A qualitative study of phenomenology of perspectives of student nurses: experience of death in clinical practice

Emotional and Psychological Experiences of Nursing students caring for Dying Patients: A phenomenology study at Mulago National Hospital, Uganda

Introduction

Caring for dying patients is associated with psychological trauma, strong emotions and enormous stress for nursing staff and nursing students who are relied on by patients and relatives in such difficult situations. Although nurses have an ability of self-control and calm approach towards death, there are still some emotions they need to "work through". Research studies have documented limited exposure of nursing students to end-of-life care and inadequate understanding of the psychological and emotional experiences they encounter during clinical placements. This study explored the psychological and emotional experiences of Ugandan student nurses on caring for the dying patients at Mulago national referral hospital during clinical placement.

Methods

A qualitative phenomenological study was conducted among fifteen undergraduate nursing students of Makerere University in clinical placement at Mulago hospital. An In-depth interview guide was used to gather data on nursing students' emotional and psychological experiences and coping mechanisms. Data was audio recorded, verbatim transcribed and thematically analyzed using Atlas. ti version 6 software.

Results

The nursing students emotional and psychological experiences when caring for dying patients were emerged into two themes; (1) Psychological and emotional reactions, (2) Coping mechanisms. The sub themes were; anger, anxiety and depression which is triggered by a combination of issues of pressure from relatives, failure to save the dying patient, thoughts of wasted efforts to reverse the dying process, limited resources, limited technical and emotional support. The students cope by seeking help from peers, engagement in problem solving, distancing from patients, spirituality and engaging in personal stress reducing activities.

Conclusion

Insights from this study provide educators with a snapshot of student encounters, emotions, and coping strategies when facing dying patients and their families. Nursing students experience various negative emotional and psychological stressors triggered by a combination of issues that need to be addressed during care of dying patients. However, they devise different coping mechanisms to continue with provision of necessary end of life care as the clinical placement contributes to their learning, experience and builds confidence among student nurses.

The experiences of nursing students participating in a student death doula service-learning program in palliative care settings: A qualitative study

Nursing students desire more training and experience in palliative care due to a need for more skills and knowledge. This descriptive qualitative study explored nursing students' experiences in participating in a student death doula service-learning program in palliative care settings. Fourteen final-year undergraduate nursing students participated in semi-structured focus group discussions via Zoom. Four focus group discussions were conducted. Six themes with 19 subthemes were developed: (1) initial feelings of fear and uncertainty, (2) death doula training and orientation, (3) palliative wards being a happier place than expected, (4) experience of watching their patients deteriorate over time, (5) benefits of participating in service-learning in palliative care settings, and (6) improving the service-learning experience. The program was well received by the nursing students, who recommended incorporating it into the nursing curriculum to enhance palliative nursing education. Additional refinements were proposed to better support nursing students during service-learning.

Nursing Students' Intention to Work in Hospice Care in the Future: A Cross-sectional Study

Studies reveal that nursing students rank hospice nursing among their least preferred career choices. The purpose of this study was to explore the association between nursing students' intention to work in hospice care in the future and their attitudes toward caring for dying patients, death anxiety, personal and/or professional experience of caring for dying patients, and type of nursing program studied. In this cross-sectional study, 200 nursing students completed an online survey based on the Frommelt Attitude Toward Care of the Dying Scale and the Turkish Death Anxiety Scale. Only 11% of the respondents were found to express interest in working in hospice care in the future. Studying in the accelerated program for nonnursing Bachelor of Arts graduates predicted a higher intention to work in hospice care in the future, than studying in the generic program (β = 0.27, P < .001). Completion of clinical experience in a medical ward predicted lower intention (β = -0.21, P < .01). These findings suggest that nursing students in the accelerated program for nonnursing Bachelor of Arts graduates should be provided with appropriate experience and support to maintain their interest in hospice nursing. Clinical experience in medical wards does not seem to be a good substitute for clinical experience in hospice care.

Perceptions and experiences of Generation Z nursing students during their practicum in an intensive care unit: A qualitative study

Background

Influenced by socio-cultural and world events, Chinese society has significant intergenerational differences. With rapid economic and cultural development, the unique characteristics of Generation Z nursing students in China may influence the clinical education environment. However, the research on Generation Z in China is still in its infancy.

