Experiencing patient death in clinical practice: Nurses’ recollections of their earliest memorable patient death

Profissionais de saúde e o processo de morte e morrer dos pacientes: uma revisão integrativa

Objetivo: conocer la producción científica sobre la relación entre los profesionales de salud y la muerte del paciente. Metodología: revisión integradora de la literatura mediante análisis de proximidad temática. Resultados: se elaboraron cuatro categorías: profesionales de salud no preparados para enfrentar la muerte; desafíos para lidiar con el proceso de muerte y morir en diferentes escenarios; tipos de muerte y sus interpretaciones, y profesionales de salud; y aspectos personales sobre cómo enfrentar la muerte. Concluciones: los profesionales de salud no están preparados para enfrentar el proceso del final de la vida; más allá de eso, sienten una falta de atención al tema, especialmente en relación con las estrategias de afrontamiento.

Prepared for end-of-life care: a concept analysis

BACKGROUND

Recent international documents have highlighted the importance of preparing the nursing workforce for end of life care. However, these documents do not make clear what prepared in the context of end-of-life care actually means. Searching the literature failed to retrieve any papers defining prepared in this context.

AIM

A concept analysis, using Walker and Avant's model, was conducted to help address this gap in the knowledge base.

RESULTS

From this analysis many attributes and antecedents were synthesised. These include that a prepared nurse would be confident to: assess the dying patient, communicate with empathy, identify and manage symptoms, recognise and deal with death and dying, understand the holistic elements of dying, be comfortable with the effects of loss and bereavement on patients and self, and be self-competent.

CONCLUSIONS

From this analysis, a clearer idea of what is needed to prepare nurses for end-of-life care is offered and suggestions for future research are made.

Third-year nursing students' lived experience of caring for the dying: a hermeneutic phenomenological approach

BACKGROUND

In preparation for practice as a Registered Nurse, it is essential that students are equipped to care for the dying patient and their family.

AIM

To explore nursing students' lived experience of caring for a dying patient and their family.

DESIGN

Hermeneutic phenomenology.

METHODS

Students who had cared for a dying patient in their final year of study were invited to participate in an interview. Participants' narratives (n = 6) were thematically analysed.

FINDINGS

Analysis revealed three themes: being caring, unexpectedness in witnessing an expected death and experiencing loss. Students demonstrated family-centred care but recounted unexpectedness in both the dying trajectory and physical changes in the dying patient. When reflecting on experiencing loss, students questioned their own actions, acknowledged the value of relationships and identified ways to cope.

CONCLUSIONS

Engaging students in the care of dying patients and providing appropriate preparation/support can influence their experience and the care they provide in the future.

The Use of Simulation to Teach Nursing Students and Clinicians Palliative Care and End-of-Life Communication: A Systematic Review

Objectives:

To present the findings of a systematic review on the use of simulation-based learning experiences (SBLEs) to teach communication skills to nursing students and clinicians who provide palliative and end-of-life care to patients and their families.

Background:

Palliative care communication skills are fundamental to providing holistic patient care. Since nurses have the greatest amount of direct exposure to patients, building such communication competencies is essential. However, exposure to patients and families receiving palliative and end-of-life care is often limited, resulting in few opportunities to learn these skills in the clinical setting. Simulation-based learning experiences can be used to supplement didactic teaching and clinical experiences to build the requisite communication skills.

Methods:

Searches of CINAHL, MEDLINE, PsychINFO, ERIC, and Web of Science electronic databases and Grey Literature returned 442 unique records. Thirty articles met the established criteria, including the SBLE must contain a nursing role.

Results:

Simulation-based learning experience are being used to teach palliative and end-of-life communication skills to nursing students and clinicians. Lack of standardization, poor evaluation methods, and limited exposure to the entire interprofessional team makes it difficult to identify and disseminate validated best practices.

Conclusion:

While the need for further research is acknowledged, we recommend this evidence be augmented by training programs that utilize SBLEs through (1) applying standards, (2) clearly specifying goals and objectives, (3) integrating externally validated scenarios, and (4) employing rigorous evaluation methods and measures that link the SBLE to the training objectives and desired clinician practice behaviors and patient outcomes.

My Patient Died: A National Study of Nursing Students' Perceptions After Experiencing a Patient Death

AIM

The purpose of this study was to examine, on a national level, nursing students' perceptions after experiencing a patient death.

