Barabara Heise and Debra Wing, Nursing
The purpose of this national study was to answer the following questions:
- What is the prevalence of nursing students encountering death in the clinical setting?
- What are the perceptions of nursing student’s first clinical encounter with death?
- What are the students’ perceptions of their knowledge and communication abilities to manage patient situations at end-of-life (EOL)?
- What actions by nurse educators might mitigate this potentially stressful situation according to students?
The objectives of this study were met through a descriptive mixed methods Qualtrics survey of members of the National Student Nurses Association (NSNA) (N=55,000). A geographically diverse random sample of nursing students was obtained (N=2804).
Three undergraduate and one graduate nursing student were mentored in the My Patient Died Study. The graduate student was mentored for approximately six months on her graduate thesis on one qualitative question in the survey which was “Without divulging protected patient information, please describe your experience when your patient died.” Later, this student changed her mind and dropped out of this study to pursue other research with a research team faculty member who also dropped out of the project. The undergraduate students involved in the study were Alison Hatch, Amy Rawlinson Hullinger, and Danielle Shkapich. These students were successfully mentored and were involved in conducting literature reviews, entering data in qualitative software (NVIVO), analyzing data, manuscript preparation, and submission of abstracts for presentation of research findings. One manuscript is in the process of being finalized for submission written by myself, Amy Hullinger and Debra Wing. In addition, Danielle Shkapich submitted an abstract to the Western Institute of Nursing Research (WIN) which was accepted for a poster presentation in April 2015. We also plan to write a manuscript for publication based on her findings to the question “As a nursing student, what would you want to be taught about dying and the death of a patient?”
Findings
Most respondents were female (80%), age 27 or less (50%), white (68%) and single (61%). The majority of nursing student participants were in a Bachelor’s of Science in Nursing (BSN) program (58%). Participants came from every state in the United States as well as the District of Columbia.
Nursing students who were present when a patient died in the clinical setting accounted for 41% of the respondents. The majority of those who experienced a patient death (62%) experienced that death during the early semesters in their nursing program.
Of those nursing students who experienced a patient death (N=1148), 27% admitted to needing help coping with the experience. While debriefing is routine when a computerized patient dies in a simulation setting in a laboratory, only 33% of those students experiencing a patient death received debriefing after an actual death.
Students were asked to rate their level of preparation (1=unprepared, 2=somewhat prepared, 3=prepared, 4=very prepared) in relation to the death and dying process, end-of-life care, and ways to cope with a patient death. Only 24% of the nursing students reported that their nursing curriculum prepared them in general EOL care. Only 17% of the nursing students felt that their curriculum prepared them to cope with the death of a patient. When asked who prepared them to cope with the death of a patient the top answer was no one.
In this national survey, students expressed both positive and negative reactions to the experience of a patient death. Positive feelings were expressed such as “peaceful”; “a blessing”; “relieved that the suffering ended”; “honored to be involved” and an acceptance of death as a natural part of life. However, more often negative feelings were expressed using such words as “shocked”; “scared”; “overwhelmed”; “numb”; “helpless”; “anger”; “upset”; “creepy”; and “surreal.” Nursing students often felt useless, unprepared, and frustrated.
Nursing students wanted to be taught more during their curriculum about EOL care. The number one category was communication with the dying patient, their family and even other nursing staff. Students suggested that they needed more personal experiences about EOL care from their faculty, more simulation experiences involving patient demise, and even having a hospice clinical experience to help them better prepare for the inevitable death of a patient when they become a practicing registered nurse.
While a few students suggested that one cannot be prepare for a patient death, most students felt that they could have been better prepared during the course of their nursing program. Inclusion of these nursing student suggestions into the curriculum may mitigate some of the negative experiences of their initial coping with a patient death.
Budget
Mentoring Environment Grant (MEG) monies were spent on the following:
- NSNA email list
- Undergraduate Research Assistants
- Statistician
- National Survey Participant Incentive gift cards
- Dissemination of research findings
- Manuscript preparation (editor)
- Poster printing
- Qualitative Data analysis instruction