Prestigious Josiah Macy Jr. Foundation President’s Grant to Expand End-of-Life Simulation for Nursing and Medical Students
Faculty researchers from Kent State University’s College of Nursing were recently funded by the prestigious Josiah Macy Jr. Foundation with a yearlong President’s Grant award totaling $35,000. The goal of their study is to help ensure the competencies of new healthcare providers to facilitate vital family communication at the end of life.
The Kent State researchers are Dana Hansen, Ph.D., APRN, ACHPN (principal investigator), Tracey Motter, DNP, RN (co-investigator), and Jennifer Shanholtzer, MSN, Ph.D. candidate, RN, CHSE (simulation lab coordinator). Their study, Catalyzing Relationships at the End of Life (CAREol) Program, will be conducted in collaboration with Northeast Ohio Medical University (NEOMED). Additional members of the research team include Mariquita Belen, M.D., Margy Sanders, LSW, and Julie Aultman, Ph.D., from NEOMED; Maureen Keeley, Ph.D., communications studies professor from Texas State University and final conversation researcher; and David Smeltzer, Associate Professor Emeritus from Kent State’s School of Media and Journalism.
Currently, undergraduate nursing students participate in an end-of-life simulation featuring student actors in the roles of patients and family members. Hansen explained that while this simulation is valuable, the team’s study will help to expand this experience and provide students with an opportunity to develop additional end-of-life communication skills through learning final conversations. Furthermore, the partnership with NEOMED will create a new interprofessional experience for both medical and nursing students.
Hansen shared that final conversation training will also be provided to clinical faculty.
“While the present simulation focuses on communication, it’s communication from the provider to the patient and their family,” she explained. “The purpose of final conversations is to bring the patient and family together at the end of life, a time when many families actually struggle connecting with one another. When a provider can assist the family in connecting, it helps to facilitate a more peaceful death for the patient and effective grieving for the family when the patient is gone. Additionally, when providers are educated in this type of end-of-life communication, it decreases their distress about the situation and therefore increases their resiliency.”
The simulation will feature a hybrid experience of online modules to provide cognitive content for final conversations and family relationships at the end of life, followed by an in-person experience with student actors. Smeltzer will develop role modeling vignettes for the online modules that demonstrate final conversation themes. These vignettes will include scenes depicting vital interactions in which a final conversation should have taken place.
Kent State nursing students will travel to NEOMED in nearby Rootstown, Ohio, for the expanded simulation at the end of Spring Semester 2021.
“NEOMED has a beautiful facility with large gathering areas and smaller conference rooms that we will utilize during the simulation,” Hansen said. “The live simulation will feature Kent State acting students who will portray a husband, who has suddenly been diagnosed with cancer, and his wife on their journey through the illness to his death. The simulation will leave holes where final conversations could have taken place. Following the live simulation, the students and faculty will break out into mock teams and have a patient care conference. The focus of the care conference will be the missing final conversation themes and how the team members may have approached the care differently.”
Since hospice and palliative caregivers deliver team-based care, biweekly team meetings are held to discuss patient’s care. The research team will provide an opportunity for students to interact in a team-focused breakout group consisting of 10-15 participants, facilitated by a member of the CAREol team. These smaller sessions will allow students to develop interprofessional communication skills while becoming more comfortable discussing end-of-life issues, which in turn will build professional resiliency.
After mock team meetings have concluded, the group will come back together for a large debriefing, during which Keeley will be instrumental in the discussion of final conversations.
“Maureen has identified the final conversation themes,” Hansen said. “These are love talk, identity talk (self and relational), spirituality and religious talk, everyday talk, difficulty relationship talk and illness/death talk. We will be working closely with her to ensure we are being authentic in how we represent final conversations to the students.”
Along with the expanded simulation, Hansen and her team will administer a pretest and posttest to students to gauge their knowledge and comfort level with interprofessional teams, confidence in talking with patients and families about their relationships and knowledge about final conversations. The team will also record and analyze the mock team meetings and larger debriefings for future publications.
A hospice nurse for more than 20 years, Hansen saw firsthand how family relationships comprised an area that needed more research attention in healthcare.
“Currently, there is not much research being conducted in communication between the patient and the family at the end of life,” Hansen explained. “On the contrary, much research is available about communication between a patient and provider in regard to delivering bad news, making treatment choices and determining advanced directives. Those are important conversations to have, but they do not address issues within the patient-family relationship and do not address love or difficult relationship conversations.”
Hansen remembers one patient and his family in particular who greatly benefited from end-of-life final conversations. His wife was very anxious and often needed to be calmed or reassured that her husband was comfortable. During one of Hansen’s visits, their grown daughter, who lived out of town, was also at the house visiting.
“I could feel the tension in the room,” Hansen recalled. “I sat down next to my patient and rested my hand, palm up, next to him on the bed. He grabbed it and held on tight. The wife and daughter gathered in, and I asked questions about their favorite memories, such as vacations as a family. All of a sudden, they were reminiscing and laughing. I was there for an hour or more. I had many other things I needed to do that day, but I felt I needed to teach this family how to come together in this situation.
“The man passed not long after that visit,” Hassen continued. “Sometime later, I received a note from one of the daughters, who happened to be a nurse, thanking me for taking the time to talk with her family. She said that she would forever be grateful. It was so simple. In the moment, I didn’t feel like I had the time, and that’s a major hurdle for many healthcare providers. But I held his hand, and I listened to their stories. As providers, we need to develop the skills that provoke a self-examination of either the patient or the family, and then we can gently guide them through this process.”
In the classroom, Hansen helps her students make connections between nurse scientists doing research, publishing their findings and using this information to influence nursing practice.
“It can be difficult for students when they first start engaging with research, but by the end of the course, many have a better understanding of how to read a research article and see how it relates to their practice,” she said.
A member of Kent State’s College of Nursing family since 2015, Hansen calls Kent State home.
“It feels like I’ve always been here and it’s where I’m supposed to be,” she noted. “I was blessed to have a strong faculty mentor, College of Nursing Interim Dean Denice Sheehan, and she has helped me grow tremendously.”
For more information about Kent State’s College of Nursing, visit www.kent.edu/nursing.
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Dana Hansen, Ph.D., APRN, ACHPN, is an associate professor of nursing at Kent State University. She is the principal investigator of a study to help ensure the competencies of new healthcare providers to facilitate vital family communication at the end of life.