Ethical challenges of death faced by nursing undergraduates in clinical practice: A qualitative study

Understanding nursing students' first experience of patient death in clinical practice: A qualitative systematic review and meta-synthesis

BACKGROUND

Witnessing patient death for the first time poses significant challenges for nursing students. Understanding their experiences can inform improvements in educational and support strategies within nursing programs.

AIM

This qualitative systematic review aimed to examines nursing students' initial encounters with patient death, emphasizing their perceptions, emotional responses, and coping mechanisms.

DESIGN

Qualitative systematic review.

REVIEW METHODS AND DATA SOURCES

A comprehensive search was conducted across ten electronic databases from their inception until February 16, 2024, with an update on October 30, 2024. Eligible studies were evaluated for quality using the Joanna Briggs Institute Critical Appraisal Checklist. Data extraction was performed using the standardized tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. The findings were synthesized, and the ConQual tool assessed the confidence in the results.

RESULTS

This systematic review included 16 studies involving 285 nursing students. Qualitative analysis identified 154 findings, categorized into six themes: (1) holistic support for patient comfort and dignity in dying, (2) perceptions of death, (3) confronting the challenges of patient death, (4) emotional impacts on students, (5) adjustments following patient death, and (6) witnessing death through novice perspectives.

CONCLUSIONS

The first encounter with patient death during clinical practice significantly impacts nursing students. Comprehensive death education and robust support systems are essential for enhancing students' coping abilities. Educators and clinical practitioners should implement support strategies that address students' needs, helping them confront patient death with composure and professionalism.

Sexual Behaviors and Intimate Relationships of Sexual Partners of Young Patients with Early-Stage Cervical Cancer: A Qualitative Study

Purpose

This study aimed to explore the sexual behaviors and intimate relationships of sexual partners of young patients with cervical cancer.

Patients and Methods

This study employed a descriptive phenomenological research design, which falls within the realm of qualitative research methods. Qualitative research typically utilizes interview techniques for gathering participants' experiences, perceptions, and behaviors. This study conduct face-to-face semi-structured interviews with the sexual partners of 15 young cervical cancer patients receiving cancer treatment to collect their experiences and perspectives on intimate relationships and sexual behavior with cervical cancer patients, and use the Colaizzi method for data analysis.

Results

Four themes were identified through the interview analysis: (1) reduction or absence of sexual behavior, (2) unpleasant sexual experiences, (3) adjustment of intimate relationships, and (4) lack of sexual health education.

Conclusion

The sexual partners of young cervical cancer patients have experienced significant shifts in their perspectives on sexual behavior and intimate relationships. These changes include reduction or absence of sexual behavior, unpleasant sexual experiences, adjustment of intimate relationships, and lack of sexual health education. Hospitals should pay more attention to the sexual behavior and intimate relationships of patients with cervical cancer and their sexual partners, and social support systems and psychological and emotional counselling services should be established for providing relevant knowledge and guidance.

Nursing Students’ Experiences With Patient Death and Palliative and End-of-life Care: A Systematic Review and Meta-synthesis

AIM

To synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settings BACKGROUND: Nurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.

DESIGN

A qualitative systematic review and meta-synthesis METHODS: PubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012-25 Feb 2023. Qualitative studies of any design reporting nursing students' experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso's 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.

RESULTS

The review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.

CONCLUSIONS

While caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.