Laura Gilpin and Dr. Barbara Heise, College of Nursing

Death, particularly the unexpected death of a patient, is an emotionally charged, highstress situation for any nurse. Nursing students encounter scenarios involving death and dying in simulation laboratories, as well as in the clinical setting. It is essential a nurse learns how to process and cope with his or her emotions regarding the death of a patient since it may occur frequently during his or her career. If a nurse cannot cope with these emotions it could lead to burn out and damage to overall emotional health.

Also, many times when a patient dies the family turns to the nurse for emotional support, which can be more easily offered when a nurse is able to efficiently cope. In simulation settings debriefing is routinely accomplished and is seen as a critical component of the learning experience. However, Leavy and colleagues (2011) found that even during formal simulation debriefing sessions nursing students were not able to fully process their emotions In real-life clinical settings, the stakes are even higher as nursing students must be able to effectively cope with the death of a patient.

Unfortunately, research on students’ first experience with death is limited. This study was conducted to examine nursing students’ perceptions of their first experience with death in the clinical setting within the Brigham Young University (BYU) College of Nursing (CON). The results were examined to determine if curricular changes, specifically debriefing, are necessary to better prepare nursing students to effectively cope with their first death experience as a nurse.

This was a descriptive mixed methods pilot study. An online anonymous survey was sent to students in the BYU CON regarding their first experience with death in the clinical setting (N=306). Students were e-mailed a brief description of the research project and an invitation to participate in the study only if they had experienced the death of a patient. Completion of the online questionnaire implied consent. The participants answered 5 demographic questions and 11 survey questions with the estimated time commitment for each participant being 15 minutes.

The online questionnaire was sent to 306 BSN nursing students in the BYU CON. Approximately 10% initially responded (N=33). A smaller group (N=25) completed the entire survey. In analyzing the qualitative results various themes repeated throughout the survey. Many of the responses included information and feelings regarding the family of the deceased patient and students unsure of how to express empathy to the family. A theme of feeling sad, shocked, and uncomfortable was evident in the students’ personal emotions; however, a few experiences and emotions indicated the experience was peaceful and happy. Overall the results showed the students felt they should not show emotion and the process of the death of a patient to be more task-oriented. This can be detrimental to a nurse if he or she does not learn it is acceptable to express emotion and it may be needed to prevent eventual burn out.

Fifty percent of the nursing students did not receive any debriefing from their clinical instructor following the event. Students commented more discussion with their clinical instructor after the death would have improved their experience. Of the fifty percent who did receive debriefing only 57% (N=7) indicated that they felt the debriefing was effective. Students’ responses showed effective debriefing included the instructor speaking with the student one-on-one and also with the clinical group in the usual post conference occurring after each clinical. Group discussion allows for peers to share various feelings, experiences, and insights surrounding the death of a patient. This discussion offers a student the opportunity to feel other students are going through the same experience and to share possible coping techniques.

A variety of emotions surface during this unpredictable time and nursing students may have difficulty reconciling their feelings concerning the death of a patient. Nursing curricula needs to routinely include debriefing sessions for nursing students in the simulation as well as in the clinical setting following the death of their patient. Nurse educators should consider curriculum changes in order to implement standardized debriefing following the death of a student’s patient and not simply rely on the instructor’s discretion or for students to handle the situation independently. The results are continually in the process of being analyzed and more themes and implications most likely will be found.

In the future this study should be expanded to include other nursing schools. The sample size in this study was small and may not be a fully accurate representation of nursing students across the country. Also, a shorter and more direct questionnaire could be helpful in shortening the time for each subject. Different types of debriefing and their effectiveness could also be studied.

This study was accepted as a poster to present at the Western Institute of Nursing (WIN) in Anaheim, CA on April 12th. An abstract was also submitted to the Utah Conference on Undergraduate Research and status regarding the submission of the study will occur in early January.

References

• Byock, I. (2002). The meaning and value of death. Journal of Palliative Medicine, 5(2), 279- 288.
• Gerow, L.,Conejo, P., Alonzo, A., Davis, N., Rodgers, S., & Domian, E. W. (2010). Creating a curtain of protection: Nurses’ experiences of grief following patient death. Journal of Nursing Scholarship, 42(2), 122-129.
• Huang, X., Chang, J., Sun, F., & Ma, W. (2010). Nursing students’ experiences of their first encounter with death during clinical practice in Taiwan. Journal of Clinical Nursing, 19, 2280-2290.
• Leavy, J., Vanderhoff, C. & Ravert, P. (2011). Code simulations and death: Processing of emotional distress. International Journal of Nursing Education Scholarship, 8(1), 1-13.
• Leighton, K., & Dubas, J. (2009). Simulated death: An innovative approach to teaching end-of-life care. Clinical Simulation in Nursing, 5, e223-230.
• Loftus, L. (1998). Student nurses’ lived experience of the sudden death of their patients. Journal of Advanced Nursing, 27, 641-648.