Abstract
Background: Registered nurses have reported feeling unprepared and lacking proper skills for critical end-of-life discussions with patients and their families (Kerr et al., 2020). Virtual reality (VR) simulation presents a novel approach to providing immersive opportunities to support learning and skill development (Liu et al, 2023; Sinurat et al.,2025). VR has been successfully integrated into nursing education to support clinical skill development (Foronda et al. 20220; Liu et al, 2023), however less research has focused on specific applications for complex medical discussions.
Purpose: This project aimed to develop and examine the feasibility of using VR simulation as an educational intervention to strengthen pre-licensure nursing students' skills in difficult end-of-life discussions.
Methods: Guided by the International Nursing Association for Clinical Simulation and Learning healthcare simulation standards of best practice framework (Watts et al., 2021), an immersive VR case scenario was developed. Case objectives, skill checklists, and specialized pre-briefing and debriefing tools were built. A 15-minute VR simulation case was implemented across three semesters in a senior pre-licensure nursing leadership course.
Results: The VR case was created and successfully implemented. Preliminary feedback emphasized student inexperience with difficult discussions and a lack of end-of-life experience during clinical rotations. Additionally, iterative adjustments were made each semester, including refinement of structure, enhancement of dialogue, and modification of briefing tools to align with learner needs.
Implications: This case development and pilot implementation provides preliminary evidence to support VR simulation as an innovative, effective pedagogical approach for developing nursing skills in end-of-life communication. It contributes to the growing evidence base for technology-enhanced simulation and provides a replicable model for addressing critical gaps in communication skills training (Foronda et al. 20220; Liu et al, 2023; Sinurat et al.,202). Future research will focus on perceived student competency and comfort with end-of-life discussions before and after VR implementation.
Notes
References:
1. Foronda, C. L., Fernandez-Burgos, M., Nadeau, C., Kelley, C. N., & Henry, M. N. (2020). Virtual simulation in nursing education: A systematic review spanning 1996 to 2018. Simulation in Healthcare, 15(1), 46-54. https://doi.org/10.1097/SIH.0000000000000411
2. Kerr, D., Milnes, S., Ammentorp, J., McKie, C., Dunning, T., Ostaszkiewicz, J., Wolderslund, M., & Martin, P. (2020). Challenges for nurses when communicating with people who have life-limiting illness and their families: A focus group study. Journal of Clinical Nursing, 29(3-4), 416–428. https://doi.org/10.1111/jocn.15099
3. Liu, K., Zhang, W., Li, W., Wang, T., & Zheng, Y. (2023). Effectiveness of virtual reality in nursing education: a systematic review and meta-analysis. BioMed Central Medical Education, 23(1). https://doi.org/10.1186/s12909-023-04662-x
4. Sinurat, S., Karo, M. B., Simbolon, R., Saragih, I. D., Tarihoran, D. E. T. A. U., Sharma, S., & Chou, F.-H. (2025). The efficacy of virtual-reality teaching and learning method in enhancing interprofessional knowledge, clinical skill performance, and self-confidence in nursing education: A systematic review and meta-analysis. Nurse Education Today, 149. https://doi.org/10.1016/j.nedt.2025.106661
5. Watts, P. I., McDermott, D. S., Alinier, G., Charnetski, M., Ludlow, J., Horsley, E., Meakim, C., & Nawathe, P. A. (2021). Healthcare simulation standards of best practice: Simulation design. Clinical Simulation in Nursing, 58, 14–21. https://doi.org/10.1016/j.ecns.2021.08.009
Sigma Membership
Delta Sigma
Lead Author Affiliation
St. John Fisher University, Rochester, New York, USA
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Pilot/Exploratory Study
Keywords:
Teaching and Learning Strategies, Simulation, Hospice, Palliative Care, End-of-Life, Terminal Care, Virtual Reality, Patient Simulation, Communication, Communication Skills
Recommended Citation
Ledwin, Kathryn M.; Abraham, Kylene; and Parker, Karen, "Virtual Reality Simulation for End-of-Life Communication: Case Development and Pilot Implementation" (2026). International Nursing Research Congress (INRC). 63.
https://www.sigmarepository.org/inrc/2026/presentations_2026/63
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-07-26
Virtual Reality Simulation for End-of-Life Communication: Case Development and Pilot Implementation
Toronto, Ontario, Canada
Background: Registered nurses have reported feeling unprepared and lacking proper skills for critical end-of-life discussions with patients and their families (Kerr et al., 2020). Virtual reality (VR) simulation presents a novel approach to providing immersive opportunities to support learning and skill development (Liu et al, 2023; Sinurat et al.,2025). VR has been successfully integrated into nursing education to support clinical skill development (Foronda et al. 20220; Liu et al, 2023), however less research has focused on specific applications for complex medical discussions.
Purpose: This project aimed to develop and examine the feasibility of using VR simulation as an educational intervention to strengthen pre-licensure nursing students' skills in difficult end-of-life discussions.
Methods: Guided by the International Nursing Association for Clinical Simulation and Learning healthcare simulation standards of best practice framework (Watts et al., 2021), an immersive VR case scenario was developed. Case objectives, skill checklists, and specialized pre-briefing and debriefing tools were built. A 15-minute VR simulation case was implemented across three semesters in a senior pre-licensure nursing leadership course.
Results: The VR case was created and successfully implemented. Preliminary feedback emphasized student inexperience with difficult discussions and a lack of end-of-life experience during clinical rotations. Additionally, iterative adjustments were made each semester, including refinement of structure, enhancement of dialogue, and modification of briefing tools to align with learner needs.
Implications: This case development and pilot implementation provides preliminary evidence to support VR simulation as an innovative, effective pedagogical approach for developing nursing skills in end-of-life communication. It contributes to the growing evidence base for technology-enhanced simulation and provides a replicable model for addressing critical gaps in communication skills training (Foronda et al. 20220; Liu et al, 2023; Sinurat et al.,202). Future research will focus on perceived student competency and comfort with end-of-life discussions before and after VR implementation.
Description
A VR simulation pilot case was developed to prepare nursing students in end-of-life communication. A 15-minute immersive VR scenario with branching dialogue was created and then implemented over three semesters, with subsequent refinements based on feedback. Results indicated students lacked experience in difficult conversations and appreciated the learning opportunity. The approach shows promise as an innovative way of teaching difficult discussions in nursing education.