MEDSURG Nursing—August 2006—Vol. 15/No. 4
Judy L. MalloryCharles L. Allen
Care of the Dying: A PositiveNursing Student Experience
Judy L. Mallory, EdD, RN, CHPN,
is anAssistant Professor of Nursing,Western Carolina University, Cullowhee,NC.
Charles L. Allen, BSN, RN,
is a StaffNurse, Harris Regional Hospital, Sylva,NC.
How a staff nurse should determine the appropriateend-of-life care experience for a nursing student, including what course work the student should have prior to the expe- rience as well as what knowl- edge and support the staff nurse and student should expect from the clinical instructor, is discussed. Trans- formative learning theory isused as the basis for enhanc- ing the student’s learning and can facilitate a positive end- of-life care experience.
istorically, nurses have not received extensive education on how tocare for dying patients and their families (Allchin, 2006; Ferrell, Virani,Grant, Coyne, & Uman, 2000). This lack of education has been reflected inthe level and quality of end-of-life (EOL) care provided to patients. NursingEOL curricula have been lacking both in didactic education and clinicalexperiences. Students who by chance cared for a dying patient wereunprepared and in some cases had little support from staff nurses or theirclinical instructors. With the funding of the End of Life Nurse EducationConsortium (ELNEC), this trend began to change (Matzo, Sherman,Sheehan, Ferrell, & Penn, 2003).
The History of Nursing Education in Relation to End-of-Life Care
Many nurses and nursing students have difficulty dealing with death(Brockopp, King, & Hamilton, 1991; Cooper & Barnett, 2005; Payne, Dean,& Kalus, 1998; Servaty, Krejci, & Hayslip, 1996; Thompson, 1985; Waltman& Zimmerman, 1992). In contrast, the International Council of Nurses(1997) stated that nurses have a unique and primary responsibility forensuring that individuals at the EOL experience a peaceful death. Thenursing role in EOL care has expanded in the last decade to includeadvanced directives, do-not-resuscitate (DNR) decisions, and palliativecare discussions (Haisfield-Wolfe, 1996).The authors have noted that, because many nurses struggle withnegative personal issues concerning death and dying, they are thereforeuncomfortable providing care to dying patients. Examples include arecent experience with a nurse caring for a dying patient. The nurseasked one author, who was in the role of nursing instructor with hospiceexperience, to talk to the family about the approaching death of apatient. In another experience, the authors witnessed staff nurses avoid-ing an approaching death conversation with family members of a dyingpatient because they wanted the hospice nurse to ask for a DNR order.The nurses openly admitted discomfort in dealing with death and dying.A recent unpublished study (Connell, 2006) found that several schoolsof nursing do not provide effective education for nursing students onEOL care options. In another study (Ferrell et al., 2000), the majority ofnurse respondents (89.5%) felt that EOL content was important to basicnursing education. However, 71% of respondents said their EOL painmanagement education was inadequate, 62% rated their overall contenton EOL care as inadequate, and 59% rated management of other symp-toms education as inadequate. The study also found that less than 35%of nurses rated their grief/bereavement support and spiritual support topatients at the EOL as effective.