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

"It was the first time someone had died before my eyes…": A qualitative study on the first death experiences of nursing students

BACKGROUND

Accompanying a person at their death is a common experience in nurse education. In addition to all death experiences that are a meaningful part of the nursing profession, the first death experience is very important. However, there is limited understanding of nursing students' first death experiences.

OBJECTIVES

This study aimed to explore nursing students' experiences of the death of a person for the first time during clinical practice.

DESIGN

This study was conducted as a qualitative study using a phenomenological design.

PARTICIPANTS

A total of 17 nursing students participated in this study.

METHODS

Data were collected through online individual in-depth interviews and were analyzed using content analysis.

RESULTS

Four main themes and eleven sub-themes emerged. The themes were meaning of death (first death, a part of life), process management (death information, physical environment, bad news), after death (empty bed, questioning, death with dignity) and education (curriculum, support, professional perception).

CONCLUSIONS

While the first experience of death provides an opportunity for students to learn, this experience reveals various negative emotions and the need for support.

Views, emotional Reaction, and Bereavement Healing Rituals of Saudi Male Nursing Students: A Qualitative Approach

AIM

The study described the perception and attitude of Saudi male nursing students towards death and dying.

METHODS

This qualitative study recruited Twelve male Saudi nursing students from Nursing Department at University, Riyadh, Saudi Arabia. Data collection was conducted using unstructured one-on-one online interviews from January to February 2021 using thematic approach to analyse the data.

RESULTS

The result of the study presented three themes. The first theme describes the Muslim Saudi male nursing student's religious beliefs and practices in terms of three concepts. The second theme is the emotional reaction of the participants. The third theme is bereavement healing rituals.

CONCLUSION

The knowledge on how nursing students with an Islamic belief view the concept of death and dying provides valuable and critical information on developing educational intervention as well as course and training contents that needs to be included in developing the competencies of these students.

Magnitude of general anxiety disorder among nursing students and its associated factors

Background

University training in nursing together with other student variables can increase the risk of anxiety in students. It is important to assess the student's level of anxiety, which can have repercussions on their training and mental health. There are several validated tools such as the generalized anxiety disorder scale (GAD-7).

Objective

To know which factors are associated with the appearance of anxiety and which protect against it in university nursing students.

Method

A cross-sectional descriptive study was carried out in which 170 university nursing students from University of Jaén participated. A bivariate and multivariate analysis was performed, calculating odds ratio and adjusted odds ratio (aOR) with 95% confidence intervals (CIs) to determine which factors were associated with a higher score on the GAD-7 questionnaire, and therefore with the presence of anxiety.

Results

In total, 66.5% (113) of the students have suffered an anxiety crisis on some occasion and 48.8% (83) of the students did not carry out activities of any kind to control anxiety and stress. Practicing religious and spiritual beliefs increased the probability of having anxiety compared to those who did not have religious beliefs (aOR = 3.92; 95% CI = 1.09, 14.08), as well as having previously suffered an anxiety crisis (aOR = 5.13; 95% CI = 2.39, 11.04). Protective factors against anxiety appear to be second-year students (aOR = 0.33; 95% CI = 0.16, 0.72) and being deeply satisfied with the teaching staff (aOR = 0.03; 95% CI = 0.01, 0.79).

Discussion/Implications for practice

Knowing the factors that are associated with the appearance of anxiety is necessary to facilitate early detection and care in nursing university students.

