1) The study evaluated the effectiveness of high-fidelity simulation in teaching end-of-life care to undergraduate nursing students. 2) A quasi-experimental study with no control group was conducted on 42 students who completed the Frommelt Attitudes Toward Care of the Dying assessment before and after a high-fidelity simulation experience. 3) Results found statistically significant improved attitudes on 11 of 30 items after the simulation, supporting the hypothesis that high-fidelity simulation can increase positive attitudes towards caring for dying patients.

1. HighFidelity Simulation in Nursing Education for EndofLife Care Essay
HighFidelity Simulation in Nursing Education for EndofLife Care Essay ON HighFidelity
Simulation in Nursing Education for EndofLife Care EssayThis is a 7 page (excluding
reference page and title page) Quantitative critic paper. Instructions and materials to work
with is included. APA 7 is a must. Template and grading Rubric must be used because the
grading is strictly based on that. Paper must be written in active voice egActive voice: the
nurse bathed the patientPassive voice: the patient was bathed by the nurseHighFidelity
Simulation in Nursing Education for EndofLife Care
Essayattachment_1attachment_2attachment_3attachment_4attachment_5attachment_6Unfo
rmatted Attachment PreviewPaper instruction Quantitative Research Critique – Assignment
Directions 1. Review Polit & Beck (2020), Box 5.3 – Guide to a Focused Critical Appraisal of
Evidence Quality in a Quantitative Research Report, to assist you in analyzing the article
listed below. o Quantitative Article – Rattani et al. (2020) (attached) o Polit & Beck (2020),
Box 5.3 (attached) 2. Use the rubric below to guide your analysis by providing a 1-3
sentence answer to each question. o The rubric headings can be used as your paper
headings & subheadings o Rubric and paper template attached. 3. Address each component
using the content from the article when furnishing your rationale. o If a research component
is not addressed in the article, you must explain whether or not this is justified. 4. Be sure to
meet the following criteria: o APA 7th edition professional paper formatting (paper
template attached) o Include both an introduction and a conclusion o 7-page limit,
excluding title and reference pages chance that the patient will be dissatisfied and regretful
regarding the decisions that were made (Mahal et al., 2015; Poon, 2012; Weeks et al., 2012).
Moreover, decision partners may become ‘proxies’ in interactions with healthcare
providers, but they often misunderstand the patient’s informational and decision needs
(Longo & Slater, 2014). Decision aids can help patients apply specific health information
while actively participating in health-related decision making (O’Connor et al., 2009; Stacey
et al., 2014).…Decision aids are most effective when they are tailored, interactive,
collaborative, and focused on the priorities of the individual patient (Fowler et al., 2011;
Jimbo et al., 2013; Ozanne et al., 2014; Sepucha et al., 2013; Stacey et al., 2014) but
interactive decision aids are rarely implemented (Jimbo et al., 2013).” HighFidelity
Simulation in Nursing Education for EndofLife Care Essay(Excerpt reprinted with
permission from Jones R., Hollen P., Wenzel J., Weiss G., Song D., Sims T., & Petroni G. (2018).
Understanding advanced prostate cancer decision making utilizing an interactive decision
aid. Cancer Nursing , 41 , 2-10.) Summary Points A research literature review is a written

2. synthesis of evidence on a research problem. Major steps in preparing a written research
review include formulating a question, devising a search strategy, developing a plan to
organize and document review activities, conducting a search, screening and retrieving
relevant sources, extracting key data from the sources, appraising studies, analyzing
aggregated information for important themes, and writing a synthesis. Research articles are
the major focus of research reviews. Information in nonresearch references—e.g., case
reports, editorials—may broaden understanding of a research problem but has limited
utility in summarizing research evidence. A primary source is the description of a study
prepared by the researcher who conducted it; a secondary source is a description of the
study written by someone else. Literature reviews should be based on primary source
material. Strategies for finding studies on a topic include the use of bibliographic databases,
the ancestry approach (tracking down earlier studies cited in a reference list of a report),
and the descendancy approach (using a pivotal study to search forward to subsequent
studies that cited it.) Electronic searches of bibliographic databases are a key method of
locating references. For nurses, the CINAHL and MEDLINE (via PubMed) databases are
especially useful. Google Scholar is also a popular and free resource. In searching a
database, users can perform a keyword search that looks for searcher-specified terms in
text fields of a database record (or that maps keywords onto the database’s subject codes)
or they search according to subject heading codes themselves. Access to many journal
