The Effect of Simulation-Based Learning Experiences on Nursing Students' Knowledge, Skills and Self-Efficacy Levels in Teaching Postmortem Care
Phase: NA
Conditions: Postmortem Care
Sponsor: Istanbul University - Cerrahpasa

12.08.2025 
Official Study Title: The Effect of Simulation-Based Learning Experiences on Nursing 
Students' Knowledge, Skills and Self-Efficacy Levels in Teaching Postmortem Care 
NCT Number: Not yet assigned 
Document Title: Study Protocol 
Document Date: 12 August 2025 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

12.08.2025 
Study Protocol 
PURPOSE AND TYPE OF THE STUDY 
This study is planned as a randomized controlled experimental design to investigate the effect 
of simulation-based learning experiences in the teaching of postmortem care on the knowledge, 
skills, and self-efficacy levels of nursing students. In this context, the CONSORT 2025 
principles (Consolidated Standards of Reporting Trials) will be followed in the design and 
implementation of the study. 
HYPOTHESES OF THE STUDY 
Hypothesis 1 (H1): The postmortem care knowledge levels of students who experience 
simulation-based learning are higher compared to those using traditional methods. 
Hypothesis 2 (H2): The postmortem care skill levels of students who experience simulation-
based 
learning 
are 
higher 
compared 
to 
those 
using 
traditional 
methods. 
Hypothesis 3 (H3): The end-of-life and postmortem care self-efficacy levels of students who 
experience simulation-based learning are higher compared to those using traditional methods. 
Additionally, it is expected that students who experience simulation-based learning will have 
higher levels of student satisfaction and self-confidence in learning. 
VARIABLES OF THE STUDY 
Independent Variables of the Study: 
• 
Demographic characteristics of the students 
Dependent Variables of the Study: 
• 
Postmortem care knowledge assessment test scores of the students 
• 
Postmortem care simulation skill checklist scores of the students 
• 
Mean scores obtained by the students from the End-of-Life and Postmortem Care Self-
Efficacy Scale 
• 
Levels of satisfaction with learning among students in postmortem care simulation 
education 
• 
Levels of self-confidence in learning among students in postmortem care simulation 
education 

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• 
Mean scores obtained by the students from the Simulation Design Scale regarding 
postmortem care 
PLACE AND TIME OF THE STUDY 
The study is planned to be conducted during the 2025-2026 academic year at the Acıbadem 
University Center of Advanced Simulation and Education (CASE). The Acıbadem University 
Center of Advanced Simulation and Education holds a Center of Excellence certification from 
the Canadian Aviation Electronics Academy (CAE). Additionally, this center, accredited by the 
Network of Accredited Clinical Skills Centers of Europe (NASCE) and the Society for 
Simulation in Healthcare (SSH), which evaluates clinical skills centers in Europe, adheres to 
international standards in simulation-based education. 
UNIVERSE AND SAMPLE OF THE STUDY 
Universe of the Study 
The universe of the study will consist of fourth-year nursing students enrolled in the Faculty 
of Health Sciences, Department of Nursing, Acıbadem University during the 2025-2026 
academic year. 
Sample of the Study 
The sample of the study will comprise fourth-year students who agree to participate and meet 
the inclusion criteria. The sample size was determined based on a power analysis (G*Power 
3.1.9.7) using data from a similar study (Alwawi & İnkaya, 2022) with an independent t-test 
sample calculation, resulting in a test power of 0.99, 99% confidence (1-α), and an effect size 
of f=1.02, requiring a minimum of 31 participants per group, totaling 62. To account for 
potential sample loss, an additional 10% of the sample will be included, planning for 34 
participants per group, resulting in a total of 68 participants. 
Randomization in the Study: The allocation of students included in the study to either the 
experimental or control group will be determined using the simple randomization method via 
the Random Allocation Software program. 
Inclusion Criteria 
• 
Being literate in Turkish 

