Senior year nursing students' self-regulated learning in complex simulation-based palliative education: A qualitative...

Palliative care generates psychological tension and high emotions worldwide. Hence, simulated palliative education for students is assumed to offer a psychologically safer environment for the repetition of skills to achieve proficiency. However, little is known about how this environment is created to shape learning, including students' responses to regulate their cognitive load so as not to become overwhelmed and abandon their tasks.

To explore nursing students' disposition to adapt, invest cognitive effort, and emotionally regulate their own learning process when navigating complex and ambiguous palliative care in a simulated environment.

A qualitative study using an interpretive description paradigm was conducted.

A university in Hong Kong, China.

Fourth-year nursing students enrolled in a practicum subject, Clinical Studies, in a 5-year bachelor's preregistration program.

Twenty-nine students in six groups, consisting of twenty-three females and six males, participated. The primary data were collected from focus groups that were audiotaped and transcribed verbatim.

Participants described a socially co-constructed experience of optimizing their learning process on the basis of an interplay of self-regulation and cognitive effort to work through complex and dynamic palliative care simulations. The process was characterized by five subthemes: 1) learning triggered by anxiety in the simulated environment; (2) actively taking responsibility for unexpected relational challenges; (3) the willingness to be flexible (open) to reprioritize and reposition oneself with patients/families; (4) being present (pausing to flexibly consider the past and what ifs); and (5) reframing care to strategically fit (focus) where patients and families were at.

Careful pedagogical design is needed to prepare students for exposure to uncertainty and complex dynamic simulation-based palliative education. Furthermore, our study results provide valuable insights into the embodied cognition of communication and collaboration, i.e., primary biological knowledge, which is theorized to minimize cognitive overload and enhance cognitive agility.