Objectives

This study aimed to explore the experiences and perceptions of Generation Z nursing students during their practicum in an intensive care unit (ICU) in the context of China's unique cultural and historical background.

Methods

A phenomenological approach was used in this qualitative study. Semi-structured, face-to-face interviews were conducted with fifteen Generation Z nursing students doing practicum in the ICU in a third-level hospital in Shanghai, China. The data were analyzed using Colaizzi's seven-step method.

Result

Three themes emerged: intelligent medical services empowering critical care, perception of multiple challenges, and affirmation of the teaching work in the ICU.

Conclusions and implications

The clinical instructors should use a combination of online and offline pedagogy, give positive guidance through role modeling, and develop the self-learning skills of Generation Z nursing students. This might help Generation Z nursing students relieve the stress of practicum in the ICU, more quickly adapt to the clinical environment, and enter nursing positions. The result of this research provided valuable information to help clinical practicum programs in China effectively educate Generation Z nursing students. Good education ensures that health care is safe and effective, making it easier for patients to get better.

"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.

Effects of a death education based on narrative pedagogy in a palliative care course among Chinese nursing students

Background

Death education has been confirmed to be an effective method to enhance nursing students' attitudes and coping abilities toward death. However, integrated Narrative Pedagogy into the death education to explore educational effectiveness is still limited. The study aimed to evaluate the effects of a death education based on Narrative Pedagogy in a palliative care course on the attitude toward death, coping with death, and attitude toward caring for the dying among undergraduate nursing students in China.

Methods

The study was designed as a pre-post intervention study with a quasi-experimental design. All the participants received 6 class hours of death education which was designed in a palliative care course. The death education includes preparation, presentation, discussion, reflection, and practice of the narrative materials. Death Attitude Profile-Revised (DAP-R), Coping with Death Scale (CDS), and Frommelt Attitude Toward Care of the Dying-Form B (FATCOD-Form B) were used to measure outcomes.

Results

Sixty undergraduate nursing students who consented. There were statistically significant increases in the mean score of neutral acceptance and approach acceptance in the DAP-R, CDS, and FATCOD-Form B before and after the intervention.

Conclusion

This death education integrated Narrative Pedagogy which indicated to improve attitude toward death, competence to cope with death, and attitude toward the care of dying patients. The findings assist teachers in understanding the importance and urgency of death education, as well as providing a favorable approach to death education. However, the long-term effectiveness still needs to study in further.

Using palliative and end-of-life simulation to enhance pre-licensure nursing students' emotional intelligence, palliative care knowledge and reflective abilities: A single group, pretest-posttest study

BACKGROUND

Nursing students have reported that they lack skills and knowledge in palliative and end-of-life care, and as a result, they faced numerous challenges caring for patients and families receiving palliative and end-of-life care during clinical attachments.

OBJECTIVES

To develop a palliative and end-of-life care simulation program and evaluate its effects on nursing students' emotional intelligence, palliative care knowledge and reflective abilities.

DESIGN

A single group, pretest-posttest quasi-experimental study.

SETTINGS

A simulation center in a Singapore university.

PARTICIPANTS

A convenience sample of 135 third-year undergraduate nursing students.

METHODS

Students attended a two-day simulation program consisting of four scenarios in total. Outcomes were measured before and after the study. Palliative care knowledge was measured using the Palliative Care Knowledge Test, emotional intelligence using the Trait Meta-Mood Scale-24, and reflective abilities using the Groningen Reflective Ability Scale. Outcome and demographic data were analyzed using descriptive and inferential statistics.

RESULTS

Total Palliative Care Knowledge Test scores (p = 0.003) and total Trait Meta-Mood Scale-24 scores (p < 0.001) improved significantly, but there was no significant change in Groningen Reflective Ability Scale scores (p = 0.650). Demographic characteristics did not significantly influence most outcome variables. Students' highest education level and experience with caring for a person receiving palliative or end-of-life care significantly affected the posttest scores of the Palliative Care Knowledge Test. Students with prior experience in caring for a person receiving palliative or end-of-life care scored significantly better in the Palliative Care Knowledge Test post-simulation compared to those who did not (p = 0.011).

