Undergraduate Nursing Students
Conditions
Brief summary
Nursing students frequently encounter dying patients during clinical placements with limited preparation, leading to negative attitudes toward end-of-life care, death anxiety, and risk of compassion fatigue. Simulation-based education offers a safe environment for experiential learning in palliative care, yet most existing programs do not integrate mindfulness components to address the psychological demands of this setting. Mindfulness-based interventions have shown promise in improving self-compassion and reducing burnout in healthcare professionals, but evidence among undergraduate nursing students remains limited. This study aims to evaluate the effects of a Mindful Simulation Training (MST) program on compassion, palliative care knowledge, attitudes toward end-of-life care, and professional quality of life among undergraduate nursing students.
Detailed description
Palliative care addresses the physical, psychological, social, cultural, and spiritual needs of patients with life-limiting illness and their families. In Hong Kong, palliative care services have expanded from hospital settings to community care homes, increasing demand for well-prepared nursing graduates. Nursing students as the future palliative care workforce often encounter dying patients during placements with inadequate educational preparation, resulting in negative attitudes, death anxiety, and emotional distress. Evidence shows nursing students report less positive end-of-life (EOL) attitudes and lower confidence than practicing nurses, with documented gaps in undergraduate palliative care curricula. Compassion fatigue is well established among nurses in palliative settings and has also been documented among nursing students during clinical placements. Conversely, compassion practice and adaptive coping are associated with reduced burnout and enhanced satisfaction. Simulation-based training provides opportunities for experiential, reflective, and affective learning in palliative care, with evidence supporting improvements in knowledge, attitudes, communication, and emotional preparedness. However, few simulation studies have integrated mindfulness components specifically targeting psychological flexibility and compassion competence. This is a three-arm, parallel-group randomized controlled trial with a sequential mixed-methods study designed to compare the effectiveness of Mindful Simulation Training (MST), Traditional Simulation Training (TST), and a Waitlist Control (WC) over a 4-week intervention period with follow-up at 8 weeks on improving the compassion, palliative care knowledge, attitudes toward end-of-life care, and professional quality of life among undergraduate nursing students.
Interventions
BEHAVIORALMindfulness-based intervention
The face-to-face mindfulness induction workshop will be delivered by a certified mindfulness instructor. The mindfulness interventions, including the tools and informal practice. Paper handouts regarding the mindfulness techniques and informal practice will be given to participants to facilitate the learning and self-paced practice.
BEHAVIORALSimulation-based learning
The simulation scenario will consist of 3 components, including pre-briefing, simulation activity, and debriefing.
Sponsors
Hong Kong Metropolitan University
The University of Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Nursing students aged 18 or above * Currently studying a full-time nursing program in Hong Kong * Regardless of the study year, e.g., Year 1 to Year 5 * Able to comprehend English and Cantonese * Able to use electronic devices to complete an online survey * Have enrolled or studied in the prerequisite course provides baseline knowledge in palliative care training
Exclusion criteria
* Nursing students who are under 18 * Have been regularly practicing instructor-led mindfulness interventions once a week or more during the past 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Compassion | Baseline, 4 weeks, and 8 weeks after baseline | Compassionate Engagement and Action Scales (CEAS) measures three themes of compassion: 1) Self-compassion; 2) Compassion for others; 3) Compassion from others. Each scale consists of 13 items to measure different elements in compassion engagement and action which will be rated on a 10-point Likert scale from 1 (never) to 10 (always) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Attitude towards Palliative Care | Baseline, 4 weeks, and 8 weeks after baseline | The Frommelt Attitudes Towards Care of Dying Scale (FATCOD-B) assesses attitudes using 30 items on a 5-point Likert scale. The scale includes an equal distribution of positive and negative statements. Participants rate their agreement with each statement on a scale from 1 to 5, where 1 represents "Strongly Disagree" and 5 represents "Strongly Agree." |
| Knowledge in Palliative Care | Baseline, 4weeks, and 8 weeks after baseline | The Palliative Care Knowledge Test (PCKT), a 20-item assessment, evaluates knowledge across five key domains: philosophy of palliative care (two items), pain management (six items), dyspnea (four items), psychiatric issues (four items), and gastrointestinal problems (four items). |
| Professional Quality of Life | Baseline, 4 weeks, and 8 weeks after baseline | The Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Version 5 (ProQoL-5) comprises three subscales: (1) Compassion Satisfaction - 10 items (2) Burnout - 10 items (3) Secondary Traumatic Stress - 10 items. ProQoL-5 assesses compassion satisfaction and compassion fatigue using 30 items rated on a 5-point Likert scale ranging from 1 to 5, where 1 represents "never" and 5 represents "very often" regarding the previous 30 days a respondent has experienced. |
Countries
Hong Kong
Contacts
PRINCIPAL_INVESTIGATORJojo Yan Yan Kwok, PhD
The University of Hong Kong
Outcome results
None listed