Facing death, facing self: nursing students' emotional reactions during an experiential workshop on life-and-death issues

The effects of hospice care education on first-year undergraduate nursing students in mainland China: A mixed-methods study

BACKGROUND

With the rising number of people with end-stage chronic diseases, the demand for hospice care has increased dramatically. As the future health professionals for the implementation of hospice care, undergraduate nursing students in mainland China still lack knowledge and skills of hospice care, thus hospice care education plays a vital role in its development.

OBJECTIVES

To understand the effects of hospice care education on nursing students' death attitudes, end-of-life attitudes, humanistic care qualities, and their learning experiences.

DESIGN

This study used a mixed-methods design.

SETTING

A University of Chinese Medicine in mainland China.

PARTICIPANTS

The first-year undergraduate nursing students (n = 65).

METHODS

A mixed-methods study was conducted to evaluate the impact of a hospice care course from March to June 2021. The quantitative part included a quasi-experimental study designed with pre- and post-intervention measurements and the qualitative part included a descriptive qualitative study with semi-structured individual interviews.

RESULTS

The quantitative data revealed that after the course, nursing students experienced improvements in their death attitudes, end-of-life attitudes, and humanistic care qualities. Two categories were identified from the qualitative data. The category of "Gain from learning" included 4 themes (Confronting death and thinking about life; Understanding and agreeing with the idea of hospice care; Perceiving the humanistic spirit of medicine; Enhancing of the nursing discipline cognition and professional identity) and the category of "Course feedback" included 2 themes (Expressing recognition for the course arrangement; Making suggestions on the course optimization).

CONCLUSIONS

Hospice care education had a positive influence on nursing students. Students expressed satisfaction with the course arrangement. However, future hospice care courses should further optimize the curriculum designs by increasing the discussion of death-related topics, sharing more real clinical cases, recruiting students from different majors, and providing clinical practice, to provide high-quality nursing education for the development of hospice care.

A Qualitative Study of Perception and Experience Toward End-of-Life Care Among Nursing Students Who Witnessed Dying People in Their Family

Introduction

This study aims to explore nursing students' perception and experience of end-of-life care (EoLC) in Indonesia, particularly in the family environment.

Methods

This study used a qualitative research design to explore the experiences and perceptions of nursing students who have witnessed the dying of their family members. The study recruited 15 nursing students using a purposive sampling method, who were then invited to reflect and write their experiences in witnessing death of their families, and perceptions towards EoLC. The written reflections were analyzed using thematic analysis.

Results

Thematic analysis showed that the experience of witnessing dying of a family member shaped nursing students' perceptions and attitudes towards EoLC. Some themes that emerged in this study included the importance of effective communication with patients and their families, symptom management, spiritual, emotional, and social support, as well as the need to improve nursing education and training.

Conclusion

This present study shows that the experience of witnessing the death of a family member shapes nursing students' perceptions of EoLC in Indonesia. This present study provides recommendations that the students must be prepared emotionally and psychologically in caring EoL or dying patients. How attitude and readiness to care EoL patients are shaped by the experience in witnessing the dying family or loved one. As such, palliative and EoL curriculum should be included methods that allow desensitization and naturalization of dying for the students in order to make them ready to provide better EoLC for patients and their families. The results of this study can contribute to improving the quality of EoLC in Indonesia.

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.

When Illness and Loss Hit Close to Home-Do Health Care Providers Learn How to Cope?

INTRODUCTION

Up to 85% of newly qualified physicians report loss or illness in themselves or a loved one. These experiences can intensify feelings of grief in the professional setting, but the range of formal training that addresses personal illness or loss is unknown. This study aimed to explore interventions that teach health care providers and trainees about personal illness experience.

METHODS

A scoping review was conducted by searching three bibliographic databases using the terms "illness," "personal," "education," and synonyms. Article screening was performed in duplicate to identify studies that described an intervention that included teaching or learning on personal experiences with illness or loss for health care providers and trainees.

RESULTS

The search yielded 4168 studies, of which 13 were included. Education most often targeted medical students (54%), resident or attending physicians (31%), and nurses (31%). Other participants included social workers and psychologists. Personal illness was most frequently taught for reflection in the context of palliative care curricula (54%). Only two studies' primary purpose was to teach about coping with grief related to personal experiences. No studies within the scope of our defined methodology described training on how to support colleagues or trainees facing personal illness or loss. Reported outcomes included improved coping skills, decreased stress, and better ability to support bereaving patients.