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• 
Being 18 years of age or older 
• 
Having no history or presence of psychiatric disorders/illnesses, not receiving 
psychiatric treatment, and not using psychiatric medication 
• 
Having not previously received education or training on postmortem care 
• 
Having not previously provided postmortem care 
Exclusion Criteria 
• 
Having lost a close relative within the last year 
DATA COLLECTION TOOLS 
Data will be collected using the "Demographic Characteristics Form," "Postmortem Care 
Knowledge Assessment Test for Nursing Students (PCKATNS)," "Postmortem Care 
Simulation Checklist (PCSC)," "End-of-Life and Postmortem Care Self-Efficacy Scale for 
Nursing Students (ELPMCSESN)," "Student Satisfaction and Self-Confidence in Learning 
Scale," and "Simulation Design Scale." 
Demographic Characteristics Form 
The Demographic Characteristics Form, prepared by the researchers based on the 
literatüre, consists of a total of 12 questions. The form includes socio-demographic data such 
as the students' age and gender, academic performance (general academic grade point average-
GPA), familiarity with simulation applications, experiences with postmortem care 
knowledge/skills, previous experience of loss, the timing of any loss if experienced, their 
perception of adequacy in supporting family members, and their opinion on the effectiveness 
of using simulation-based learning methods. The form also includes three questions related to 
exclusion criteria: experiencing a close loss within the last year, having previously provided 
postmortem care, and having participated in education or training on end-of-life care or death. 
Additionally, students will be asked to indicate their perceived level of adequacy in providing 
postmortem care on a Visual Analog Scale ranging from 0 to 10. 
Postmortem Care Knowledge Test for Nursing Students 
The Postmortem Care Knowledge Test for Nursing Students (PCKTNS) is a multiple-
choice test with five options and 25 questions, developed by the researchers based on the 

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literatüre and aligned with the content of the theoretical education. Each question in the 
knowledge test is worth four (4) points. The total score obtainable from the test ranges from 0 
to 100. The average completion time for the test is 30 minutes. An increase in the score indicates 
a higher level of postmortem care knowledge, while a decrease indicates a lower level. This test 
will be administered as a pre-test to students in both the experimental and control groups before 
the theoretical education. The Postmortem Care Knowledge Test for Nursing Students will be 
submitted to expert opinion by the researchers. 
Postmortem Care Simulation Skill Checklist 
The Postmortem Care Simulation Skill Checklist is designed by the researchers based 
on the literatüre and tailored to the simulation scenario to evaluate the psychomotor skills and 
teamwork of students in applying postmortem care following simulation-based education. The 
checklist includes application steps related to postmortem care and allows the researcher to 
assess whether students perform the relevant steps. The checklist contains 27 application steps 
expected from the student. Each step is scored as "Performed: 1 point," "Partially Performed: 
0.5 points," and "Not Performed: 0 points" based on the execution of the skill. The maximum 
total score obtainable from the Postmortem Care Simulation Checklist is 27, and the minimum 
total score is 0. An increase in the student's score on the checklist is considered to indicate a 
higher level of performance in postmortem care application steps. The Postmortem Care 
Simulation Skill Checklist will be submitted to expert opinion by the researchers for evaluation 
of its appropriateness. 
End-of-Life and Postmortem Care Self-Efficacy Scale for Nursing Students 
The End-of-Life and Postmortem Care Self-Efficacy Scale for Nursing Students, 
developed by Conley in 2023 to assess nursing students' self-efficacy in end-of-life and 
postmortem care, underwent a Turkish validity and reliability study by Kovancı, Bilgin, and 
Öcalan in 2024. The original scale consists of 18 items and is a visual analog scale. Participants 
can rate each item on the scale from 0 (no confidence) to 100 (high confidence). The mean 
score obtained from the scale indicates the self-efficacy level. A mean score of 90-100 is 
interpreted as very high, 80-89 as high, 70-79 as moderate, 60-69 as low, and 59 or below as 
very low self-efficacy. The Cronbach's alpha coefficient of the original scale was found to be 
0.93. The Turkish validity and reliability study determined the Cronbach's alpha coefficient as 
0.90. 

