Background In UK, palliative and end of life care services are under significant strain due increased number of dying population and aging palliative care nursing workforce combined with staff shortages and a recruitment crisis. Conversely, current nurse education do not prepare students with positive attitude and necessary end of life care skills to meet this critical workforce crisis. Comparing to traditional teaching methods, simulation is proven to enhance clinical skills and positive attitudes, yet little is known about its effectiveness on End of Life care Education.

Aim To design, use and assess the effectiveness of high-fidelity simulation teaching session for first year nursing students on dealing with first death experiences in their clinical placement.

Methods Using qualitative approach, this study conducted with two stages. At first, two groups (n=48) of total eight first year students groups (n=167) randomly selected and received two high-fidelity simulation scenarios on end of life care topics; rest received traditional methods a seminar led discussion. In the second stage, when all return from their first clinical placement, we conducted in total of 12 individual in-depth interviews with both students who attended simulation based teaching (n=7) and also with traditional teaching methods (n=5). Data were analysed using Framework design.

Findings Despite both teaching-learning strategies improved students' knowledge on end of life care, in contrast traditional methods students who received simulation based End of Life care Education were better prepared in terms of emotional experience and enhanced hands on practical skills in their first clinical placement. Limitations of using simulation as teaching-learning strategy for teaching end of life care topics were identified.

Conclusions Using simulation based end of life care teaching-learning strategies perceived to produce positive clinical outcomes. Further research needed to explore wider application of simulation in diverse end of life care topics in preregistration nursing education and clinical practice.