Background Despite growing numbers of children with life-limiting conditions (Fraser, Gibson-Smith, Jarvis, et al. Palliat Med. 2021; 35(9): 1641–1651), increased complexity of care and acknowledgement of the need for a competent and capable workforce, challenges in the teaching of paediatric palliative care (PPC) education remains (Malcolm, McGirr. Nurs Educ Today. 2020; 89:104417). Simulation learning was introduced to involve a children’s hospice care team in authentic immersive learning situations. Simulation is widely used in education (Berragan. Nurs Educ Today. 2011; 31: 660–663), but is limited in paediatric palliative care (Wells, Montgomery, Hiersche. BMJ Support Palliat Care. 2022;12:e497–e500).

Methods Simulations were designed following a Learning Needs Analysis to meet individual and organisational needs. Topics have included sepsis and acute deterioration, care after death, advance care planning communication, seizures, delivering symptom management in community settings and emergency tracheostomy management. Simulations were prepared with key learning outcomes identified, candidate and facilitator information briefs and set-ups required. Simulation sessions include a 10-minute pre-brief, 15 minutes simulated scenario and 30 minutes debrief with refreshments. Each session is delivered by 2 facilitators for 4 staff members. Quantitative and qualitative feedback was gathered using a 5-point Likert scale and free text questions. Facilitators have reflected on the process.

Results Challenges. Few staff within the hospice had formal training in, or previous experience of, delivering simulation teaching debrief sessions. Participants’ anxiety pre and during simulation and anxiety from doctors who were called by participants during scenarios. Little evidence of paediatric palliative care simulations so innovation needed. Low-fidelity equipment in hospice due to cost of high-fidelity equipment. Balancing acute clinical care learning needs with palliative care learning needs.

Benefits. Empowering staff. Well received by staff. Developing clinical skills and leadership. Improved safety. Identifies ongoing training needs. Extended into non-clinical training for whole organisation (such as fire safety and communication). Need to identify learning needs first.

Conclusion Despite practical challenges, initial high staff anxiety and limited previous experience and evidence, hospice staff find realistic immersive simulation-based learning positive for learning and practice, improving safety and leadership.