Using Qualitative Feedback to Adapt a Communication Simulation for Nursing Students and Novice Nurses.

Nurses and nursing students must be competent to provide quality care in a population with increasing serious illness needs. A significant gap exists in nursing education and professional development, in palliative care communication, and in its role in serious illness. Simulation-based education provides a dynamic, interactive platform to practice communication strategies in a safe setting. This paper describes how an established, standardized palliative communication simulation was adapted to fill curriculum gaps in prelicensure and nurse residency programs. The original simulation was adjusted to prelicensure students in an unfolding scenario in their third and fourth year of a 4-year prelicensure nursing program. Students practiced conversations about symptom management, advance directives, and advance care planning in their third year. In the students' fourth year, they use communication tools to discuss goals of care with the same patient they met the previous year. Key modifications from the original simulation included guided discussions based on a foundational article about palliative care concepts, as well as pre- and post-reflections on students' feelings about engaging in these conversations. The nurse residency program incorporated all phase 1 adaptations used in the prelicensure version. Data was gathered through a simple open-ended question, and results from students and nurse residents showed that they had less fear and anxiety about conversations and learned approaches to talking with patients. Implementing more palliative care training, including simulations, provides greater exposure to effective communication.