The Effect of Simulation-Based Postmortem Care on Nursing Students' Knowledge, Skills, and Self-Efficacy Levels

Overview

PURPOSE AND TYPE OF THE RESEARCH This study is designed as a randomized controlled experimental study to investigate the impact of simulation-based learning experiences in the teaching of postmortem care on the knowledge, skills, and self-efficacy levels of nursing students. RESEARCH HYPOTHESES Hypothesis 1 (H1): The postmortem care knowledge levels of students who experience simulation-based learning are higher compared to those taught through traditional methods. Hypothesis 2 (H2): The postmortem care skill levels of students who experience simulation-based learning are higher compared to those taught through traditional methods. Hypothesis 3 (H3): The self-efficacy levels of students who experience simulation-based learning in end-of-life and postmortem care are higher compared to those taught through traditional methods. Additionally, it is anticipated that students who undergo simulation-based learning experiences will exhibit higher levels of student satisfaction and confidence in their learning process within this study.

The purpose of nursing is to provide individualized care to meet the needs of an individual throughout their lifespan, which begins with fertilization and ends with death. In alignment with this fundamental objective, nurses facilitate the preservation, maintenance, and enhancement of an individual's health, the restoration of function or recovery in cases of illness, and the provision of a peaceful, dignified, and good death during the final stages of life. The end-of-life period is defined as the individual's last months and days. End-of-life care encompasses a comprehensive approach that includes appropriate nursing interventions addressing the bio-physiological, psychological, social, cultural, and environmental dimensions of an individual before, during, and after death (postmortem). This form of care serves as an indicator of the quality of patient care and assists family members in accepting the reality of death through family-centered approaches. The final phase of end-of-life care, postmortem care, holds significant importance as it involves the nurse's awareness of their own emotions, the preservation of the deceased individual's dignity until the very end, the provision of opportunities for family members or loved ones to initiate a positive grieving process through farewell and religious/cultural rituals, and the fulfillment of legal and procedural requirements. Postmortem care entails the physical care of the deceased individual, delivered in a manner respectful of the values and preferences of both the deceased and their family members, while adhering to infection control measures, ethical standards, and legal protocols. Additionally, it includes the provision of psychosocial support to grieving family members during the mourning process. Despite its critical role within palliative care in nursing, there is a notable scarcity of research focused on postmortem care. Death represents the final stage of life, a universal experience for all living organisms, marking the irreversible cessation of vital functions. According to the World Health Organization (WHO) 2024 statistics, approximately 60 million individuals die globally each year, equating to an average of 164,000 deaths per day. Historically, death frequently occurred in home settings; however, the increasing and aging population, the rise in chronic diseases, and advancements in medical diagnostics, care, and treatment interventions that extend life have led to the hospitalization of terminally ill individuals for ongoing care and treatment. These factors have resulted in the majority of deaths occurring in healthcare settings, such as hospitals, thereby increasing the likelihood of nurses and nursing students encountering death. Studies involving nursing students have highlighted that providing care to individuals in the dying process, those nearing death, or the deceased presents multifaceted challenges and is considered a significant issue. Previous research has indicated that nursing students' initial experiences with patient death are often accompanied by negative emotions such as fear, sadness, disappointment, anxiety, helplessness, inadequacy, and guilt. Furthermore, these emotions may lead nursing students to adopt maladaptive coping mechanisms, including suppression, avoidance, and detachment. Limited studies related to this topic have revealed that nursing students feel inadequately prepared and struggle to cope with death and postmortem care, reporting a lack of readiness to care for the deceased and their families. In Turkey, limited descriptive and qualitative studies with nursing students have identified deficiencies in knowledge regarding end-of-life care, as well as difficulties in managing and delivering such care. However, it is imperative that nursing students possess adequate knowledge and skills to address challenging situations, such as postmortem care. Moreover, their self-efficacy levels are critical in effectively applying these knowledge and skills. The concept of self-efficacy reflects the distinction between possessing knowledge and skills and utilizing these abilities in challenging contexts. Consequently, education and training play a pivotal role in fostering knowledge, skills, and self-efficacy in end-of-life and postmortem care. Nevertheless, global undergraduate nursing curricula are noted for their deficiencies in addressing end-of-life and postmortem care education and a strong emphasis is placed on the need for enhanced training at the undergraduate level. Studies further indicate that postmortem care education is inadequately addressed, with students feeling unprepared and exhibiting low self-efficacy in providing postmortem care. Such education is often limited to theoretical discussions within the broader context of end-of-life or palliative care. A review of international literature reveals only one non-randomized pre-test/post-test study implementing an augmented reality-based mentorship program for newly graduated nurses in postmortem care. Similarly, a national literature review identified a single study by Uzun and Cerit (2024) that utilized creative drama to deliver postmortem care education to nursing students. These studies suggest that augmented reality and creative drama methods effectively enhance postmortem knowledge and skills; however, they underscore the need for further research, particularly randomized controlled trials. Additionally, while self-efficacy-a factor potentially influencing students' readiness for end-of-life care-has been explored in non-experimental studies, no studies have specifically addressed it in the context of postmortem care. A comprehensive review, however, suggests that simulation-based learning methods in nursing education could address the educational needs in end-of-life and postmortem care. The literature further recommends that simulation methods be employed, as they are considered an effective means of developing skills expected of all nurses in end-of-life care. Simulation-based learning is defined as a learning process that replicates situations or events as closely as possible to those encountered in clinical practice. Increasingly utilized in nursing education over the years, this method provides nursing students with safe environments to practice and enhance their skills. Simulation-based learning offers a secure setting, particularly in hospitals and other care delivery environments, to address complex challenges such as sudden changes in a patient's condition or the care of multiple patients. It enables healthcare professionals to minimize the risk of patient harm while ensuring the provision of adequate and high-quality care. Studies suggest that simulations related to end-of-life care can positively influence nursing students' knowledge, confidence, and communication skills, although the number of such simulation studies remains limited, indicating a need for further research. However, no studies have been identified that utilize high-fidelity simulation as a method to acquire competencies (knowledge, skills, and self-efficacy) in end-of-life and postmortem care. This research aims to determine the impact of simulation-based learning experiences on the knowledge, skills, and self-efficacy levels of nursing students in the teaching of postmortem care.