DISCUSSION

Specific training on personal illness experience is limited, with gaps in continuity of learning, particularly for continuing medical education. Future curricula can equip providers with coping strategies while enabling improved resilience and patient care.

Comparison of Attitudes Toward Death Between University Students Who Receive Nursing Education and Who Receive Religious Education

This study aims to compare attitudes toward death between university students who receive nursing education and who receive religious education. This study is cross-sectional in nature. It was conducted with the participation of 197 university students in a university located in the Eastern part of Turkey between June and August, 2017. Data were collected using the socio-demographic form and Turkish form of Death Attitudes Profile-Revised. Of all the students participating in the study, 52.8% received nursing education and 47.2% received religious education. It was found that majority of both groups had no education about death, or found the education they received insufficient. Besides, no significant differences were found between the students who received nursing education and who received religious education in terms of their attitudes toward death (p > 0.05). Results showed that students who received nursing education and who received religious education had similar attitudes toward death. In conclusion, the education given to students about the religious or health aspects of death in accordance with the curriculum seemed to have no effects on students' developing positive attitudes toward death.

All Things Death and Dying: Health Professional Students Participating in the Death Café Model

Death and dying remains a taboo topic in many social settings, and is underrepresented in health profession training. This report describes the use of the Death Café model as a forum for engaging students in discussion of death and dying with their peers and other health professionals. A Death Café is an opportunity for individuals to gather in an informal environment to exchange thoughts about issues associated with death, dying, loss, and illness. This report outlines the preparation, implementation, and evaluation of a Death Café event hosted at a nursing school as part of an academic health center. Twenty-four participants from five disciplines participated in discussions, reported positive experiences, and desired to learn more about issues surrounding death and dying. Findings from this event suggest that this approach may be useful for institutions seeking to provide additional learning opportunities for students and/or healthcare professionals on palliative and end-of-life care in a supportive and enabling context.

Learning end-of-life care within a constructivist model: Undergraduate nursing students' experiences

BACKGROUND

Although nursing education aims to equip nursing students to provide care to dying patients and their families, nurses often feel ill-prepared to cope with the emotional labour involved in end-of-life care.

OBJECTIVES

The aim of the study was to explore and describe nursing students' experiences of end-of-life care through experiential learning within a constructivist educational model.

METHOD

A qualitative, descriptive design was used. As part of introducing experiential learning, innovative educational practices were initiated during a second year level undergraduate nursing module on end-of-life care. Qualitative data on second-year nursing students' experiences were collected through written reflections and analysed using open coding.

RESULTS

The themes that emerged revealed participants' sensory and emotional experiences during the learning opportunities. Participants reflected on what they learnt and clarified their values related to death and dying. They indicated how they would apply the new meanings constructed in clinical practice.

CONCLUSION

A constructivist educational model of experiential learning holds potential to enhance value clarification and nursing students' sensory and emotional awareness of death and dying. Experiential learning is recommended to develop nursing students' competency inproviding end-of-life care.

Reported clinical outcomes of high-fidelity simulation versus classroom-based end-of-life care education

BACKGROUND

Nursing students often experience increased anxiety, lack of clinical skills and poor coping mechanisms when dealing with death and dying for the first time.

AIMS

To design, use and assess the effectiveness of high-fidelity simulation teaching versus classroom-based end-of-life care (EoLC) teaching for first-year nursing students on dealing with their first death experiences in clinical placements.

METHODS

A qualitative phenomenography approach was taken. First-year nursing students (n=187) were randomly allocated to receive either classrtoom-based (n=139) or high-fidelity simulation-based EoLC teaching (n=48). When all participants had returned from their first clinical placement, 12 individual in-depth interviews were carried out. Data were analysed using framework analysis.

RESULTS

Comparative data analysis revealed four key themes as clinical outcomes: recognising death and dying; knowledge into practice; preparedness for clinical eventualities; and emotional preparedness.

CONCLUSIONS

Despite the fact that both strategies improved students' knowledge of EoLC, simulation-based EoLC education was perceived as better in terms of enhanced practical skills and improved emotional experience in their first clinical placement.

Advances and Challenges

This study describes nursing students’ reflections on taking an online course on death and dying. In a semistructured paper, students described fears of caring for clients at end of life (EOL), important content learned, and remaining discomforts. Data were analyzed using directed content analysis. Consistent themes were noted among the papers. Student reflections on the knowledge they gained closely followed initial fears. Several students appreciated the ability to reflect on their experiences in a nonjudgmental setting. Overall, the data showed that nursing students can become more confident in EOL care through online education. Knowledge gains and continued fears about the same topics suggest EOL confidence lies along a continuum and may require ongoing education. Future research should focus on offering online continuing education on EOL to practicing nurses.