BACKGROUND

Death is a highly stressful experience for nursing students. Debriefing, which routinely occurs with a patient's demise in the simulation setting, typically does not happen in actual death situations.

METHOD

A mixed-methods design using quantitative and qualitative questions as part of an anonymous survey was sent to the membership of the National Student Nurses' Association. Of approximately 55,000 members, 2,480 responded to the survey.

RESULTS

Experiencing a patient death as a student occurred for 41 percent of participants in the nationally representative sample. Of those who experienced a patient death, 64 percent did not receive any debriefing.

CONCLUSION

Most nursing students did not feel prepared to care for a dying patient and the patient's family. Students need and want more education on end-of-life nursing care.

Including personal development in palliative care education to address death anxiety

BACKGROUND

Death anxiety may interfere with health care workers' (HCW) relationship with patients and their families.

AIMS

Evaluate an intervention to address death anxiety and improve HCW skills dealing with patients/families in palliative and end-of-life care.

DESIGN

Quasi-experimental mixed methods approach with a pre-test/post-test design.

PARTICIPANTS

208 HCWs receiving the intervention and working in end-of-life care, in and out of palliative care units, were invited to answer quantitative and qualitative questionnaires. In the end, 150 returned with quantitative answers and of these, 94 with qualitative answers as well. Additionally, out of the 150 participants, 26 were recruited for interview.

RESULTS

Pre-and post-test results revealed a significant reduction in levels of death anxiety, an increase in existential wellbeing, and a significant improvement in HCWs' perception of the quality of their helping relationship skills with patients/families. Content analysis provided an understanding of the difficulties experienced by the HCWs and the positive impact of the intervention.

CONCLUSION

An intervention to address death anxiety and help relationship skills can reduce the use of avoidance mechanisms and improve HCW self-perceived psycho-existential support to patients/families.

Improving End-of-Life Care Knowledge Among Senior Baccalaureate Nursing Students

Objective:

It is imperative that nurses are proficient and comfortable providing care to patients at the end of life. Recent studies show that nurses’ knowledge of end-of-life care is less than optimal. Effective, evidence-based methods to infuse palliative and end-of-life care education into the undergraduate nursing curriculum are needed.

Methods:

A descriptive pre- and postassessment evaluating senior nursing students’ acquisition of knowledge on end-of-life care after attending the End-of-Life Nursing Education Consortium (ELNEC) core course was conducted. The course evaluation included qualitative statements.

Results:

Before the ELNEC course, one-third of the students had cared for a dying patient during clinical rotations, yet 85% reported they had not received adequate training in end-of-life care. Posttest questions related to palliative care, symptom management, communication, and grief indicated that students acquired significant knowledge after participating in the ELNEC course ( P < .05).

Conclusion:

The ELNEC core course is an effective way to improve nursing students’ knowledge of palliative and end-of-life care.

Mixed-Methods Study of the Impact of Chronic Patient Death on Oncologists’ Personal and Professional Lives

Purpose:

Although some research has found that health care professionals experience grief when their patients die, within the oncology context, few studies have examined the impact of this loss on oncology personnel. Given the paucity of empirical studies on this topic, this research explored the impact of patient death on oncologists.

Methods and Materials

This study used a mixed-methods design. The qualitative component used the grounded theory method of data collection and analysis. Twenty-two oncologists were recruited from three adult oncology centers. Purposive sampling was used to gain maximum variation in the sample. The quantitative component involved a convenience sample of 79 oncologists recruited through oncologist collaborators.

Results:

The qualitative study indicated that frequent patient death has both personal and professional impacts on oncologists. Personal impacts included changes to their personality, gaining of perspective on their lives, and a strain to their social relationships. Professional impacts included exhaustion and burnout, learning from each patient death, and decision making. The frequency analysis indicated that oncologists experienced both positive and negative impacts of patient death. A majority reported that exposure to patient death gave them a better perspective on life (78.5%) and motivated them to improve patient care (66.7%). Negative consequences included exhaustion (62%) and burnout (75.9%) as well as compartmentalization of feelings at work and at home (69.6%).

Conclusion:

Frequent patient death has an impact on oncologists’ lives, some of which negatively affect the quality of life for oncologists, their families, and their patients.