articles is becoming easier through online resources, especially for articles available in an
open-access format. References must be screened for relevance, and then pertinent
information must be extracted for analysis. Two-dimensional evidence summary tables
(matrices) facilitate the extraction and organization of data from the studies, as does a good
coding scheme. A research critique (or critical appraisal) is a careful evaluation of a study’s
strengths and weaknesses. Critical appraisals for a research review tend to focus on the
methodologic aspects and findings of retrieved studies. The analysis of information from a
literature search involves the identification of important themes—regularities (and
inconsistencies) in the information. Themes can take many forms, including substantive,
methodologic, and theoretic themes. In preparing a written review, it is important to
organize materials logically. HighFidelity Simulation in Nursing Education for EndofLife
Care EssayThe reviewers’ role is to describe study findings, the dependability of the
evidence, evidence gaps, and (in the context of a new study) contributions that the new
study would make. Study Activities Study activities are available to instructors on . Box 5.1
Information to Consider for Data Extraction in a Literature Review Source
Outcomes/Dependent variables Citation Contact details of lead author Outcomes (or
phenomena in qualitative studies) Time points for outcome data collection Methods For
each key outcome: Study design Outcome definition Method of data collection (e.g., self-
report, observation) Specific instrument (if relevant) Level of evidence Research tradition
(qualitative) Longitudinal or cross-sectional Methods of bias control (e.g., blinding)
Methods of enhancing trustworthiness (qualitative) Reliability, validity information Results
Qualitative: Summary of major themes Quantitative: for each outcome of interest Summary
of results Participants Number of participants Power analysis information Effect size Key
characteristics of the sample p values Age Confidence intervals Subgroup analyses Sex

3. Ethnicity/race Evaluation Socioeconomic Diagnosis/disease Major strengths Major
weaknesses Overall quality rating Comorbidities Country Method of sample selection
Attrition (percent dropped out) Other Intervention/Independent variable(s) Theoretical
framework Funding source Key conclusions of the study authors Independent variable
Intervention or influence Comparison Number of (intervention) groups Specific
intervention (e.g., components of a complex intervention) Intervention fidelity Broadly
adapted from Table 7.3.a of the Cochrane Handbook for Systematic Reviews (Higgins &
Green, 2011). Box 5.2 Substantive Codes for a Literature Review on Factors Affecting
Nurses’ Management of Children’s Pain Codes for Nurse Characteristics Associated With
Their Pain Management Behavior (Independent Variables) 1. 2. 3. 4. 5. 6. 7. 8. Nurses’ pain
management knowledge or specialized pain training Nurses’ years of nursing experience
Nurses’ pain attitudes and beliefs Demographic nurse factors (e.g., age, sex, education, has
own children) Nurses’ role/credential/status (e.g., RN, CNS, APN, NP) Other nurse factors
(e.g., self-efficacy, personal experience with pain) Organizational factors (e.g., nurses’
workload, organizational culture) Participation in interventions to improve nurses’ pain
management skills Codes for Nurses’ Pain Management Behaviors (Dependent Variables) A.
B. C. D. E. Nurses’ assessment of children’s pain Nurses’ pain management—general
strategies Nurses’ use of analgesics for pain management Nurses’ use of nonpharmacologic
methods of pain management Provision of guidance to parents about managing their child’s
pain Box 5.3 Guide to a Focused Critical Appraisal of Evidence Quality in a Quantitative
Research Report SECTION OF THE REPORT Method Research design Population and sample
Data collection and measurement Procedures Results Data analysis CRITICAL APPRAISAL
QUESTIONS Was the most rigorous design used, given the purpose of the study? What was
the level of evidence for the type of question asked—and is this level the highest possible?
Were suitable comparisons made to enhance interpretability? Was the number of data
collection points appropriate? Was the period of follow-up (if any) adequate? Did the design
minimize threats to the internal validity of the study (e.g., was randomization and blinding
used, was attrition minimized)? Did the design enhance the external validity and
applicability of the study results? If there was an intervention, did it have a strong
theoretical basis? Was the population identified? Was the sample adequately described?
Was a good sampling design used to enhance the sample’s representativeness of the
population? Were sampling biases minimized? Was the sample size adequate? Was a power
analysis used? Were key variables operationalized using the best possible methods (e.g.,
interviews, observations)? Were clinically important and patient-centered outcomes
measured? Did the data collection methods yield data that were reliable, valid, and
responsive? If there was an intervention, was it rigorously developed and implemented?