Nurse faculty perceptions of end-of-life education in the clinical setting: a phenomenological perspective

BACKGROUND

Caring for patients at the end of life is an emotionally and physically challenging task. When patients approach the end of life, nurses are in a key position to enhance their quality of life by providing emotional support and physical symptom management. Patients and their families need nurses who are comfortable discussing various treatment options and levels of care. Therefore, it is essential that nurses receive both didactic and clinical education on end-of-life nursing care in their nursing curriculum, before entering the healthcare workforce.

OBJECTIVES

The purpose of this interpretive phenomenological study was to explore the experiences of nursing clinical instructors as they guide nursing students who care for dying patients in the clinical setting.

DESIGN

The research design of this study was qualitative.

SETTING

This study sought to explore the experiences of nursing clinical instructors; however, due to the busy nature of hospital nursing units, participants were interviewed in a private location on their university campus.

PARTICIPANTS

Ten full-time nursing faculty members participated in this study. The average time spent in a full time faculty position was 16.5 years.

METHODS

A semi-structured interview was conducted with each participant. The interviews were recorded and transcribed. Data was analyzed utilizing Colaizzi's method of thematic analysis.

RESULTS

Six major themes emerged from the data, which will be discussed and illustrated with participants' descriptions.

CONCLUSIONS

It was evident from this study that educating nursing students on care of a dying patient is not only important but essential to future nursing practice. Nurses who learn about end-of-life care from trusted nursing educators may enter the profession prepared to address patient's questions regarding end of life issues.

End of life care education, past and present: a review of the literature

BACKGROUND

Research on end of life care education suggests that undergraduate nursing students are largely unprepared to provide end of life care to dying patients and their families. Although there have been attempts to address the issue of lack of preparedness, little is known on how to improve this.

LITERATURE REVIEW AIMS

To examine how end of life care education has been delivered to undergraduate nursing students and to critically discuss the research on modes of delivery and teaching strategies.

REVIEW METHODS

An extensive literature search on end of life care education in the undergraduate nursing curriculum was conducted in CINAHL, Mosby's Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 18 research papers published between 1984 and 2012 that met the selection criteria are included in the review.

FINDINGS

Findings of these 18 articles are reported under two main themes: Modes of End of Life Education Delivery and End of Life Care Education Initiatives.

CONCLUSION

This review highlights issues with end of life care education and suggests that end of life care simulation is an innovative strategy that may help to prepare undergraduate nursing students to provide quality end of life care.

Integrating professional apprentices into an end-of-life course

Nursing education faces several challenges in providing quality and meaningful education. Providing such an education is most important in teaching end-of-life care, as nurses are pivotal in helping patients to achieve a good death. A good death is often based on physical comfort, preparation for death, and completion of social and emotional tasks. Many obstacles hinder a patient's wishes about dying, including how nurses perceive their role in end-of-life care situations and knowing how to intervene on behalf of the patient. Therefore, nursing education needs to create meaningful and relevant learning experiences to enable future nurses to effectively care for the dying patient. To this endeavor, the Palliative and End-of-Life Care course described in this article integrated knowledge through the use of three professional apprenticeships: (a) acquiring and using knowledge and science (cognitive), (b) using clinical reasoning and skilled know-how (practice), and (c) ethical comportment and formation (moral reasoning).

Nursing students' perceptions toward the nursing profession from clinical practicum in a baccalaureate nursing program-a qualitative study

The purpose of this study was to explore senior nursing students' perceptions toward the nursing profession and their experiences in clinical practicum in Taiwan. This study used semistructured interview guides and unstructured face-to-face dialogue with the participants based on a qualitative method. A purposive sample with a snowball method from a baccalaureate nursing program in Southern Taiwan was used to recruit participants. A total of 30 senior nursing students participated in this study. Data were collected from February to May 2011. The interviews were transcribed verbatim, and data were analyzed based on the phenomenological approach of qualitative methodology. Data were categorized into three major themes: in-depth recognition of nursing, recognition of the meaning and value of life, and decision conflicts for being a nurse. The findings of the study not only help nursing educators further understand the educational effects of clinical practicum, but also provide information for managers of medical organizations to recruit and train newly graduated nurses.