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Student Satisfaction and Self-Confidence in Learning Scale 
The Student Satisfaction and Self-Confidence in Learning Scale, developed by Jeffries 
and Rizzolo in 2006 with 13 items to measure students' satisfaction with simulation activities 
and their self-confidence in learning, underwent a Turkish validity and reliability study by 
Ünver et al. in 2017 and was revised to 12 items. The scale items are evaluated on a five-point 
Likert scale and consist of two sub-dimensions. The first sub-dimension, "Satisfaction with 
Current Learning," includes five items, and the second sub-dimension, "Self-Confidence in 
Learning," includes seven items. The total Cronbach's Alpha coefficient of the scale is 0.89. 
The Cronbach's Alpha coefficients of the sub-dimensions are 0.85 and 0.77, respectively. An 
increase in the total score obtained from the scale indicates a higher level of student satisfaction 
and self-confidence in learning. 
Simulation Design Scale 
The Simulation Design Scale, developed by Jeffries and Rizzolo in 2006, underwent a 
Turkish validity and reliability study by Ünver et al. in 2017. The scale consists of five sub-
dimensions—Objectives and Information (5 items), Support (4 items), Problem Solving (5 
items), Feedback/Guided Reflection (4 items), and Degree of Realism/Fidelity (2 items)—and 
a total of 20 items. The total Cronbach's Alpha coefficient of the scale is 0.90, with sub-
dimension Cronbach's Alpha coefficients of 0.77, 0.73, 0.76, 0.75, and 0.86, respectively. The 
scale is evaluated in two sections. The first section assesses whether the best simulation design 
elements are implemented in the simulation activity, while the second section evaluates the 
degree of importance students attribute to these design elements. The first section is rated as 
"Strongly Disagree," "Disagree," "Neutral," "Agree," "Strongly Agree," and "Not Applicable." 
The second section is rated as "Not Important," "Somewhat Important," "Neutral," "Important," 
and "Very Important." Scale scores are calculated by dividing the total of the overall and sub-
dimension scores by the number of items. An increase in the score in the first section indicates 
the presence of the best simulation design elements in the activity, while an increase in the score 
in the second section indicates a higher level of importance attributed by students to the 
simulation. 
 
 

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RESEARCH PROCESS 
First Stage 
Preparation Phase: 
The "Demographic Characteristics Form," "Postmortem Care Knowledge Assessment Test for 
Nursing Students (PCKATNS)," and "Postmortem Care Simulation Checklist (PCSC)" data 
collection tools, as well as the postmortem care simulation scenarios (teaching scenario and 
evaluation scenario) prepared by the researcher, will be submitted for expert opinion. Expert 
opinions will be evaluated using the Content Validity Index (CVI) as recommended in the 
literatüre. 
Permission to use the "End-of-Life and Postmortem Care Self-Efficacy Scale for Nursing 
Students (ELPMCSESN)," "Student Satisfaction and Self-Confidence in Learning Scale," and 
"Simulation Design Scale" data collection tools will be obtained from the authors. 
The study will be conducted as a Randomized Controlled Trial (RCT), and following the 
approval of the ethics committee, it will be registered at https://clinicaltrials.gov/. 
To teach postmortem care application to participants in the experimental and control groups 
and to reinforce the content of the theoretical education, a "Postmortem Care Skills Video" will 
be prepared by the researcher as an educational material. This video will be submitted for expert 
opinion. 
In the study, which includes fourth-year nursing students as the sample group, a "Scenario Case 
Video" (including the patient’s history and current condition) related to a deceased individual 
will be prepared to help students understand the narrative before being included in the 
postmortem care simulation scenario. This video will depict the health history of the individual 
immediately before their death and indicate that the individual is in their final minutes before 
death. The Scenario Case Video will begin with a nurse entering the room to administer nursing 
interventions for respiratory activity to an individual exhibiting dyspnea and apnea symptoms 
(oxygen therapy will be applied via a reservoir mask from the central oxygen system at 15 
L/min). During the nurse’s care application, the patient will show apnea periods, followed by 
the development of respiratory arrest, prompting a blue code to be called. The video will end 
with the blue code team entering the patient’s room with an emergency cart. This video will be 
shown to students in the experimental group before the teaching simulation and to students in 
both the experimental and control groups before the evaluation simulation. Following the video, 
students will be taken to the postmortem care simulation scenario in pairs. 

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Postmortem Care Simulation Scenario 
 
