Journey of touching death, nursing undergraduates' experiences in the simulated death graded exposure Programme: A qualitative descriptive study in China

Background

Nursing undergraduates receive inadequate training in death and end-of-life care within the education system, resulting in feelings of unpreparedness and inadequacy when confronted with their first death event in clinical practice, as well as a low willingness to engage in end-of-life care.

Objective

To explore the cognitive and emotional experiences of nursing undergraduate students participating in the simulated death graded exposure programme, and to evaluate the educational significance of the programme.

Design

A qualitative descriptive study design.

Setting

A comprehensive university in Jiangsu Province, China.

Participants

In October 2023, twenty-eight (age range, 19–21 years; 21 [75 %] female;) first-year nursing undergraduates were recruited to participate in the simulated death graded exposure programme.

Methods

The research team developed and implemented a systematic simulated death graded exposure programme, consisting of four parts: end-of-life farewell role-playing, simulated funeral experience, post-simulation recovery and death reflection. Semi-structured interviews were conducted after the experience, and the interview data were analysed using content analysis.

Results

The nursing students' experiences in the simulated death graded exposure programme could be divided into three phases through a longitudinal process: approaching death (dying), immersing in the world of death (death), and initiating the transformation of life's meaning (rebirth). In the first phase, participants felt integrated into the simulated roles, experienced the complex emotions of approaching death, and ultimately accepted the declaration of death. In the second phase, participants experienced a highly realistic simulation of death, guiding physical symptoms and emotional reactions. Additionally, their awareness of death began to awaken and disperse, leading to profound reflections on death. In the third phase, participants engaged in a process of self-examination which culminated in a self-proclaimed healing process from the experience of the simulated death. Through deep reflection, they were reacquainted with their values and professional mission.

Conclusions

The simulated death graded exposure programme enhances nursing students' psychological preparedness and emotional adjustment helping to prepare them for experiencing death in a clinical context, and deepens their understanding of life and death. This programme provides a practical example of nursing professionals' training and education in end-of-life care.