Bereavement and Professional Competencies: Exploring the Personal Experience of Death Among Nursing Students - A Qualitative Study

Purpose: To explore the death experiences of nursing students in their personal lives. Methods: This study employed a qualitative descriptive design using the semi-structured interview approach. A purposive sampling method was used to recruit 24 nursing students from September 2020 to July 2022. Data were analyzed using Colaizzi's analysis method. Lincoln and Guba's criteria was used to evaluate the trustworthiness of the data. Results: Four main themes emerged from the interviews: (a) reactions to encounters with death; (b) adjustment strategies; (c) personal growth induced by the death experiences; and (d) professional reflections for preparing nurse role. Conclusions: Although the death of a loved one makes nursing students suffer from grief and emotional distress, we show that the experience promotes the personal growth and professional competencies of nursing students and thereby, developing their overall aptitude towards the profession. Death experiences of nursing students have shown to allow them to reflect on both life and death, to consider the demands of the nursing profession, and to provide foundation for nursing students to be more empathetic and compassionate when facing death in the future. Exploring death experiences of nursing students is vital in better providing better quality education and personal support for nursing students.

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.

The use of games by nurses in palliative care: a scoping review

Background: Nursing is at the forefront of palliative care. Games are an innovative strategy in palliative care training. Aims: This study aimed to examine the usefulness of games for nurses in palliative care. Methods: A scoping review was conducted using the following databases: CINAHL and PUBMED (which includes MEDLINE, PsycINFO, SCOPUS and SciELO). The steps outlined by the Joanna Briggs Institute were followed. Findings: Of the 685 articles initially identified, 17 were included for analysis. Games used were role-play (n=12), card games (n=1), digital games (n=1), board games (n=1), reflection games (n=1) and experimental games (n=1). Games were aimed at nurses (n=6) and nursing students (n= 1 1). Game advantages included: improved palliative care knowledge, increased communication skills, reduced negative emotions and increased multidisciplinary team skills. Conclusions: Effective and innovative pedagogical techniques are required training techniques for nurses and nursing students who provide palliative care, as they can reduce negative emotions such as fear, anguish and guilt.

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

BACKGROUND

The characteristics of nursing work determine that nursing practice is inseparable from ethical considerations and decision-making. Nursing students have difficulty in dealing with death and it is necessary to explore the ethical challenges faced by nursing undergraduates in the process of clinical practice of nursing dead or dying patients.

OBJECTIVE

To explore the ethical challenges faced by undergraduate nursing students in nursing of dead or dying patients.

DESIGN

This study was conducted with a phenomenological approach in a qualitative design.

SETTINGS, PARTICIPANTS, METHODS

The purposive sample of the study consisted of 35 nursing undergraduates in their last year of education at the bachelor level in nursing who had experience of clinical practice. They voluntarily participated in the study. Data were collected through semi-structured interviews and analyzed using the Colaizzi analysis method.

RESULTS

Through analysis of interviews, four themes were identified: (1) Distant death is coming-inadequate preparation; (2) Making decisions between the needs of different positions-difficult balance; (3) Experience a patient's death up close-irresistible resistance; (4) Providing bereavement care after a patient's death-insurmountable obstacle.

CONCLUSION

This study shows that nursing undergraduates face ethical challenges in the process of caring for dead or dying patients and the early identification of these ethical challenges is of great significance. University and hospital leaders should pay attention to the ethic and death education of nursing undergraduates so as to help nursing students prepare for clinical practice.

Validation of General Anxiety Disorder (GAD-7) questionnaire in Spanish nursing students

Background

Nursing students are at risk of anxiety during their university education.

Objective

To determine the psychometric characteristics of the General Anxiety Disorder (GAD-7) questionnaire in a population of university nursing students.

Methods

A cross-sectional study was carried out with 170 students at the University of Jaen (Spain) in 2022. An online questionnaire was administered that included sociodemographic and student profile variables, the GAD-7 questionnaire, and the Goldberg anxiety subscale. An exploratory factor analysis (EFA), validation with convergence, and reliability analysis using Cronbach's α were performed.

Results

The EFA identified a single component that explained 63.50% of the variance. It was positively correlated with the Goldberg anxiety subscale (r = 0.653; p < 0.001). A statistically significant association was observed with academic year, gender, and having experienced an anxiety crisis (p < 0.005). Internal consistency with Cronbach's α was 0.903.

Conclusion

The GAD-7 presents appropriate psychometric characteristics for use in a university population of nursing students. It is capable of detecting symptoms and generalized anxiety disorder, making it a useful and simple tool for detecting anxiety-related problems in this population.