The simulation is planned in three stages: pre-briefing (orientation), simulation implementation, 
and debriefing (reflection) sessions. The scenario content has been developed based on the best 
practice standards published by the International Nursing Association for Clinical Simulation 
and 
Learning 
(INACSL), 
considering 
simulation 
design 
criteria. 
The Postmortem Care Simulation Scenario has been prepared by the researchers based on 
relevant literatüre and aligned with simulation learning objectives (performing physical 
postmortem care on a deceased individual, establishing effective communication with the team 
and family members during postmortem care, creating an appropriate environment for family 
members to say goodbye after postmortem care during the grieving process, accurately 
documenting postmortem nursing care, and coordinating the deceased individual’s transfer to 
the 
morgue). 
The 
scenario 
is 
planned 
to 
last 
approximately 
20 
minutes. 
High-fidelity simulation design optimizes learning outcomes by mimicking real clinical 
environments through three core parameters: conceptual, physical, and psychological realism. 
Conceptual realism refers to the alignment of the scenario with theoretical and clinical reality, 
incorporating real clinical contexts and logically connecting to learning objectives. In this study, 
conceptual realism will be achieved through the clinical and theoretical appropriateness of the 
postmortem care simulation scenario. Physical realism involves the simulation environment 
and tools visually, audibly, and tactilely reflecting the clinical setting. In this study, physical 
realism will be ensured by arranging the environment (palliative care clinic-patient room, quiet 
and serene setting, a photograph of the patient and family at the bedside, prayer beads, a prayer 
book, syringes, ampules, sponges scattered on the floor after CPR, blood stains dripping from 
the patient’s arm onto the bed and floor, a patient file on the nightstand with a death report and 
a morgue transfer form to be filled out by nurses) and applying a postmortem moulage to a 
high-fidelity mannequin (pale-yellow skin, sweaty forehead and chest, dark circles under the 
eyes, cyanotic lips and earlobes, open eyes, dentures removed during intubation placed on the 
nightstand, a wedding ring, nasogastric tube (NGT), IV catheters (18 Gauge) in both arms, 
defibrillator pads on the chest, urinary catheter, anti-embolic stockings, a Biatain dressing for a 
stage-4 pressure ulcer on the sacrum, fecal incontinence due to sphincter relaxation). 
Psychological realism reflects participants’ emotional and professional responses specific to 
real clinical situations. In this study, psychological realism will be achieved in the postmortem 
care simulation through the case video to engage participants emotionally and foster a 

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connection with the scenario, as well as through teamwork and an empathetic, emotional 
approach to a family member (the daughter) during the grieving process. Additionally, to 
enhance the physical realism of the simulation, a review article titled "Postmortem Care 
Simulation Moulage Algorithm: A Way to Enhance Realism" will be prepared to develop a 
postmortem moulage algorithm for the high-fidelity simulated mannequin. This algorithm will 
later be used in the study’s simulation scenario. 
Second Stage 
Implementation Phase: 
 
During the implementation phase of the study, the research design template outlined below will 
be followed. The study will commence after obtaining the necessary ethics committee and 
institutional 
permissions. 
Following the expert opinions on the Postmortem Care Simulation Scenarios, a pilot study will 
be 
conducted 
with 
a 
group 
of 
students 
representing 
the 
sample. 
The participants in both the experimental and control groups will be administered the "Informed 
Consent Form," "Demographic Characteristics Form," "Postmortem Care Knowledge Test for 
Nursing Students (PCKTNS)," and "End-of-Life and Postmortem Care Self-Efficacy Scale for 
Nursing Students (ELPMCSESN)" prior to the theoretical education. Following the pre-tests, 
it is planned to provide theoretical education for approximately 4 class hours (with each class 
hour lasting 45 minutes). The first 2 hours of the theoretical education will cover topics related 
to Death and General Aspects of Death, while the remaining 2 class hours will be delivered as 
a 
PowerPoint 
presentation 
focusing 
on 
postmortem 
care 
application 
content. 
Following the theoretical education, both the experimental and control groups will be shown 
the "Postmortem Care Skills Video." Additionally, prior to the teaching simulation for 
postmortem care, the experimental group will be shown the "Scenario Case Video," after which 
the scenario prepared for the teaching simulation will be implemented. At this stage, no 
intervention will be applied to the control group. Four weeks after the learning simulation 
administered to the experimental group, participants from both the experimental and control 
groups will be taken to the evaluation simulation in pairs. Prior to the postmortem care 
evaluation simulation, students from both the experimental and control groups will be shown 
the "Scenario Case Video," followed by the application of the scenario prepared for the 
evaluation simulation. At this stage, participants will be evaluated according to the 

