2026 Theses Doctoral

Impact of Trauma-informed Psychologically Safe Debriefing Method on Attitudes and Debriefing Experience in Nursing Students Following an End-of-Life Simulation

Steele, Julie

A student’s first experience with death can have a profound influence on their attitudes toward the care of dying patients. Undergraduate nursing students often feel unprepared for end-of-life (EOL) care. Despite recommendations to teach EOL care, current methods used in nursing curricula are often insufficient to prepare students for the realities of caring for dying patients and their families.

This study examined differences in attitudes toward the care of dying patients and the debriefing experience of active participants and observers using the Trauma-informed, Psychologically Safe (TiPS) debriefing method compared to a traditional Plus-Delta debriefing after an EOL simulation. Guided by Kolcaba’s Comfort Theory, this multisite, quasi-experimental study employed a two-group, pretest-posttest design with an equivalent comparison group.

A total of 145 final year traditional Bachelor of Science in Nursing students either actively participated in (n = 60) or observed (n = 85) in an EOL simulation that included the withdrawal of life support and the implementation of intensive comfort measures. Following the simulation, students participated in either the TiPS debriefing or a Plus-Delta debriefing. Data were collected at baseline and immediately postintervention using the Frommelt Attitude Toward Care of the Dying- Form B, and the Debriefing Experience Scale, and role selection.

Data were analyzed using descriptive statistics, Mann-Whitney U tests, independent samples t tests, and two-way analysis of variance. There was a marginally significant difference in attitudes toward the care of dying patients (p = .05) from pretest to posttest suggesting a potential but not pronounced impact from the simulation. Attitudes toward the care of dying patients showed similar improvement in both groups, indicating no differential effect of the debriefing method. However, participants in the TiPS debriefing group had a statistically significantly more positive debriefing experience than those in the Plus-Delta group. There were no differences noted in attitudes or debriefing experience between active participants and observers.

The findings also revealed that debriefing method and role did not jointly affect attitudes toward the care of dying patients. Students’ attitudes toward the care of dying patients can improve after an EOL simulation irrespective of debriefing methods used. The TiPS debriefing method is favored by students and effectively improves their debriefing experience after an EOL simulation, regardless of participant role. Nurse educators can optimize their resources by including an observer role, if all students participate in the structured debriefing.