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A review and discussion a of the literature relating to the experiences of Irish Undergraduate B.Sc. student nurses caring for patients and their families at the end of life in an acute setting.

A review and discussion a of the literature relating to the experiences of Irish Undergraduate B.Sc. student nurses caring for patients and their families at the end of life in an acute setting.

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An essay for the 2011 Undergraduate Awards (Lecturer Nomination) Competition by Kate Bridgeman. It is nominated by Lecturer Maria Bailey of University of Limerick in the category of Nursing & Midwifery
An essay for the 2011 Undergraduate Awards (Lecturer Nomination) Competition by Kate Bridgeman. It is nominated by Lecturer Maria Bailey of University of Limerick in the category of Nursing & Midwifery

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Published by: Undergraduate Awards on Sep 01, 2012
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10/27/2013

 
A review and discussion of the literature relating to the experiences of IrishUndergraduate B.Sc. student nurses caring for patients and their families at the end of life in an acute setting.Abstract.
This paper presents a consideration and discussion of the literature relating to the experiencesof Irish Undergraduate BSc student nurses caring for patients and their families at the end of life in an acute setting. In Ireland as many as 15,000 patients die in acute general care settingseach year (IHF 2009). Palliative care is, as a result, an important component of the work of most health care professionals. The demand for palliative care services can be expected toincrease in the coming years with advancing technology and increasing life longevity(Palvish and Ceronsky 2009). It is therefore essential that all should have knowledge in this
area, and feel confident in the core skills required (Ling and O’ Síoráin 2005).
The findingsof this review suggest that there are relatively few recently published Irish studies in the area
of students’ perception of caring for the terminally ill within the acute hospital setting
.
 
Background
 According to the IHF (2009) approximately 30,000 people die in Ireland every year. Themajority of these deaths occur within a hospital environment, outside of the home. It has beencalculated that at least half of all deaths take place in acute hospitals (48%) or hospices (4%).Dying at home adds up to a quarter (25%) of the total with one fifth dying in long stayfacilities (20%). This means almost 15,000 deaths occur in acute/general hospitals per annum(The IHF 2009).The demand for palliative care services can be expected to increase in the coming years withadvancing technology and increasing life longevity (Palvish and Ceronsky 2009). Accordingto The National Audit of End of life care in hospitals in Ireland 2008/2009, of 999 patientswho died in Irish hospitals, nearly 9/10 of these patients died in acute hospitals (Mckeown
et al
2010).The World Health Organisation (WHO) (2002:
84
) defined palliative care as
“An approach that improves the quality of life for patients and their families facing the problem
associated with life-threatening illness through the prevention and relief of suffering by means of 
 
early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
This definition led to a wide recognition that the principles of palliative care should beapplied as early as possible in the course of any chronic, ultimately fatal illness and not justlimited to patients with cancer (World Health Organisation 2002, p.84). Similarly accordingto the National Institute of Clinical Excellence (2004) palliative care should offer a supportsystem to help patients to live as actively as possible until death, while also helping the
family to cope during the patients’ illness and in their own bereavement.
 
Given the inevitability that some patients in the health care system will die, palliative care isan important component of the work of most health care professionals. It is thereforeessential that all should have knowledge in this area, and feel confident in the core skills
required (Ling and O’Síoráin 2005). As m
any patients die in acute general care settings eachyear (The IHF 2009), it follows that of all the healthcare professionals, it is nurses who spendthe most time caring for such patients. Working in clinical practice under the supervision of registered general nurses, undergraduate student nurses are frequently one of the main caregivers. These students can therefore contribute either positively or negatively to the quality of care received by the patient and his/her family. This literature review considers theexperiences of undergraduate student nurses in caring for patients at the end of life.
Review and discussion of literature
A literature review is the process of identifying what has already been written on the topicbeing studied (Vivar
et al
, 2007). Parahoo (2006) argues that a literature review is a processthat serves to inform the various stages of a project and to put into context what is alreadyknown on the subject.(Cronin
et al,
2008) argues that a literature review provides the readerwith a detailed background on current knowledge available while illuminating thesignificance of new research, a review of the literature can also provoke research ideas byidentifying gaps in the literature and assist the researcher in devising a research questionKeywords used when searching and retrieving literature for this review included Death;Dying; End of Life; Palliative Care; Nurse; Student Nurse and Undergraduate Student Nurse.The use of electronic databases such as Academic Search Premier, Health and Wellness, Sageand CINAHLwere beneficial in identifying appropriate literature in the area of interest.
 
Themes to emerge from the literature included: preparation for the end of life care forundergraduate student nurses, challenges to caring for a dying patient for an undergraduatestudent nurse and formal/informal coping mechanisms.This review will commence with a brief discussion of the development of palliative care inIreland within the international arena. This will be followed with a review and discussion of the literature relating to the identified themes.
Development of Palliative care in Ireland
The development of the modern hospice movement is attributed to Dame Cicely Saunders
who in 1967established the first modern hospice, St Christopher’s Hospice, in London (TheIrish Hospice Foundation (IHF) 2008b). Then in the late 1980’s palliative medic
ine became arecognised speciality in the United Kingdom (UK). During this period the influence of St
Christopher’s spread to other countries, including Ireland and The Irish Association for Palliative care was established in the early 1990’s. In 1995 the
Irish Medical Councilrecognised Palliative Medicine as a medical speciality and the first Irish Palliative medicineConsultant was appointed. Currently in 2010, Ireland has approximately 30 consultants inPalliative Medicine (Irish Hospice Foundation 2008b).As many as 15,000 patients die in acute general care settings each year (IHF 2009). Parish
et al
 
(2006) argues that in regards to acute hospitals, there is a belief that patients’ who are
receiving end of life care may not experience support which fully reflects appropriatepalliative care management. Similarly Roche-Fahy and Dowling (2009) maintain that theacute hospital setting is cure-orientated, technologically advanced, dramatic and fast-pacedand these aspects may cause the provision of comfort being rendered unrecognised and/orunacknowledged.Palliative care is, as a result an important component of the work of most health careprofessionals. It is therefore essential that all should have knowledge in this area, and feelconfident in the core
skills required (Ling and O’ Síoráin 2005). It follows that of all the
healthcare professionals, it is the nurses who spend the most time caring for such patients.Working in clinical practice under the supervision of a registered general nurse,undergraduate nurses are frequently one of the main care givers. Nursing education programstherefore are preparing nursing students to practice in the context of a fast changing and

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