Mindful Simulation Training in Palliative Care Education for Nursing Students

Effects of Mindful Simulation Training in Palliative Care Education for Nursing Students: A Randomized Controlled Trial

Nursing students frequently encounter dying patients during clinical placements with limited preparation, leading to negative attitudes toward end-of-life care, death anxiety, and risk of compassion fatigue. Simulation-based education offers a safe environment for experiential learning in palliative care, yet most existing programs do not integrate mindfulness components to address the psychological demands of this setting. Mindfulness-based interventions have shown promise in improving self-compassion and reducing burnout in healthcare professionals, but evidence among undergraduate nursing students remains limited.

This study aims to evaluate the effects of a Mindful Simulation Training (MST) program on compassion, palliative care knowledge, attitudes toward end-of-life care, and professional quality of life among undergraduate nursing students.

Study Overview

• Status: Active, not recruiting
• Conditions: Undergraduate Nursing Students
• Intervention / Treatment: Behavioral: Mindfulness-based intervention; Behavioral: Simulation-based learning

Detailed Description

Palliative care addresses the physical, psychological, social, cultural, and spiritual needs of patients with life-limiting illness and their families. In Hong Kong, palliative care services have expanded from hospital settings to community care homes, increasing demand for well-prepared nursing graduates. Nursing students as the future palliative care workforce often encounter dying patients during placements with inadequate educational preparation, resulting in negative attitudes, death anxiety, and emotional distress. Evidence shows nursing students report less positive end-of-life (EOL) attitudes and lower confidence than practicing nurses, with documented gaps in undergraduate palliative care curricula. Compassion fatigue is well established among nurses in palliative settings and has also been documented among nursing students during clinical placements. Conversely, compassion practice and adaptive coping are associated with reduced burnout and enhanced satisfaction.

Simulation-based training provides opportunities for experiential, reflective, and affective learning in palliative care, with evidence supporting improvements in knowledge, attitudes, communication, and emotional preparedness. However, few simulation studies have integrated mindfulness components specifically targeting psychological flexibility and compassion competence.

This is a three-arm, parallel-group randomized controlled trial with a sequential mixed-methods study designed to compare the effectiveness of Mindful Simulation Training (MST), Traditional Simulation Training (TST), and a Waitlist Control (WC) over a 4-week intervention period with follow-up at 8 weeks on improving the compassion, palliative care knowledge, attitudes toward end-of-life care, and professional quality of life among undergraduate nursing students.

• Study Type: Interventional
• Enrollment (Estimated): 182
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong
    • Hong Kong Metropolitan University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Nursing students aged 18 or above
• Currently studying a full-time nursing program in Hong Kong
• Regardless of the study year, e.g., Year 1 to Year 5
• Able to comprehend English and Cantonese
• Able to use electronic devices to complete an online survey
• Have enrolled or studied in the prerequisite course provides baseline knowledge in palliative care training

Exclusion Criteria:

• Nursing students who are under 18
• Have been regularly practicing instructor-led mindfulness interventions once a week or more during the past 6 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mindful Simulation Training (MST); The intervention consists of one session of a 60-min face-to-face mindfulness induction workshop, three sessions of weekly self-paced mindfulness practice, and one session of a 60-min simulation workshop.	Behavioral: Mindfulness-based intervention; The face-to-face mindfulness induction workshop will be delivered by a certified mindfulness instructor. The mindfulness interventions, including the tools and informal practice. Paper handouts regarding the mindfulness techniques and informal practice will be given to participants to facilitate the learning and self-paced practice.; Behavioral: Simulation-based learning; The simulation scenario will consist of 3 components, including pre-briefing, simulation activity, and debriefing.
Active Comparator: Traditional Simulation Training (TST); The participants will attend one session of a 60-min simulation workshop and receive the mindfulness materials upon completion of the 2-month study period.	Behavioral: Simulation-based learning; The simulation scenario will consist of 3 components, including pre-briefing, simulation activity, and debriefing.
No Intervention: Waitlist Control (WC); The wait-list control group will continue with usual learning activities and receive the mindful simulation training upon completion of the 2-month study period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Compassion	Compassionate Engagement and Action Scales (CEAS) measures three themes of compassion: 1) Self-compassion; 2) Compassion for others; 3) Compassion from others. Each scale consists of 13 items to measure different elements in compassion engagement and action which will be rated on a 10-point Likert scale from 1 (never) to 10 (always)	Baseline, 4 weeks, and 8 weeks after baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Attitude towards Palliative Care	The Frommelt Attitudes Towards Care of Dying Scale (FATCOD-B) assesses attitudes using 30 items on a 5-point Likert scale. The scale includes an equal distribution of positive and negative statements. Participants rate their agreement with each statement on a scale from 1 to 5, where 1 represents "Strongly Disagree" and 5 represents "Strongly Agree."	Baseline, 4 weeks, and 8 weeks after baseline
Knowledge in Palliative Care	The Palliative Care Knowledge Test (PCKT), a 20-item assessment, evaluates knowledge across five key domains: philosophy of palliative care (two items), pain management (six items), dyspnea (four items), psychiatric issues (four items), and gastrointestinal problems (four items).	Baseline, 4weeks, and 8 weeks after baseline
Professional Quality of Life	The Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Version 5 (ProQoL-5) comprises three subscales: (1) Compassion Satisfaction - 10 items (2) Burnout - 10 items (3) Secondary Traumatic Stress - 10 items. ProQoL-5 assesses compassion satisfaction and compassion fatigue using 30 items rated on a 5-point Likert scale ranging from 1 to 5, where 1 represents "never" and 5 represents "very often" regarding the previous 30 days a respondent has experienced.	Baseline, 4 weeks, and 8 weeks after baseline

Collaborators and Investigators

• Sponsor: Hong Kong Metropolitan University
• Collaborators: The University of Hong Kong
• Investigators: Principal Investigator: Jojo Yan Yan Kwok, PhD, The University of Hong Kong

Study record dates

Study Major Dates

• Study Start (Actual): March 2, 2026
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): June 1, 2028

Study Registration Dates

• First Submitted: March 25, 2026
• First Submitted That Met QC Criteria: March 25, 2026
• First Posted (Actual): March 31, 2026

Study Record Updates

• Last Update Posted (Actual): March 31, 2026
• Last Update Submitted That Met QC Criteria: March 25, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: HE-SF2026/09

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No