Danielle Shkapich and Barbara Heise, College of Nursing
Introduction
The purpose of this qualitative study was to analyze the recommendations of nursing students nationwide who have experienced a patient death while in nursing school regarding end-of-life (EOL) curricula. Many nursing students are not adequately instructed on how to perceive and react to death. For registered nurses, dealing with death is an evitable part of their careers. Without adequate instruction, student nurses are less prepared to deal with such circumstances in their future practice. While many studies regarding the benefits of EOL training have been published, this study takes the next step in determining, on a national basis, what students recommend regarding EOL instruction. With adequate understanding of student concerns, educators are better able to provide quality instruction and support to student nurses regarding quality EOL care.
Methodology
This project is part of an ongoing study conducted by the principal investigator, Dr. Barbara Heise, PhD. A Qualtrics survey was conducted on-line with the National Student Nurses Association (NSNA) (membership approximately 60,000 student nurses). The survey addressed nursing students’ perspectives on death and dying in the clinical setting.
This study provides a qualitative analysis of the responses to one question: “As a Nursing Student, what would you want your nursing faculty to teach/prepare you about dying and the death of a patient?” (n=785).
Qualtrics survey data was analyzed with NVIVO (10.0) using an iterative process until saturation was obtained according to themes relative to nursing students’ experiences with death in a clinical setting. Trustworthiness and rigor of analysis was assured by verification of themes by Dr. Heise.
Results
(n=785)
Communication with patient’s loved ones= 29.04%
End-Of-Life nursing care= 24.84%
Coping skills= 22.42%
Supportive care to patient’s loved ones= 18.60%
Communication with dying patient= 16.56%
Dying process= 11.85%
Post mortem care= 10.32%
Supportive care to dying patient= 9.17%
Learn from experience= 7.39%
Debriefing= 5.61%
Discussion
Communication is one of the most essential skills involved in the practice of nursing. Especially in the tense and emotional circumstances of death, students seem to feel an added measure of inadequacy when communicating with a patient’s loved ones. It makes sense that this crucial skill would be the highest concern in students today. Moreover, students seem to grasp the notion of how vital and instrumental therapeutic communication can be to dying patients and their families. Considering the essential nature of this skill, it would be wise for instructors to educate students on how to approach difficult circumstances from a communication standpoint. That, alone, could be one of the most influential teachings a student may receive on EOL care.
Furthermore, it is interesting and surprising to find that students were more concerned about how to talk to and care for the patient’s loved ones than the patient themselves. The reasoning behind this finding is a great foundation for additional studies.
Additional research should also be conducted regarding how best to implement and enforce these EOL teaching themes to further our understanding of student preparedness. In doing so, we can learn not only what students need to learn but how to most effectively teach it.
Conclusion
With the results provided by this study, nursing instructors are better able to tailor their EOL instruction to the concerns of the student nurses themselves. As a result, this knowledge can now be used as an essential supplement to the EOL instruction that students already receive. We are hopeful that as instructors take these recommendations into consideration, students will feel better prepared to provide quality EOL care to dying patients and their families now and throughout their careers.