How Gen AI is helping nursing students build confidence in end-of-life conversations
An article written by Dr Karen Hall, Ms Josephine Tighe, A/Prof Stephen McKeever, Dr Myles Ojabo, Irene Monde Simonda and Dr Julie Shaw
A safe place to practise difficult conversations
End-of-life (EOL) conversations are some of the most sensitive and emotionally charged interactions that are integral to professional nursing practice. For many nursing students, approaching these discussions for the first time can feel daunting. Our research study explored how Generative AI (Gen AI) characters might help students build confidence and competence in a safe, supported environment. [1] Instead of practising with real patients or peers, students engaged in simulated conversations with AI-generated characters representing diverse cultural, spiritual, and medical backgrounds. These simulations allowed students to explore complex topics, including treatment preferences, spirituality, cultural values, and voluntary assisted dying.
Before the simulation began, students completed a survey assessing their comfort and perceived competence in discussing EOL care. A post simulation survey indicated meaningful improvement in students’ self-reported competence across all measures, with gains ranging from 15% to 34%. Many described the activity as a low-pressure environment where they could practise without worrying about saying the wrong thing or causing emotional distress. This sense of psychological safety emerged as a major strength of Gen AI to support education.
What students found valuable
The students highlighted the opportunity to interact with characters from diverse cultural and spiritual backgrounds different from their own. Many of them said the experience expanded their understanding of how beliefs and values shape a person’s end-of-life preferences. The Gen AI characters enabled students to reflect more deeply on cultural safety, an essential dimension of nursing practice to care for Australia’s diverse population.
The simulation's interactive nature was another key benefit. Students described it as engaging, easy to navigate, and far more dynamic than traditional ways of learning. Several of them commented that the AI responses felt surprisingly realistic, giving them a chance to utilise some communication skills such as showing empathy and active listening skills that are often difficult to develop without real-life experience.
But it wasn't perfect
Despite the simulation's many strengths, students also recognised the limitations of current AI tools. Some found that the characters lacked emotional nuance, making certain conversations feel flat or less authentic than interactions with real people. Other students noticed occasional repetition or inconsistencies in the AI’s responses. A few students struggled to phrase their questions in ways the AI characters could effectively interpret, which sometimes disrupted the flow of the discussion.
These limitations are important reminders that AI should complement, rather than replace human-based learning, particularly in areas that rely heavily on empathy, emotional intelligence, and relational communication.
Why this matters for the future of nursing education
Australia’s nursing workforce cares for people from diverse cultural, spiritual, and linguistic backgrounds. To provide truly person-centred and culturally safe care, nurses must be able to communicate respectfully and confidently with individuals whose beliefs and values may differ significantly from their own. It is important to note that students often have limited opportunities to experience or practice these conversations before they graduate.
This study demonstrates that Gen AI can offer a flexible, engaging, and psychologically safe way to explore complex communication scenarios. As AI continues to evolve particularly in emotional realism and cultural nuance, it shows strong potential as a tool for building foundational end-of-life (EOL) communication skills. When used thoughtfully, Gen AI can enhance students’ learning without replacing the irreplaceable: genuine human connection.
For nursing students preparing to enter practice, these early experiences with Gen AI may offer valuable support as they build confidence to engage in some of the most meaningful and challenging conversations of their careers.
Reference
- Hall K, McKeever S, Ojabo M, Simonda I, Tighe J, Shaw J. End-of-life education: An explorative study using artificial intelligence simulations in undergraduate nursing. Nursing Outlook. 2026;74(1):102652
Image supplied by author created using Microsoft Copilot
Authors
Dr Karen Hall
Senior Lecturer, Nursing
Swinburne University of Technology
Josephine Tighe
Senior Lecturer, Nursing
Swinburne University of Technology
A/Prof Stephen McKeever
Associate Professor, Nursing
Swinburne University of Technology
Dr Myles Ojabo
Lecturer
Swinburne University of Technology
Irene Monde Simonda
Casual Academic (Nursing)
La Trobe University
Dr Julie Shaw
Advisory Board Member
Institute of Health & Management (IHM)