Is it time to change our approach to end of life education in undergraduate nursing?

This week’s EBN twitter chat on Wednesday 4th March between 8-9 pm (UK time) will focus on end of life education in undergraduate nursing. This week’s Blog has been written by Dr Claire Lewis from Queens University Belfast and provides some areas to think about ahead of the Twitter Chat. Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

Providing care to patients who are at end of life and their families is a known area of concern for undergraduate nursing students. Many have reported feelings of anxiety and emotional distress when faced with the experience of providing care to a dying patient (See Cooper and Barnett, 2005).

Despite these concerns, end of life care has traditionally been poorly delivered within undergraduate nursing curricula. Evidence suggests that nursing students and newly qualified nurses feel inadequately prepared to provide quality care to patients at end of life and support to their families (Cavaye and Watts, 2010). Many report concerns about knowing what to say to patients and their relatives; concerns about their own fears and reaction to death; and practical issues such as symptom management and care of the body after death.

Anecdotally, I know my own undergraduate nursing students share these concerns. On many occasions the subject of death and dying has been raised in class discussions and they are eager to ask questions about my own clinical experience of caring for people at end of life. We dedicate a substantial amount of our overall teaching hours towards end of life care, and the teaching format follows the traditional model of large group lectures followed by a small group tutorial sessions. However, it has been suggested in a review by Gillan et al (2014) that traditional didactic teaching formats such as large group lectures are not best suited to teaching end of life care as they do not provide an opportunity for students to reflect on their own experiences and concerns. Rather, students should be exposed to end of life care teaching methods which promote active and experiential learning. In short, more innovative ways of teaching. Innovative approaches to end of life education have included the use of cinemeducation (the use of film in teaching); storyboarding (narrative story telling); hospice volunteer programmes; problem based learning through case studies; and the use of high fidelity simulation.

My own recent area of interest and research is the use of high fidelity simulation to teach end of life care. It is generally accepted that increased exposure to patients receiving end of life care will improve students’ competence and confidence in delivering care to this patient group. However, many students may have limited opportunities in the course of their clinical placements to gain such experience. High fidelity patient simulation uses computerised manikins to simulate real life clinical scenarios. It has been demonstrated to provide experiences and educational outcomes comparable to that of clinical placement

High fidelity simulation allows students to develop their practice skills and improve their critical thinking and decision making in a safe and non-threatening environment. From the limited evidence available, end of life care simulation has been proposed as a viable teaching method given its positive impact on knowledge acquisition, communication skills, student satisfaction and level of engagement in learning. We plan to test this in our own School this year as an alternative method of delivering end of care education for both undergraduate nursing students and medical students.

As nurse educators it is imperative that we prepare students adequately for the delivery of end of life care given a negative first experience with death can impact greatly on a nursing student’s future practice (Terry and Carroll, 2008). Not only will this warrant confidence in their ability but it will also ensure patients and their families are afforded the highest standard of care at this highly emotive and sensitive time. After all, we only get one chance to get it right.

Questions to consider:

  • How can we adequately prepare students for their first experience of death?
  • How is end of life care best taught to undergraduate nursing students?
  • Are teaching methods such as simulation appropriate to deliver end of life education?


  • Cavaye, J. and Watts, J.H. (2010) End of life education in the pre-registration nursing curriculum. Journal of Research in Nursing, 17(4), p.317-326.
  • Cooper, J. and Barnett, M. (2005) Aspects of caring for dying patients which cause anxiety to first year nursing students. International Journal of Palliative Nursing, 11(8), p.423-430.
  • Gillan, P., van der Riet, P., Jeong, S. (2014) End of life care education, past and present: a review of the literature. Nurse Education Today, 34(3), p331-342.
  • Terry, L.M., Carroll, J. (2008) Dealing with death: first encounters for first year nursing students. British Journal of Nursing, 17(12), p.760-765


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