Page 252 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Nursing students’ views on advance directives

exercises, which emphasize both procedural knowledge experiential activities—have demonstrated preliminary
and moral reasoning, may have fostered deeper ethical trends of superior effectiveness compared to traditional
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reflection. Embedding structured discussions on the methods, with a standardized mean difference of 0.73
ethical complexities of organ donation could therefore be in knowledge outcomes. Applying this model to AHD
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essential to balance factual instruction with personal and education could increase accessibility, reinforce key
cultural exploration. concepts through spaced learning, and optimize long-term
The module’s emphasis on simulation and role-play retention as well as real-world application.
likely contributed to students’ increased awareness of Integrating behavioral audit strategies alongside
communication needs regarding therapies and pain innovative blended delivery models could therefore enable
management. Previous research confirms that experiential nursing programs not only to foster attitudinal change but
learning promotes both practical skill acquisition and also to achieve measurable improvements in the quality of
empathic engagement. Future curricular initiatives could advance-care conversations, ultimately enhancing patient-
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further enhance these outcomes by integrating high- centered care at the end of life.
fidelity simulations and standardized patient encounters to An additional priority is fostering emotional resilience.
strengthen skills in navigating difficult conversations. Palliative care environments expose nurses to profound
Interprofessional learning is increasingly recognized ethical and emotional challenges, and resilience skills are
as a best practice in palliative care education, promoting crucial for sustaining professional well-being. Rushton
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collaboration and role clarity among future health-care et al. proposed a collaborative model for building moral
teams. Expanding educational modules to include joint resilience through structured debriefings and peer support.
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sessions with medical, social work, and allied health Embedding such reflective practices into palliative care
students may foster more holistic, patient-centered education, especially after high-intensity simulations, may
approaches to end-of-life care. help students process difficult emotions, mitigate moral
distress, and promote long-term professional sustainability.
The module’s impact on students’ spiritual perspectives
also deserves attention. The unanimous shift away from “no Taken together, the findings support the strategic
religious assistance” reflects the importance of addressing incorporation of AHD education within broader
cultural and spiritual diversity in palliative training. Studies palliative care training, emphasizing active, reflective,
have shown that spiritual beliefs and family dynamics and interprofessional methodologies to prepare nursing
strongly influence end-of-life decisions. 13,16 Incorporating students for the complex realities of end-of-life care.
multicultural case vignettes and discussions could better Although the open-ended responses yielded valuable
prepare students to honor each patient’s unique worldview. insights into students’ evolving perspectives, the
The thematic content of the free-text responses qualitative analysis was intentionally kept descriptive
provided valuable insight into students’ evolving views, rather than interpretive. Rather than applying a formal
particularly regarding dignity, autonomy, and spirituality. coding framework, the analysis focused on identifying
Even without statistical significance, these narratives the most frequent semantic patterns to capture emerging
enhance our understanding of how students internalize sentiments across the cohort. This approach allowed
end-of-life concepts. for an overview of key conceptual areas such as dignity,
autonomy, and spirituality; however, it limited the
To move beyond attitudinal change, it is crucial to interpretive depth typically afforded by more structured
assess whether these educational interventions translate qualitative methodologies such as reflexive thematic
into measurable effects on clinical practice. Audit-and- analysis 38,39 or framework analysis. 40,41 In addition, the
feedback interventions have been shown to improve absence of triangulation and peer debriefing may have
nursing compliance with documentation practices, constrained the trustworthiness of the findings. 42-44 Future
with post-intervention rates exceeding 70% in several studies should therefore consider incorporating rigorous
educational settings. 32-35 Embedding structured audits of qualitative designs—including iterative coding, inter-rater
AHD-related conversations during clinical placements, reliability checks, and deeper contextual interpretation—
coupled with individualized feedback, could provide to more fully explore the moral reasoning and emotional
objective evidence linking student participation in such responses elicited by end-of-life training.
training to improvements in both the quality and frequency
of end-of-life discussions. 4.1. Limitations and future directions
Moreover, blended learning approaches—which This study presents several limitations that should be
combine asynchronous e-learning with face-to-face acknowledged. First, no data were collected on the disease

Volume 9 Issue 3 (2025) 244 doi: 10.36922/EJMO025250263