Fear of Death between Nursing Students in the Academic and Professional Programs

BACKGROUND OF THE STUDY:. Nurses inevitably witness death in their professional practice. These experiences can trigger fear of a patient’s death, fear of their own death or fear of the dying process. A review of literature revealed the absence of studies on dying and feelings towards the dying process particularly fear of death among students in the Indonesian context. AIM OF THE STUDY: This study explored the levels of fear of death and the differences between students enrolled sophomore academic program and those in the professional program. METHODOLOGY: This was a quantitative comparative study that utilized a cross-sectional design. Collett-Lester Fear of Death Scale was adapted to measure the fear of death among the respondents by using univariate analysis. Bivariate analysis was also utilized by applying the independent T-test to determine the significance of the difference in the data results. All 50 professional students were included in the study while simple random sampling was done to select 50 students enrolled in the academic program.   RESULTS: The level of fear of death among the sophomore students was moderate to high, while those in the professional program was moderate. Furthermore, the T-test revealed a p-value of 0.010 indicating a significant difference in the level of fear of death among sophomore academic program students compared to students in the professional program. CONCLUSION: There is a significant difference in the level of fear of death between sophomore nursing students in the academic program compared to those in the professional nursing program.

Intensive care experiences of intern nurse students: A qualitative study

OBJECTIVES

This study aimed to describe the experiences of nursing interns in the intensive care unit (ICU).

DESIGN

This study was a descriptive qualitative research.

SETTINGS, PARTICIPANTS, METHODS

The study data were collected via focus group interviews of 25 nursing interns in the two different ICUs of a university hospital who had volunteered to participate in the study. There were four focus group interviews in all, one for each of four different groups of nursing interns. The semi-structured interview form was used in the study.

RESULTS

Seven themes emerged in the study: fear, awareness of nurses' roles, finding opportunities for self-improvement, difficulty in caregiving, difficulty in communicating with the patients and the care team, experiencing ambivalent feelings related to death, and adaptation to the clinical environment.

CONCLUSIONS

Doing one's internship in the ICU was evaluated by the nursing interns in this study as a beneficial practice despite the difficulties involved in it. It is recommended, that intensive-care practices be included in the undergraduate education program for nurses and that appropriate guidance and monitoring be given to the nursing interns in ICUs.

Nursing students' experience of providing frontline COVID-19 support: A qualitative study

Understanding the unique experience of nursing students providing frontline support in COVID-19 hospital wards is crucial for the design of strategies to improve crisis management and mitigate future pandemic outbreaks. Limited research concerning this phenomenon has been published. This qualitative study aimed to understand the experience of providing support from COVID-19 frontline nursing students' perspective. Online interviews were conducted with nine nursing students from April to May 2020; interview data were analyzed by content analysis using Burnard's method. Six main categories emerged from the data analysis: "experiencing a rapid transition from student to professional," "fear and uncertainty of the unknown," "resilience throughout the crisis," "sense of belonging to a team," "shared responsibility," and "importance of the profession." Based on these findings, multicomponent strategies that function in parallel with practical contexts should be developed to enable students to diligently adapt their abilities to their new role and cope with health crises.

Experiences and Perceptions of Nursing Students during the COVID-19 Crisis in Spain

