Student actors bring realism to end-of-life simulation experience

From Touch Point Online Magazine, Summer 2019 – Vol. III, Issue 2

Within The Olga A. Mural Simulation Lab at Kent State University College of Nursing, a hospice scenario unfolds. A relatively new simulation experience within the college, junior nursing students tend to a dying mother and answer questions and concerns from her two adult children and tensions build.  Who is this family in distress? Theater students from the School of Theater and Dance who act to provide a sense of realism to the simulation experience; equipped with only a basic storyline, use improvisation to drive the simulation forward and build a realistic scenario for nursing students to experience.

“Every simulation is different. The theater students get to practice their improvisational techniques based on what the nursing students and other actors do because there isn’t a script,” said Dr. Tracey Motter, associate dean for undergraduate programs. “The actors have fun and the nursing students have a real person to talk to and communicate with.”

End-of-life care is discussed throughout the nursing program, but this is a unique opportunity for students to interact directly with the family and patient during a heightened emotional time. While only a handful of nursing students are exposed to a patient’s death in the clinical setting, all of them will experience death and dying at one point in their careers. With this knowledge, the college felt it was important to provide all students with this learning opportunity.

“It really helps students learn to listen, rather than complete actions that have little effect on the patient’s outcome. To listen, you have to remain in the room and be fully present which is difficult when you’re uncomfortable,” said Dr. Motter. “Nurses are task-driven. It’s easy to do IVs and dressings, but to sit still, listen and be present with the dying patient and family members, that’s a skill that can be challenging for some.”

Additionally, faculty recognized nurses in general have a tendency to say phrases such as ‘it’ll all be okay’ at inappropriate times and it was important to them to better educate the students. After struggling to hold an end-of-life simulation with manikins, a conversation with Eric van Baars, M.F.A., school director and associate professor in the School of Theater and Dance, led to a partnership with the theater students.  

“With a manikin, students work through the simulation but it’s obvious it’s not real. But with the actors, if the son is upset, he’s going to be yelling and saying, ‘Why are you doing this?’ ‘Do you want my mom to die,’” said Jennifer Metheney, MSN, RN, CNE, associate lecturer. “That anger is right in the nursing students’ faces. Even though they know the patient isn’t actually dying, the emotions are all there, human to human, and that changes the experience.”

Students learn about advanced directives, physiological signs and symptoms and therapeutic communication so that when the end is near, they are equipped to provide education and comfort to the family and guide them through the dying process. When it is time for the patient to pass away, the simulation suspends reality and the scene is reset with only the actors portraying the adult children. The nursing students’ role changes to being present with the family members. “You don’t just walk away,” said Metheny. “You spend time with the family because they have now, in a way, become your patients, too.”

On occasion, there have been students who’ve experienced the death of a loved one go through the simulation. While given the option to just observe, most choose to participate. “We weren’t sure how they would do, but they were better than their peers,” said Dr. Motter. “They told us, ‘I know this is what really happens. Having been on the other side, I saw how I could help the family.’”

A debriefing session, where most of the learning takes place, immediately follows the simulation. As the nursing students decompress, they discuss what happened and ways care could have been improved. They also hear what it was like to be a patient from the patient’s point of view from the student actors.

“The theater students share how certain phrases or actions by the nursing students made them feel as the family member or dying patient,” said Dr. Motter. “Sometimes the students have an easier time accepting feedback from their peers verses the professors.”

While other nursing programs around the country provide simulation experiences with actors, few are incorporating actors into an end-of-life scenario. This realistic experience will help Kent nursing students know what to do in a real situation. Although each end-of-life process is unique, students can think back to this experience and feel confident they are prepared for what they may encounter.

Fox 8 Cleveland reporter Roosevelt Leftwich covered the spring 2019 end-of-life simulation for the evening news. Watch his coverage to see the end-of-life simulation in action:



POSTED: Friday, July 5, 2019 - 11:46am
UPDATED: Thursday, August 1, 2019 - 11:06am
Mariah Gibbons