Design, implementation, and evaluation of an end-of-life care educational program for undergraduate nursing students

Nurses, as the largest group of healthcare providers, play a key role in end-of-life care. However, this topic has received limited attention in nursing curricula, particularly in Iran, despite the essential role of education in improving care quality. This study aimed to design, implement, and evaluate an educational program on end-of-life care for undergraduate nursing students. This type I complex mixed-methods study was conducted in two phases between 2023 and 2025. In the first phase, students’ educational needs were identified through scoping reviews and semi-structured interviews, followed by qualitative analysis, and an educational program was developed based on the Harden model. In the second phase, a quasi-experimental, non-equivalent-groups design study was conducted with sixth-semester nursing students assigned to intervention and control groups. The intervention group received four sessions of end-of-life care training using active learning approaches, while the control group received no intervention. Students’ attitudes, knowledge, and perceived performance were assessed before and one month after the intervention using standardized questionnaires. Six main themes were identified, including principles of end-of-life care, physical care, psychosocial care, spiritual care, care challenges, and post-death care, with particular emphasis on psychosocial and spiritual care as key components. Also, ANCOVA results indicated significant between-group effects for attitude (F(1,63) = 11328.85, p < 0.001, η 2 = 0.994), knowledge (F(1,63) = 145.80, p < 0.001, η 2 = 0.679), and perceived performance (F(1,63) = 116.40, p < 0.001, η 2 = 0.628) after controlling for baseline scores. The qualitative findings were consistent with and provided support for the quantitative results. The educational program developed based on the Harden model significantly improved nursing students’ attitudes, knowledge, and perceived performance in end-of-life care. Incorporating this content into undergraduate nursing curricula and continuing education programs is recommended . Not applicable.