Effective communication is a fundamental skill for healthcare providers, especially in nurse-patient relationships. It becomes particularly challenging when dealing with emotionally charged situations like death, grief, or the delivery of distressing news (Stout-Aguilar et al., 2018). In these situations, both healthcare providers and patients may experience negative psychological responses, leading to complex and difficult communication (Grimston et al., 2018).

Perinatal nurses play a vital role in supporting women and their families during the perinatal period, which includes pregnancy and post-childbirth. Their responsibilities are multifaceted and crucial for the well-being of both the mother and the newborn. Palliative care for children, especially the transition from curative to palliative care, presents emotional challenges for nurses. Feelings of guilt and helplessness often accompany these situations (Atout, 2020). When neonates or fetuses face severe illness or an unfavorable prognosis, nurses bear the crucial responsibility of engaging in timely and adept end-of-life (EOL) discussions with parents. These conversations aim to provide choices that enhance the neonate's quality of life and facilitate decisions regarding life-sustaining treatments. The goal is to alleviate the suffering of dying neonates, minimize their distress, provide comfort to parents and support the entire family. Adequate family support entails offering clear and honest information about the EOL process for the neonate, advocating not only for the neonate but also for the entire family (Kilcullen and Ireland, 2017).

Previous studies have highlighted that clinicians receive insufficient training in neonatal palliative care during their formal education and continuing education (Beltran and Hamel, 2021, Bowen et al., 2020). Nurses caring for parents with dying neonates may experience stress due to a lack of knowledge and skills in palliative care. This can lead to doubts about their ability to communicate effectively and competently with grieving family members. This caregiver stress is well-documented (Grimston et al., 2018, Stenekes et al., 2019). Nurses without communication training in this specific context may be hesitant to initiate EOL discussions, which can hinder the provision of palliative care (Isaacson et al., 2019, Stenekes et al., 2019). Given the differences between discussing prognosis for infants and adults, there's a need for tailored course content to assist care providers.

Communication skills, particularly those related to discussing poor prognosis, delivering bad news, addressing EOL care and managing ethical issues, have been identified as the most critical educational needs for nurses in two systematic review studies (Atout, 2020, Beltran and Hamel, 2021). Effective training in these communication skills often involves role-playing, case-based learning and interactive workshops. Research has shown that communication training that emphasizes empathy, active listening and non-verbal communication significantly enhances healthcare professionals' ability to navigate difficult conversations with patients and their families (Ghoneim et al., 2019).

Scenario-based simulation has been integrated into nursing education for developing communication skills (Chang et al., 2022, Peterson et al., 2021). Simulation, as an immersive technique, allows learners to engage in realistic tasks and experiences within authentic settings. It is increasingly adopted in healthcare education across various disciplines (Tropea et al., 2020). Simulation enables learners to practice skills, receive feedback and learn from patient responses in a safe environment, bridging the gap between theory and practice (Fitzgerald and Ward, 2019, Brock et al., 2019). Simulation allows learners to immerse themselves in clinical scenarios and gain insights from the patient's perspective. Through feedback during these interactions, autonomous learning is fostered, leading to enhanced communication skills, crisis management abilities, critical thinking and increased overall confidence (Stout-Aguilar et al., 2018, Rashwan et al., 2021). Palliative care education increasingly integrates simulation-based teaching, which has demonstrated effectiveness in improving knowledge, procedural competence, communication skills and confidence (Bowen, 2020). Valen et al. (2020) argued that combining simulation with support and constructive dialogue enhances student nurses' learning outcomes in palliative care. Additionally, authentic scenarios and standardized evaluation criteria facilitate the assessment of learner competencies.

The study focuses on comparing Scenario-Based Simulation (SBS) and traditional lectures to identify the more effective method for enhancing competence and confidence in palliative communication among nurses. Additionally, standardized patients (SPs) were employed to provide an objective assessment of nurses' performance, with the ultimate goal of enhancing perinatal palliative care practice.