HighFidelity Simulation in Nursing Education for EndofLife Care EssayDid most participants
allocated to the intervention group actually receive it? Were data collected in a manner that
minimized bias? Were appropriate and powerful statistical methods used? Did the analysis
help to control for confounding variables? Were Type I and Type II errors avoided or
minimized? Were subgroup analyses undertaken to better understand the applicability of
the results to different types of people? DETAILED GUIDELINES Box 9.1, page 201; Box 10.1,
page 223 Box 31.1, page 720 Box 13.1, page 274 Box 14.1, page 291; Box 15.1, page 336 Box

4. 9.1, page 201; Box 10.1, page 223 Box 17.1, page 381 Box 18.1, page 408 Box 31.1, page 720
Findings Discussion Interpretation of the findings Summary Assessment Were the findings
adequately summarized? Was information about effect size and precision of estimates
(confidence intervals) presented? Were findings reported in a manner that facilitates a
meta-analysis, and with sufficient information needed for EBP? Box 17.1, page 381 Box 21.1,
page 465 Were interpretations consistent with the study’s limitations? Were causal
inferences, if any, justified? Was the clinical significance of the findings discussed? Did the
report address the generalizability and applicability of the findings? Despite any limitations,
do the study findings appear to be valid—do you have confidence in the truth value of the
results? Does the report inspire confidence about the types of people and settings for whom
the evidence is applicable? Box 5.4 Guide to a Focused Critical Appraisal of Evidence Quality
in a Qualitative Research Report SECTION OF THE REPORT Method Research
design/research tradition CRITICAL APPRAISAL QUESTIONS DETAILED GUIDELINES Box
22.1, page 490 Is the identified research tradition congruent with the methods used to
collect and analyze data? Was an adequate amount of time spent with study participants?
Was there evidence of reflexivity in the design? Sample and setting Box 23.1, page 506 Was
the group or population of interest adequately described? Were the setting and sample
described in sufficient detail? Was a good method of sampling used to enhance information
richness? Was the sample size adequate? Was saturation achieved? Data collection Box 24.1,
page 526 Were appropriate methods used to gather data? Were data gathered through two
or more methods to achieve triangulation? Were the data of sufficient depth and richness?
Procedures Box 24.1, page 526 Do data collection and recording procedures appear
appropriate? Were data collected in a manner that minimized bias? Enhancement of
trustworthiness Box 26.1, page 580 Did the researchers use effective strategies to enhance
the trustworthiness/integrity of the study? Was there “thick description” of the context,
participants, and findings, and was it at a sufficient level to support transferability? Do the
researchers’ methodologic and clinical experience enhance confidence in the study findings
and interpretations? Results Data analysis Box 25.1, page 553 Was the data analysis
strategy compatible with the research tradition and with the nature and type of data
gathered? Findings Box 25.1, page 553 Were findings effectively summarized, with good use
of excerpts and strong supporting arguments? Did the analysis yield an insightful,
provocative, authentic, and meaningful picture of the phenomenon under investigation?
Theoretical integration Box 25.1 page 553 Were the themes or patterns logically connected
to each other to form a convincing and integrated whole? Discussion Interpretation of the
findings Box 25.1, page 553 Were the findings interpreted within an appropriate social or
cultural context, and within the context of prior studies? Were interpretations consistent
with the study’s limitations? Did the report address the transferability and applicability of
the findings? Summary Assessment Do the study findings appear to be trustworthy—do you
have confidence in the truth value of the results? HighFidelity Simulation in Nursing
Education for EndofLife Care EssayDoes the report inspire confidence about the types of
people and settings for whom the evidence is applicable? Box 5.5 Guidelines for Critically
Appraising Literature Reviews 1. 2. 3. 4. 5. 6. 7. Is the review thorough—does it include all
major studies on the topic? Does it include recent research (studies published within the

5. previous 1-3 years)? Are studies from other related disciplines included, if appropriate?