In the early stages of the 2019 coronavirus pandemic in Spain, the Spanish health system was overwhelmed, mainly due to a lack of personnel, and many hospital centers collapsed by following avalanche of patients with COVID-19; this meant that the National System of Health called for fourth-year nursing students to come to the hospital as health care personnel. Our aim was to describe the perceptions and experiences of a sample of nursing students during the early stages of the outbreak. We conducted a qualitative study with an empirical-phenomenological approach. Twenty nursing students in their final year of study in Spain were recruited using purposive and snowball sampling. They participated in in-depth interviews between 20 April and 10 May 2020. The interviews were transcribed and then analyzed using Haase’s adaptation of Colaizzi’s phenomenological method. Four main themes emerged from data analysis: “social responsibility and pride as a health worker”, “pressure caused by working with COVID-19 patients”, “feeling defenseless and let down”, and “personal growth as a health worker”. These main themes were further divided into 11 theme categories. Due to an intense work day for several days in a row, the students were tired and mentally exhausted. Even so, they managed to overcome any difficulties, demonstrating their professional dedication and resilience. Greater preparatory support should be provided to safeguard the well-being of these future healthcare providers. More intensive preparatory training is necessary for health sciences students to facilitate crisis preparedness and effective crisis management. It is necessary to implement support from healthcare systems, including sufficient personal protective equipment, as well as contracts that accurately reflect the work they do. It is necessary for nursing supervisors to have effective communication in the performance of their functions with nursing students; this dialogue helps to clearly explain which are the functions that students must perform when they are carrying out their internships. There is also a need for preparatory training in managing infectious diseases such as COVID-19.

The palliative care difficulty levels of the nursing students during clinical practices

PURPOSE

This study aimed to determine the palliative care difficulties experienced by nursing students during their clinical practice.

DESIGN AND METHODS

This descriptive and cross-sectional study was conducted with 305 nursing students at a university in Turkey. Data were collected using a student identification form and the palliative care difficulties scale.

FINDINGS

Nursing students experience a moderate level of difficulty in providing care for palliative care patients and receiving expert support facilitates their care initiatives.

PRACTICE IMPLICATIONS

It is important to support nursing students during their nursing education courses and clinical training, along with psychiatric nursing skills.

A journey through roses and thorns: becoming a physician by learning from patients with life-threatening illnesses. A qualitative study with international medical students

The medical students' well-being may be threatened by various stressors associated with providing care to different kinds of patients. This study aims to explore students' clinical experiences with patients who suffer from life-threatening illnesses, focusing on potential risk and protective factors. Audio-recorded and face-to-face interviews were conducted and transcribed verbatim. The "Interpretive Description" approach was used to analyse data. Overall, ten medical students with a mean age of 28 years old were interviewed. Well-being promoting factors were the following: therapeutic relationships, work-life balance, social support and communication, perception of improvement in knowledge and availability of advanced directives. Whilst factors that may reduce well-being included death exposure, managing emotions, communication difficulties, internal conflicts and disagreements, lack of knowledge and subjective concerns. These findings shed light on facets that are inherent parts of clinical experience with patients suffering from a life-threatening illness and that may turn in risk or protective factors for the medical students. Understanding the students' subjective experiences may aid in the improvement of the current educational programs, as well as in the development of tailored supportive and preventative interventions to promote well-being and professional competencies among this kind of students.

Nurses' Attitude Toward Caring for Dying Patients in a Nigerian Teaching Hospital

Introduction

Death and the dying experience are common phenomena in all clinical settings. Death and the dying presents physical and emotional strain on the dying patient, his relations and professional caregivers.

Objective

The study therefore assessed the sociodemographic determinants of nurses’ attitudes towards death and caring for dying patient.

Method

A cross–sectional design was used to study 213 randomly selected nurses, working in one of the tier one teaching hospital in Nigeria. Attitude towards death and the dying was collected with Frommelt Attitude Care of the Dying and Death Attitude Profit–Revised questionnaire. The data collected was analysed with SPSS version 20 and inferential analyses were considered statistically significant at p < 0.05.

Results

The study revealed that most of the nurses had negative attitudes toward the concept of death (76.5%) and caring for dying patient (68%). Furthermore, a chi-square test revealed significant associations between the nurses’ years of working experience (χ² = 24.57, p <.00) and current unit of practice (χ² = 21.464; p = .002) and their attitude towards caring for the dying patient. Also, nurses’ age (χ² = 13.77, p = .032), professional qualifications (χ² = 13.774, p = .008), and current ward of practice (χ² = 16.505, p = .011) were significantly associated with their attitudes to death. Furthermore, the study observed a significant association between nurses’ attitudes to death and caring for the dying patient (χ² = 11.26, p < 0.01).

