Supporting students May

Questions/ Questions What situations/issues do students face in caring for patients and families at the end of life? Quels sont les défis/difficultés que les étudiants peuvent rencontrer lors des soins du client et de leur famille en fin de vie ? What teaching strategies or supports have you used to address these situations? Quelles stratégies d’enseignement ou de soutien avez- vous utilisées pour ces situations ?

Issues Many nurses and nursing students have difficulty dealing with death (Payne et, al.1998; Servaty et al., 1996; Waltman & Zimmerman 1992; Brockopp et al., 1991; Thompson, 1985 in Mallory 2003) Students reported “true feeling of inadequacy” in their ability to provide both patients and families with emotional support at the end-of-life. Coming from a Canadian study to uncover students’ concerns about caring for the dying. (Milton, 1984).

ISSUES Feelings of personal inadequacy result in death anxiety (Beck,1997) Initial feelings of hesitancy and discomfort (Allchin,2006) Negative attitudes, stress, avoidance, sadness, non open communication, stereotyped attitudes (Allchin,2006)

Issues Anxiety in 1 st year nursing students (Cooper, 2005) Coping with the physical suffering of patients Not knowing what to do or say The severing of the relationship with the patient The type of death Cardiopulmonary resuscitation Postmortem care Use of coping mechanisms

Professional and Societal Influences (Quint, 68) Value of recovery care Personal gratification and professional rewards working with patients who are getting well Expectations from the public: high esteem for the life-saving capabilities of nurses and doctors Our society has little contact with those who are dying (young people in urban, industrialized societies)

Strategies Providing nursing students with opportunities to experience caring for dying patients decrease their death anxiety (Beck, 1997) Include EOLC content in nursing curricula (theory and clinical) (Brajtman & al,2007; Mallory,2003) Prepare students by providing a detailed patient report (Mallory,2006) Introduce student to patient and family and explain the student’s role in caring for the patient (Mallory,2006)

Strategies Provide students with suggestions of ways to interact with patient and family Suggest palliative measures which student can initiate Emphasize the importance for student nurses of the power of silence & presence “I really enjoyed talking with families and the patient…. I learned that you don’t have to speak all the time and that a person’s support is sometimes the only thing needed.” ( Kwekkeboom & al,2005). Provide opportunity to role play difficult conversations

Strategies (Mallory,2006) Encourage students to identify any additional patient needs and suggest further interventions or consults Provide follow-up de-briefing, and give feed-back to student Allow students to discuss their thoughts and feelings about the experience Encourage self-reflection

Strategies Small group discussions/clinical conferences built upon ‘teachable moments’ have shown value (Hsu,2007; Kwekkeboom et al, 2005; Birkholtz et al, 2004; Mallory,2003) : 1) video trigger tapes 2) use of narrative 3) reflection/reaction papers 4) use of art, poetry, music (Johnson, 2005)

Educators can create the atmosphere Learners are encouraged to evaluate their beliefs and views on the subject by using self-reflection. (Mallory, 2003) Be aware of your own personal feelings related to death and dying. (Mallory, 2006)

References Allchin, L. (2006). Caring for the dying: Nursing student perspectives. Journal of Hospice and Palliative Nursing, 8(2), Beck, C.T. (1997). Nursing students' experiences caring for dying patients./ Nurs Educ.;36(9): Birkholz, G., Clements, P. T., Cox, R., & Gaume, A. (2004). Students’ self-identified learning needs: A case study of baccalaureate students designing their own death and dying course curriculum. Journal of Nursing Education, 43(1), Brajman, S., Fothergill-Boubonnais, F., Casey, A., Alain, D. & Fiset, V. (2007). Providing direction for change: A survey of Canadian Baccalaureate Nursing students’ learning needs in end-of life Care. International Journal of Palliative Nursing, 13(5), Cooper, J. & Barnett, M. (2005). Aspects of caring for dying patients which cause anxiety to first year student nurses. International Journal of Palliative Nursing, 11 (8), Ferrell, B, Virani, R., & Grant, M. (1999). Analysis of end-of-life content in nursing textbooks. Oncology Nursing Forum, 26,

References Hsu, L. (2007).Conducting clinical post-conference in clinical teaching: A qualitative study. Journal of Clinical Nursing. 16 (8), Johnson, A., Jackson, D. (2005). Using the arts and humanities to support learning about loss, suffering and death. International Journal of Palliative Nursing, 11(8), Kirrchhoff.K. T., Beckstrand, R. L., & Anumandla, P.R. (2003). Analysis of end-of-life content in critical care nursing textbooks. Journal of Professional Nursing, 19 (6), Kwekkeboom, K.L., Vahl, C., & Eland, J. (2005). Companionship and education: A nursing student experience in palliative care. Journal of Nursing Education, 44 (4), Mallory, J. L., & Allen, C. L. (2006). Care of the dying: A positive nursing student experience. MEDSURG Nursing, 15(4), Mallory, J.L. Mallory, J. L. (2003). The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students. Journal of professional Nursing, 19 (5),

References Milton, I.C. (1984). Concerns of final year baccalaureate students about nursing dying patients. Nursing Eduction.;32(7): Quint, J, C. (1968). Preparing nurses to care for the fatally ill. International Journal of Nursing studies, 5 (1), Thompson, G. T. (2005). Effects of end-of-life education on baccalaureate nursing students. AORN Journal, 82 (3), Walsh, S. M., & Hogan, N. S. (2003). Oncology nursing education: Nursing students’ commitment of “presence” with the dying patient and the family. Nursing Education Perspectives, 24 (2),