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"Postmortem 
Care 
Simulation 
Checklist." 
Following the evaluation simulation, the students will be administered the "Postmortem Care 
Knowledge Test for Nursing Students (PCKTNS)," the "End-of-Life and Postmortem Care 
Self-Efficacy Scale for Nursing Students (ELPMCSESN)," the "Student Satisfaction and Self-
Confidence in Learning Scale," and the "Simulation Design Scale. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Official Study Title: The Effect of Simulation-Based Learning Experiences on Nursing 
Students' Knowledge, Skills and Self-Efficacy Levels in Teaching Postmortem Care 
NCT Number: 
Not yet assigned 
Document Title: 
Statistical Analysis Plan 
Document Date: 12 August 2025 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Statistical Analysis Plan 
Data Analysis: 
The data will be analyzed using the SPSS 25.0 software package, and statistical significance 
will be evaluated at a p<0.05 level. In evaluating the study findings, descriptive statistical 
methods (mean, standard deviation, median, frequency, percentage, minimum, maximum) will 
be used, alongside determining the normality of parameters with Shapiro-Wilk and 
Kolmogorov-Smirnov tests. For pairwise comparisons of parameters showing normal 
distribution, an independent t-test will be used; for parameters not showing normal distribution, 
Mann-Whitney U test and Kruskal-Wallis variance analysis will be applied. To assess the 
relationship between variables, Pearson correlation analysis will be used for those showing 
normal distribution, while Spearman Rho correlation analysis will be applied for those not 
showing normal distribution. Analysis of variance for repeated measures will be utilized for 
repeated measurements. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Official Study Title: 
The Effect of Simulation-Based Learning Experiences on Nursing Students' Knowledge, 
Skills and Self-Efficacy Levels in Teaching Postmortem Care 
NCT Number: 
Not yet assigned 
Document Title: 
Informed Consent Form 
Document Date: 12 August 2025 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

12.08.2025 
 
 
INFORMED CONSENT FORM FOR VOLUNTARY PARTICIPATION IN THE STUDY 
This research is a doctoral thesis study titled "The Effect of Simulation-Based Learning 
Experiences in the Teaching of Postmortem Care on the Knowledge, Skills, and Self-Efficacy 
Levels of Nursing Students," conducted by [Ozan ACAR], a doctoral student in the 
Fundamentals of Nursing Program at the Istanbul University-Cerrahpaşa Graduate Education 
Institute, under the supervision of Assoc. Prof. Dr. Aylin ÖZAKGÜL. This form has been 
prepared to inform you about the research conditions and to obtain your consent for voluntary 
participation. 
What is the Purpose of the Study? 
This research aims to determine the effect of simulation-based learning experiences in the 
teaching of postmortem care on the knowledge, skills, and self-efficacy levels of nursing 
students. 
What Do We Expect from You? 
If you agree to participate voluntarily in the study, you will be asked to respond to the questions 
in the demographic characteristics form and the scales related to the subject. Additionally, your 
participation in the theoretical education session on postmortem care and your performance of 
simulation applications aligned with scenario objectives are expected. This process has been 
designed to contribute to your professional development. 
How Will We Use the Information We Collect? 
Your participation is entirely based on voluntariness. In the research, your personal data will be 
kept confidential and will only be evaluated by the researcher for scientific purposes. The 
information you provide will not be linked to your identity and will only be analyzed in 
aggregate form. The data obtained may be used in the doctoral thesis and scientific publications. 
During the research, no information that is disturbing or unlawful will be requested from you 
in any way. 
 

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Things You Need to Know About Participation: 
• 
This research is not suitable for individuals who have lost a close relative within the last 
year. (Please contact the researcher.) 
• 
Responses to the demographic characteristics form and scales will be processed in 
accordance with the Personal Data Protection Law No. 6698 (KVKK) and relevant 
legislation, adhering to confidentiality principles. The data obtained will be anonymized 
and will not contain any information that identifies your personal details. The data will 
not be shared with third parties and will only be used, presented, and published for the 
scientific purposes of this study. Furthermore, compliance with KVKK legislation and 
ethical principles in scientific research will be meticulously ensured at every stage of 
the research process. 
• 
The data obtained during the study will be securely stored, respecting confidentiality 
and data security principles. The data will be retained for 5 years as required by 
scientific ethics committees and will then be destroyed using appropriate methods. 
• 
You have the right to withdraw your participation at any point during the study; this 
decision will not result in any negative consequences. 
• 
The research is being conducted with the approval of the Acıbadem University and 
Acıbadem Health Institutions Medical Research Ethics Committee (ATADEK). 
For More Information: 
If you wish to obtain detailed information about the research, you can contact us using the 
following contact details: 
Supervisor Contact: Assoc. Prof. Dr. Aylin ÖZAKGÜL 
Email: aylin.ozakgul@iuc.edu.tr 
Researcher Contact: Ozan ACAR 
Email: ozan.acar@ogr.iuc.edu.tr 
Phone: +90 505 061 98 35 
 
 
 

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Consent: 
I have read the information above and agree to participate in this research entirely on a voluntary 
basis. 
Name-Surname 
Date 
_ _ /_ _/_ _  
Signature 
 
* Please complete and sign the form, then submit it to the researcher.