Kopp and Hanson (2012) reported that students express a lack of preparation by the nursing curriculum for EOL care and a lack of opportunities in the clinical setting to increase their comfort in giving care to dying patients. Hamilton (2010) suggested that students need opportunities to increase coping strategies to decrease fear and anxiety when confronted with death and dying. Little information exists regarding EOL issues specific to unexpected death, the bearing of bad news, and postmortem care. Leighton and Dubas (2009) posited that nursing literature indicates a lack of education related to death and dying, resulting in unprepared students who will be called on to care for patients at the end of life sometime in their careers.
This EOL simulation was specifically developed for Competencies II, a front-loaded, skills-based course with both laboratory (1 credit) and clinical (1 credit) components. Competencies II is offered during the first semester of the junior year in a 4-year traditional baccalaureate nursing program and runs concurrent with students' first medical-surgical practicum. Students participate in three simulations over the course of the semester: (a) a medication administration simulation in week 2, (b) a blood transfusion reaction simulation mid-semester, (c) and this EOL simulation in the last week of the course. This simulation addresses the following main objectives that are...