DNP Final Report: IMPROVING UNDERGRADUATE NURSING STUDENTS' SELF-EFFICACY WITH DIFFICULT CONVERSATIONS: AN EVIDENCE-BASED QUALITY IMPROVEMENT PROJECT

Nursing students have minimal preparation and a lack of self-efficacy when engaging in difficult conversations with patients, especially those in end-of-life care. This project aimed to improve nursing students' self-efficacy by implementing an end-of-life scenario during a communication simulation. The following PICOT question guided the systematic search for evidence: Will undergraduate nursing students (P) who participate in communication simulations that engage students in difficult conversations (I), compared to not having communication simulations that engage students in difficult conversations (C), have improved self-efficacy in difficult conversations (O) during the Spring semester of 2024 through the Spring semester of 2025 (T)? After a database search, fifteen articles were selected for the BOE related to simulation-based learning (SBL), face-to-face or online in combination with standardized patients (SPs), team-based learning (TBL), traditional didactic, or video recordings. The New General Self-Efficacy Scale (NGSE), an eight-question Likert scale, was administered to the students (n=51) before and after the communication simulation. There was a notable difference between the pre-mean of 34.05 (SD 3.78) and the post-mean of 36.52 (SD 4.30), with an increase of 7.2% in the student's self-efficacy after the simulation. The 2 nd PDSA cycle resulted in a similar result as the pilot did, indicating the pre-mean of 33.41 (SD 4.40) and the post-mean of 35.76 (SD 4.19), with an increase of 7.03%. This project showed that hospice communication simulations improve nursing students’ self-efficacy.