communication skills, culture, end-of-life, nursing students, undergraduate



  1. Li, Hui MD
  2. Gu, Huaiting PhD
  3. Chi, Cheng PhD
  4. Jiang, Hong MD
  5. Zhou, Yuanyuan RN
  6. Jia, Wenxiao
  7. Liu, Qiushi MD


Nurses face many difficulties and challenges related to how patients and their families deal with communication about end-of-life (EOL) care in China because of the strong influence of traditional Chinese culture. Moreover, education and training opportunities in EOL communication skills for nursing students are rare in mainland China. This study designed a progressive case involving a common EOL communication dilemma related to traditional Chinese culture and trained 50 undergraduate nursing students in EOL communication skills. A quasi-experimental design was used to compare the training outcomes of nursing students who were divided into a standardized patient simulation group and a role-playing group. The role-playing group (23 participants) was trained via group case discussion and role-playing among classmates, while the standardized patient simulation group (27 participants) completed EOL communication training by interacting with standardized patients and their families in a high-fidelity simulation. Attitudes toward death, self-confidence in EOL communication, and communication learning were evaluated in both groups during preintervention and postintervention. The results showed that all 3 variables improved after the intervention. This study shows that EOL communication skills training has a positive effect on nursing students to a certain extent.