Conclusion

This study concluded that nurses had negative attitudes towards death and dying and therefore prescribes, as part of continuing professional development strategy, the need for requisite positive value – laden, ethnoreligious specific education regarding end of life care.

Nursing Students' Experiences With Death and Terminal Patients During Clinical Education

The aim of this study is to explore nursing students' experiences with death and terminal patients during clinical education. A secondary analysis of qualitative data that were collected through 11 focus group interviews with nursing students was performed. Data obtained from the interviews were analyzed using thematic analysis. There were a total of 9 themes across 3 contexts. Data were grouped under the following themes: feelings experienced when encountering death for the first time, reactions to the first encounter with death, factors affecting the reactions to death, involvement in terminal patient care, being informed about the physical process that terminal patients are going through, students' approach toward terminal patients and their relatives, health professionals' approach toward terminal/dying patients/their relatives, changes in the ideas about death, and changes in the ideas about terminal/dying patients. The study shows a lack of guidance on the part of teachers who also avoid patients and families who are considered terminally ill.

Comparing Symptom Ratings by Staff and Family Carers in Residents Dying in Long-Term Care Facilities in Three European Countries, Results From a PACE Survey

CONTEXT

Symptom management is essential in the end-of-life care of long-term care facility residents.

OBJECTIVES

To study discrepancies and possible associated factors in staff and family carers' symptom assessment scores for residents in the last week of life.

METHODS

A postmortem survey in Belgium, The Netherlands, and Finland: staff and family carers completed the End-of-Life in Dementia-Comfort Assessment in Dying scale, rating 14 symptoms on a one-point to three-point scale. Higher scores reflect better comfort. We calculated mean paired differences in symptom, subscale, and total scores at a group level and inter-rater agreement and percentage of perfect agreement at a resident level.

RESULTS

Mean staff scores significantly reflected better comfort than those of family carers for the total End-of-Life in Dementia-Comfort Assessment in Dying (31.61 vs. 29.81; P < 0.001) and the physical distress (8.64 vs. 7.62; P < 0.001) and dying symptoms (8.95 vs. 8.25; P < 0.001) subscales. No significant differences were found for emotional distress and well-being. The largest discrepancies were found for gurgling, discomfort, restlessness, and choking for which staff answered not at all, whereas the family carer answered a lot, in respectively, 9.5%, 7.3%, 6.7%, and 6.1% of cases. Inter-rater agreement κ ranged from 0.106 to 0.204, the extent of perfect agreement from 40.8 for lack of serenity to 68.7% for crying.

CONCLUSION

There is a need for improved communication between staff and family and discussion about symptom burden in the dying phase in long-term care facilities.

Content analysis of the effects of palliative care learning on the perception by nursing students of dying and dignified death

BACKGROUND

Providing care for dying people and the death of patients are stressing situations faced by nursing students during their clinical practice. Learning about palliative care improves the management of emotions and the ability to cope when caring for patients in end-of-life processes. However, there is little knowledge on the effect of this learning on the students' perceptions of their own death.

OBJECTIVES

To determine the effect of a palliative care course on the thoughts of nursing students about their own death.

DESIGN

A qualitative, descriptive, and comparative study was conducted based on content analysis, administering an open-ended questionnaire on dying and death at the start and end of a palliative care course.

PARTICIPANTS

The study included 85 volunteers studying Palliative Care in the second year of their Nursing Degree at the University of Granada (Spain).

RESULTS

Students described their perceptions in more detail after the course, with more numerous code citations, and their post-course responses evidenced a reduction in anxiety about their own death and an increased recognition of the need to respect the decisions of patients for a dignified death.

CONCLUSIONS

Palliative care learning modifies the perception by nursing students of their own death and their understanding of a dignified death, which may enhance the care they deliver to patients at the end of life.