{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T18:05:24Z","timestamp":1779991524002,"version":"3.53.1"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Special Project of the Scientific Research Development Center of Higher Education Institutions of the Ministry of Education of China","award":["(ZJXF2022300)"],"award-info":[{"award-number":["(ZJXF2022300)"]}]},{"name":"the Open Project of Luzhou Key Laboratory of Wound Healing Basic Research and Clinical Application, School of Nursing, Southwest Medical University","award":["(2025KFKTYB14)"],"award-info":[{"award-number":["(2025KFKTYB14)"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Palliative care often involves nursing for complex patient groups at the end of life, which requires specialized knowledge and ethical considerations. Therefore, it is full of challenges when carrying out practical teaching. Nursing students, as the next generation of healthcare professionals, will assume the important responsibility of providing specialized health services related to end-of-life care (EOLC). A deficit in direct clinical practice may impede the acquisition of essential knowledge and ability in palliative care for nursing students.Virtual clinical simulation (VCS) is acknowledged as an effective educational tool in nursing education. However, its application in palliative care education remains underexplored, particularly through rigorous study designs. While VCS has been tested in areas such as acute care or clinical deterioration, there is a global scarcity of randomized controlled trials (RCTs) evaluating its effectiveness in palliative care education, and relevant research in China remains limited. In this study protocol, we hypothesize that VCS will improve nursing students\u2019 knowledge, ability, and attitudes regarding palliative care, compared to conventional teaching alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study protocol outlines a prospective RCT aimed at evaluating the educational benefits of incorporating VCS into the curriculum for nursing students at a medical university in southwestern China.These students, registered for the elective\n                      <jats:italic>Cultural Perspectives on Death and End-of-Life Education<\/jats:italic>\n                      will be systematically invited to join this research. The study will randomly assign 96 students into two distinct groups: a control group and an intervention group, each comprising 48 students. The control group will participate solely in conventional classroom teaching, whereas the intervention group will receive both conventional classroom teaching and enhanced learning through an additional VCS system, aimed at improving their knowledge, ability and attitudes regarding palliative care. The intervention is grounded in experiential learning theory, which supports the use of simulated environments to foster reflective practice and skill acquisition. Assessments will occur at baseline and post-intervention of the VCS, with the primary metrics for evaluation encompassing variations in students\u2019 knowledge, ability, and attitudes concerning palliative care, as well as their satisfaction with VCS pedagogy and confidence in applying their newly acquired skills and knowledge in practical medical settings. As this is a protocol paper, no outcome data are yet available.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>VCS may be an effective tool to enhance nursing students\u2019 palliative care knowledge, ability, and attitudes, and it provides scientific evidence to inform nursing students in selecting the most appropriate approach for their palliative care education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Chinese Clinical Trial Registry: ChiCTR2500096377, Registered on January 22, 2025.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349168","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T17:28:26Z","timestamp":1779989306000},"page":"e0349168","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of virtual clinical simulation in palliative care education for nursing students: Protocol of a randomized controlled trial"],"prefix":"10.1371","volume":"21","author":[{"given":"Zhixiang","family":"Sun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pingpin","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunyan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5616-8791","authenticated-orcid":true,"given":"Jing","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meifang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"issue":"3","key":"pone.0349168.ref001","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"F Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"pone.0349168.ref002","article-title":"Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide","volume":"63","author":"WE Rosa","year":"2022","journal-title":"J Pain Symptom Manage"},{"issue":"3","key":"pone.0349168.ref003","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3928\/00220124-20210216-07","article-title":"Global Integration of Palliative Nursing Education to Improve Health Crisis Preparedness","volume":"52","author":"WE Rosa","year":"2021","journal-title":"J Contin Educ Nurs"},{"key":"pone.0349168.ref004","article-title":"Care of the dying - medical student confidence and preparedness: mixed-methods simulation study","author":"G Wells","year":"2022","journal-title":"BMJ Support Palliat Care"},{"key":"pone.0349168.ref005","doi-asserted-by":"crossref","first-page":"106037","DOI":"10.1016\/j.nedt.2023.106037","article-title":"The impact of virtual clinical simulation on nursing students\u2019 palliative care knowledge, ability, and attitudes: A mixed methods study","volume":"132","author":"L Zhang","year":"2024","journal-title":"Nurse Educ Today"},{"key":"pone.0349168.ref006","doi-asserted-by":"crossref","first-page":"104194","DOI":"10.1016\/j.nedt.2019.08.012","article-title":"Predicted difficulties, educational needs, and interest in working in end of life care among nursing and medical students","volume":"83","author":"B Dobrowolska","year":"2019","journal-title":"Nurse Educ Today"},{"key":"pone.0349168.ref007","doi-asserted-by":"crossref","first-page":"103625","DOI":"10.1016\/j.nepr.2023.103625","article-title":"Nursing students\u2019 experiences with patient death and palliative and end-of-life care: A systematic review and meta-synthesis","volume":"69","author":"SQ Yoong","year":"2023","journal-title":"Nurse Educ Pract"},{"issue":"1","key":"pone.0349168.ref008","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1186\/s12909-024-05668-9","article-title":"Experiencing and enduring patient distress: the distress of palliative care patients and its emotional impact on physicians in training","volume":"24","author":"A Tarot","year":"2024","journal-title":"BMC Med Educ"},{"key":"pone.0349168.ref009","doi-asserted-by":"crossref","first-page":"106189","DOI":"10.1016\/j.nedt.2024.106189","article-title":"The effectiveness of virtual reality technology in student nurse education: A systematic review and meta-analysis","volume":"138","author":"P Huai","year":"2024","journal-title":"Nurse Educ Today"},{"key":"pone.0349168.ref010","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ecns.2022.05.006","article-title":"Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis","volume":"69","author":"JJM Sim","year":"2022","journal-title":"Clin Simul Nurs"},{"issue":"1","key":"pone.0349168.ref011","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1186\/s12909-023-04662-x","article-title":"Effectiveness of virtual reality in nursing education: a systematic review and meta-analysis","volume":"23","author":"K Liu","year":"2023","journal-title":"BMC Med Educ"},{"issue":"1","key":"pone.0349168.ref012","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s12909-020-1939-6","article-title":"Comparative value of a simulation by gaming and a traditional teaching method to improve clinical reasoning skills necessary to detect patient deterioration: a randomized study in nursing students","volume":"20","author":"A Blani\u00e9","year":"2020","journal-title":"BMC Med Educ"},{"issue":"3","key":"pone.0349168.ref013","doi-asserted-by":"crossref","DOI":"10.2196\/11529","article-title":"Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial","volume":"21","author":"JM Padilha","year":"2019","journal-title":"J Med Internet Res"},{"issue":"9","key":"pone.0349168.ref014","article-title":"Comparison of virtual patient simulation with mannequin-based simulation for improving clinical performances in assessing and managing clinical deterioration: randomized controlled trial","volume":"16","author":"SY Liaw","year":"2014","journal-title":"J Med Internet Res"},{"issue":"12","key":"pone.0349168.ref015","first-page":"1109","article-title":"Nurses\u2019 Hospice Knowledge Scale: Development, Reliability and Validity","volume":"19","author":"Y Shen","year":"2022","journal-title":"Chinese J Nurs Educ"},{"issue":"1","key":"pone.0349168.ref016","first-page":"179","article-title":"Latent classes and influencing factors of hospice care cognitive ability levels among nursing students","volume":"45","author":"Y Dong","year":"2024","journal-title":"J Kunming Med Univ"},{"issue":"06","key":"pone.0349168.ref017","first-page":"982","article-title":"Development and reliability and validity test of questionnaire on palliative care ability of undergraduate nursing students","volume":"35","author":"J Zhao","year":"2021","journal-title":"Chinese Nurs Res"},{"issue":"6","key":"pone.0349168.ref018","first-page":"817","article-title":"Current status and influencing factors of hospice care ability among undergraduate nursing students","volume":"20","author":"X Ming","year":"2022","journal-title":"Chin Gen Pract Nurs"},{"issue":"1","key":"pone.0349168.ref019","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/104990910302000108","article-title":"Attitudes toward care of the terminally ill: an educational intervention","volume":"20","author":"KHM Frommelt","year":"2003","journal-title":"Am J Hosp Palliat Care"},{"key":"pone.0349168.ref020","volume-title":"Revise and application of Chinese version of Frommelt attitudes toward care of the dying scale form B","author":"L Wang"},{"issue":"7","key":"pone.0349168.ref021","first-page":"1145","article-title":"Willingness to provide hospice care for terminally ill cancer patients and its influencing factors among nursing students","volume":"37","author":"ZQ Luo","year":"2023","journal-title":"Chin Nurs Res"},{"issue":"11","key":"pone.0349168.ref022","first-page":"500","article-title":"Designing and implementing models for the innovative use of simulation to teach nursing care of ill adults and children: A national, multi-site, multi-method study","volume":"5","author":"PR Jeffries","year":"2006","journal-title":"National League for Nursing"},{"issue":"8","key":"pone.0349168.ref023","article-title":"Use of simulation among Chinese nursing students","volume":"9","author":"AL Wang","year":"2013","journal-title":"Clin Simul Nurs"},{"issue":"2","key":"pone.0349168.ref024","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"F Faul","year":"2007","journal-title":"Behav Res Methods"},{"issue":"1","key":"pone.0349168.ref025","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.nedt.2014.09.009","article-title":"Effectiveness of patient simulation in nursing education: meta-analysis","volume":"35","author":"S Shin","year":"2015","journal-title":"Nurse Educ Today"},{"key":"pone.0349168.ref026","doi-asserted-by":"crossref","first-page":"105164","DOI":"10.1016\/j.nedt.2021.105164","article-title":"The effectiveness of the virtual patient-based social learning approach in undergraduate nursing education: A quasi-experimental study","volume":"108","author":"G-J Hwang","year":"2022","journal-title":"Nurse Educ Today"},{"key":"pone.0349168.ref027","doi-asserted-by":"crossref","first-page":"1351300","DOI":"10.3389\/fmed.2024.1351300","article-title":"Enhancing nursing competency through virtual reality simulation among nursing students: a systematic review and meta-analysis","volume":"11","author":"M-K Cho","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"pone.0349168.ref028","doi-asserted-by":"crossref","first-page":"104182","DOI":"10.1016\/j.nepr.2024.104182","article-title":"Effect of virtual reality training on clinical skills of nursing students: A systematic review and meta-analysis of randomized controlled trials","volume":"81","author":"M-Y Lin","year":"2024","journal-title":"Nurse Educ Pract"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T17:28:31Z","timestamp":1779989311000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349168"}},"subtitle":[],"editor":[{"given":"Mostafa","family":"Shaban","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0349168","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}