Nursing students frequently encounter dying patients during clinical placements with limited preparation, leading to negative attitudes toward end-of-life care, death anxiety, and risk of compassion fatigue. Simulation-based education offers a safe environment for experiential learning in palliative care, yet most existing programs do not integrate mindfulness components to address the psychological demands of this setting. Mindfulness-based interventions have shown promise in improving self-compassion and reducing burnout in healthcare professionals, but evidence among undergraduate nursing students remains limited.

This study aims to evaluate the effects of a Mindful Simulation Training (MST) program on compassion, palliative care knowledge, attitudes toward end-of-life care, and professional quality of life among undergraduate nursing students.

Palliative care addresses the physical, psychological, social, cultural, and spiritual needs of patients with life-limiting illness and their families. In Hong Kong, palliative care services have expanded from hospital settings to community care homes, increasing demand for well-prepared nursing graduates. Nursing students as the future palliative care workforce often encounter dying patients during placements with inadequate educational preparation, resulting in negative attitudes, death anxiety, and emotional distress. Evidence shows nursing students report less positive end-of-life (EOL) attitudes and lower confidence than practicing nurses, with documented gaps in undergraduate palliative care curricula. Compassion fatigue is well established among nurses in palliative settings and has also been documented among nursing students during clinical placements. Conversely, compassion practice and adaptive coping are associated with reduced burnout and enhanced satisfaction.

Simulation-based training provides opportunities for experiential, reflective, and affective learning in palliative care, with evidence supporting improvements in knowledge, attitudes, communication, and emotional preparedness. However, few simulation studies have integrated mindfulness components specifically targeting psychological flexibility and compassion competence.

This is a three-arm, parallel-group randomized controlled trial with a sequential mixed-methods study designed to compare the effectiveness of Mindful Simulation Training (MST), Traditional Simulation Training (TST), and a Waitlist Control (WC) over a 4-week intervention period with follow-up at 8 weeks on improving the compassion, palliative care knowledge, attitudes toward end-of-life care, and professional quality of life among undergraduate nursing students.

Inclusion Criteria:

• Nursing students aged 18 or above
• Currently studying a full-time nursing program in Hong Kong
• Regardless of the study year, e.g., Year 1 to Year 5
• Able to comprehend English and Cantonese
• Able to use electronic devices to complete an online survey
• Have enrolled or studied in the prerequisite course provides baseline knowledge in palliative care training

Exclusion Criteria:

• Nursing students who are under 18
• Have been regularly practicing instructor-led mindfulness interventions once a week or more during the past 6 months