Ethics based educational interventions on end-of-life care for undergraduate nursing students: A scoping review

Nurses face various ethical dilemmas and conflicts in end-of-life care; however, there is no evidence of effective undergraduate ethics education on the topic settings to address them.

This review aimed to describe educational interventions for end-of-life care focused on ethical content in undergraduate nursing education and their outcomes for students.

This review used Arksey and O'Malley's five-stage scoping process.

This study used the Ovid (CINAHL and MEDLINE) and PubMed bibliographic databases from 2012 to 2023. We included literature on qualitative, quantitative, and mixed-methods research that could provide information about ethical end-of-life care (EOLC) education interventions in undergraduate nursing programs. We excluded review articles to avoid duplication. The search string included ("education, nursing" OR "education, nursing, baccalaureate") AND ("ethics") OR ("terminal care" OR "hospice care" OR "end of life care" OR "palliative care"). The scope of this study was limited to studies on educational interventions for EOLC ethics in undergraduate nursing education.

The search yielded 4190 articles, of which 25 were included in the analysis. Fourteen of the 25 studies were conducted in the USA, whereas the others were conducted in various parts of the world. No intervention research articles were found that focused on EOLC ethics itself, which was either incorporated as part of the nursing education for EOLC or included in ethics education as an EOLC case study. Of these, 17 studies included lectures to teach EOLC ethics, and four used scenarios and case studies as teaching methods. Twelve studies used scenarios for simulation education. Seven studies combined lectures and simulations. The lectures improved students' knowledge and attitudes toward death, and their confidence in EOLC. As a result of the simulation intervention, in addition to improvements in knowledge and attitudes, participants gained communication skills, comfort with caregiving, confidence, self-efficacy, and the ability to reflect on their attitudes.

The results suggest that while lectures are effective for acquiring ethical knowledge and attitudes related to EOLC based on ethical competency, simulations are more effective for acquiring practical skills such as communication, self-efficacy, and reflection. Incorporating ethical issues in simulations is hoped to broadly develop ethical practice competencies.