Online Simulation in Palliative Care Education for Early-Career Nurses in Japan: A Pre–Post Exploratory Evaluation of Perceived Outcomes and Feasibility

Background: Early-career nurses often encounter difficulties in symptom management and communication with patients and families in palliative care. Although simulation-based education improves clinical competence, most programs require in-person participation. Evidence regarding the feasibility and outcomes of fully online simulation with immediate feedback for palliative care training remains limited. Objective: To examine the perceived outcomes and feasibility of a fully online simulation-based palliative care education program for early-career nurses in Japan. Design: Exploratory pre–post, single-arm study. Setting/Subjects: The study was conducted in Japan and included 34 early-career nurses with 2–4 years of clinical experience who participated in a 90-minute online program delivered via Zoom. Measurements: The program comprised briefing, simulation, group work, and debriefing sessions focusing on total pain and communication. Outcomes were assessed at baseline, immediately post-intervention, and 1 month after using the Palliative Care Difficulties Scale, Nurses’ Difficulty with Cancer Care Scale, Palliative Care Self-reported Practices Scale, and measures of confidence and satisfaction. Open-ended responses were analyzed descriptively. Results: Scores improved significantly from baseline in Palliative Care Difficulties Scale scores for symptom alleviation ( p = 0.024, d = 0.41) and communication ( p = 0.002, d = 0.57). Confidence in recognizing total pain ( p = 0.008, d = 0.63) and communication ( p = 0.011, d = 0.66) increased from baseline. Researcher-rated practice levels improved in 9 of 14 items, and mean satisfaction was 5.2/6. Qualitative findings indicated that most participants applied their learning in clinical practice. Conclusions: These findings suggest that the program may contribute to improvements in perceived difficulties and confidence, supporting its potential feasibility as an educational model.