Does the review rely mainly on primary source research articles? Is the review merely a
summary of existing work, or does it critically appraise and compare key studies? Does the
review identify important trends and gaps in the literature? Is the review well organized? Is
the development of ideas clear? Does the review use appropriate language regarding the
tentativeness of prior findings? Is the review objective? Does the author paraphrase, or is
there an overreliance on quotes from original sources? If the review is part of a research
report for a new study, does the review support the need for the study? If it is a review
designed to summarize evidence for clinical practice, does the review draw reasonable
conclusions about practice implications? Original Article Effectiveness of High?Fidelity
Simulation in Nursing Education for End?of?Life Care: A Quasi?experimental Design Salma
Amin Rattani1, Zohra Kurji1, Amina Aijaz Khowaja1, Jacqueline Maria Dias2, Anila Naz
AliSher3 1 School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan,
2College of Health Sciences, University of Sharjah, Sharjah, UAE, 3College of Nursing, King
Edward Medical University, Lahore, Pakistan Abstract Background: Providing end of life
(EOL) care is a component of palliative care but dealing with dying patients and their family
members is stressful for the healthcare providers. To prepare them for providing EOL care,
the high?fidelity simulation could be used as a pedagogy in which real?life scenarios are
used on the computerized manikins mimicking the real patients. Aims: The aim of this study
was to measure the effectiveness of high?fidelity simulation to teach EOL care in the
palliative nursing course in the undergraduate nursing education program at the School of
Nursing and Midwifery at Aga Khan University which is private university in Karachi,
Pakistan. Methods: This study was approved by the ethics review committee of Aga Khan
University. It was hypothesized that exposure to high?fidelity simulation will lead to an
increased positive attitude in participants towards the care of dying. A quasi?experimental
design was used. In line with the design, there was no control group. The same group of
students (n = 42) were assessed through Frommelt Attitudes Toward Care of the Dying
(FATCOD) Part B assessment tool. Permission for using this tool was obtained from Dr.
Katherine Frommelt, the author of this tool. Research participants filled this tool before and
after the intervention, i.e., providing EOL care to a patient in a high?fidelity simulation lab.
Results: Out of 30?FATCOD items, significant attitude change was detected on 11?items of
which 8 were positively worded statements and 3 were negatively worded statements. As
per the hypothesis, it was expected for the positively worded statements that the mean
score for the posttest would be significantly greater than the pretest mean score (pretest
score < posttest score). The hypothesis was proved for items 1, 4, 10, 18, 22, 25, 27, and 30
as their t?value was significant at 0.05 alpha value (one?tailed). For the negatively worded
statements, it was expected that the mean score for the posttest would be significantly
lower than the pretest (pretest score > posttest score). The hypothesis was proved for items
5, 6, and 11 as their t?value was significant at 0.05 alpha value (one?tailed).
Conclusion:HighFidelity Simulation in Nursing Education for EndofLife Care EssayIn this
research teaching, EOL care through high?fidelity simulation had improved the attitudes of
students toward providing care. This pedagogy also provided the participants with a
learning opportunity to deal with their own emotions. These findings provide a way

6. forward for teaching EOL and other complex skills of clinical practice. Keywords: Clinical
teaching, end?of?life care, Frommelt Attitudes Toward Care of the Dying tool, high?fidelity
simulation, nursing education, palliative care Introduction A multidisciplinary approach
toward palliative care encompasses providing end of life (EOL) care and dealing with death
and dying.[1] Weisse et al. assert that the health?care providers report a lack of training in
EOL care and limited opportunities to learn about the dying process of a person[2] Nurses
are required to support the patient and family during the dying process and bereavement.
This process involves symptom control and pain management.[3] However, nursing
graduates do not feel prepared for providing palliative care[2?4] and they acknowledge the
need to increase palliative care education in undergraduate nursing curricula.[2,3]
Highlighting the importance of educating and Access this article online Quick Response
Code: Website: www.jpalliativecare.com DOI: 10.4103/IJPC.IJPC_157_19 312 training
nurses for providing palliative care, Pesut and Greig emphasize that nurses are the frontline
care providers for patients and families at EOL. Therefore, it is essential that through
education and training, these care providers are to be prepared for providing palliative
care.[5] Limited availability of clinical Address for correspondence: Asst. Prof. Salma Amin
Rattani, Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan. E?mail:
rattani@ualberta.ca Submitted: 05-Sep-19 Revised: 02-Nov-19 Accepted: 31-Dec-19
Published: 29-Aug-20 This is an open access journal, and articles are distributed under the
terms of the Creative Commons Attribution?NonCommercial?ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work non?commercially, as long as
appropriate credit is given and the new creations are licensed under the identical terms. For
reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com How to cite this article:
Rattani SA, Kurji Z, Khowaja AA, Dias JM, AliSher AN. Effectiveness of high-fidelity
simulation in nursing education for end-of-life care: A quasi-experimental design. Indian J
Palliat Care 2020;26:312-8. © 2020 Indian Journal of Palliative Care | Published by Wolters
Kluwer – Medknow Rattani, et al.: Effectiveness of simulation in teaching EoL care settings
in nursing education may not allow direct experience in palliative and EOL care but the use
of simulation?based learning may enable educators to foster the skills required for fulfilling
the complex palliative care needs of their patients and their family members.[6] Simulation
is just like a real situation[6,7] to provide learners with pertinent experience un
…HighFidelity Simulation in Nursing Education for EndofLife Care Essay