CONCLUSIONS

The palliative and end-of-life simulation program significantly improved nursing students' emotional intelligence and palliative care knowledge. Further research is needed on developing a reliable tool to measure nursing students' palliative care knowledge. Future simulations should include structured and deliberate reflection features aside from debriefings to enhance reflective abilities, which is an important nursing competency. More research is needed on the effect of palliative and end-of-life care simulations on emotional intelligence and reflective abilities, and the influence of demographic variables on nursing students' outcomes.

Nurses' Caring Experiences for Dying Patients: A Meta-Synthesis Review

Nurses play an important role in caring for dying patients. The ability to face a dying patient is a vital necessity and skill for nurses. Nurses' experiences in dealing with dying patients help to identify the factors affecting nursing care. Therefore, this meta-synthesis explains nurses caring experiences for dying patients. In this meta-synthesis review, English qualitative articles related to nurses' caring experiences with dying patients that were published in Google Scholar, PubMed, Web of Science, Scopus, and CINAHL databases were selected. The results presented in 4 themes and 4 sub-themes, including (i) dual parallel nursing care (patient care and family care), (ii) conflict between nurses' beliefs and care duties, (iii) care reflections on the nurse (positive and negative care reflection, and (iv) coping strategies of nurses. This study shows that nurses provide diverse care to dying patients and their families, which has had positive and negative reflections on their personal and professional lives. Nurses sometimes had a conflict with their beliefs and treatment protocols, which hesitate to perform the treatment. Although nurses use various coping strategies when caring for dying patients and their families, they need more strategies to cope with multi-faceted physical, mental, spiritual, educational, and management issues.

Thriving psychological well-being in undergraduate nursing student: a grounded theory study with the life grid approach

BACKGROUND

Psychological well-being (PWB) plays a vital role in successful adaptation to the Bachelor of Nursing journey and affects career development. However, there is little known about the functional and social processes associated with enhancing well-being specific to the subjective perspective of nursing students.

AIM

To investigate how nursing students promote their psychological well-being to conceptualize thriving psychological well-being.

METHOD

This qualitative study analyzed and reviewed a life grid and semi-structured in-depth interviews of 20 Chinese Nursing graduates by investigators and participants, following Charmaz's constructivist grounded theory. The constant comparative method was used to analyze data. This study took place between 2020 and 2022.

RESULTS

All participants experienced fluctuations in psychological well-being. This study identified a new understanding of how nursing students enhance their psychological well-being. Thriving awareness was co-constructed as the core category and based on the relationship with a supportive environment, the thriving psychological well-being of nursing students is conceptualized.

CONCLUSIONS

It is imperative to enhance the psychological counseling and support for nursing students during their clinical placements, during the period just entering university as well as after repeated outbreaks of COVID-19. Nursing educators and administrators could develop appropriate educational programs and interventions based on the theoretical model-Thriving psychological well-being.

Nursing Students' Spiritual/Religious Coping Strategies Dealing With First Experience of Witnessing Death During Clinical Practices

This study aims at determining spiritual/religious coping strategies of nursing students dealing with the first experience of witnessing death during clinical practices. One of the qualitative research approaches, a descriptive phenomenological study was designed. The study was carried out with 14 nursing students studying at a state university in Turkey. The students' first experiences of witnessing death were examined by the personal in-depth interviewing method. Data were analyzed using the thematic analysis method. The following five main themes were identified by the analysis: Perception of death; Witnessing death for the first time; Coping with death experience; Needs and recommendations; Impact of spirituality and religion. The obtained findings were presented according to the COREQ criteria. The findings showed that witnessing death for the first time is a difficult experience that affects students in various ways and students prayed and performed their prayers frequently to cope with the death experience.

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 impact of violence on women’s health. The present as a reflection of the past: A qualitative study

The objective of the study is to analyze the impact of violence on women’s health and the feelings generated during the period of exposure to violence. This is a qualitative study with an interpretative phenomenological design in which 16 women participated—4 through interviews and 12 through stories. The data obtained were analyzed using the Colaizzi approach. The results were structured into 3 themes according to how the women interpreted their experiences. The themes were physical consequences: visible traces; psychological consequences: stormy days and sunny days; and social consequences: from loneliness to a new world. In conclusion, the women in this study considered all those (very diverse) physical pathologies to be important. They encompassed a series of psychological disorders that lasted over time, causing considerable suffering and complicating the participants’ ability to relate to the rest of society, especially men. Similarly, the participants identified a series of positive consequences when they left the traumatic situation empowered after overcoming gender-based violence.