Teaching end of life to nursing students
An article written by Cindy Hoang
Working as a nurse during the COVID-19 pandemic had many challenges. One of them was caring for a person who was at the end of their life. However, instead of being surrounded by loved ones, they were alone. The only comforting hand and soothing presence felt by patients during this time was from their health care workers.
For a student or graduate nurse who may not have had many experiences with death, this would have been extremely confronting. The COVID-19 experience showed us the significant role nurses play in caring for people at end-of-life (EOL). However, research has demonstrated that nursing students often feel underprepared and anxious when caring for a dying patient. [1,2] So how is it currently being taught in higher education? In recent years, EOL simulations have become a popular teaching methodology.
Simulation based learning (SBL) is an experiential learning experience where a “situation [is] made to resemble clinical practice as closely as possible”. [3] In a recent scoping review, we looked at the current research on EOL simulations in undergraduate nursing education. Many common themes emerged, however the one which really sparked my interest was the influence of the facilitator. Students were able to identify key qualities in an educator which promoted their learning.
Being an educator, I find teaching someone how to care for a dying person much harder than teaching someone how to care for a patient with chest pain requiring intervention. On one hand, we have clinical skills that have set steps and the other hand, soft skills. How do you effectively teach someone sympathy, therapeutic communication, and kindness? Qualities which are so important when caring for people at EOL but there is no concrete step-by-step process to achieving this. It varies widely and knowing what to do and how to say it often changes based on the situation. There are no best practice guidelines for facilitation of an EOL simulation, which is what I am ultimately trying to achieve with my PhD.
Now more than ever, I think it is important to highlight the need for a more robust curriculum which can lead to well-rounded nurses capable of entering the workplace armed with the skills to care for people at EOL, across the lifespan. It’s interesting when I first started my PhD about EOL, I immediately associated it with care of the older person. But that really is not the case. While we do have an ageing population, it is a good reminder for us all that death does not have preferences.
References
- Heise BA, Gilpin LC. Nursing Students' Clinical Experience With Death: A Pilot Study. Nurs Educ Perspect. 2016 Mar-Apr;37(2):104-6.
- Hjelmfors L, Strömberg A, Karlsson K, Olsson L, Jaarsma T. Simulation to Teach Nursing Students About End-of-Life Care. J Hosp Palliat Nurs. 2016 Dec;18(6):512-8.
- Jeffries PR. Simulation in nursing education: from conceptualisation to evaluation. Washington (DC): National League for Nursing; 2007 p. 28.
Cindy Hoang
PhD Candidate
Lecturer in Nursing, La Trobe University
and Cardiac Nurse, Alfred Hospital