Measuring undergraduate nursing students' knowledge of Christian, Islamic, and Hindu death rituals: A national study

BACKGROUND

Globally, research indicated undergraduate nursing students have limited knowledge, in caring for people at the time of death. With increasing immigrant populations, undergraduate nursing students and nurses seeking to provide culturally competent care lacked specific knowledge regarding the death rituals of other religions which presents a major knowledge gap that must be addressed. This study measured undergraduate nursing students' knowledge of specific death rituals as practised by three world religions (Christianity, Islam and Hinduism) in the Republic of Ireland.

AIM

The current study aimed to measure undergraduate nursing students' knowledge of specific death rituals as practised by three world religions (Christianity, Islam, and Hinduism).

DESIGN

This study used a quantitative descriptive cross-sectional design.

PARTICIPANTS

Nursing students from all 13 higher education institutions (HEIs) registered with the Nursing and Midwifery Board of Ireland were invited to participate. Out of these, eight HEIs consented, representing a total of 5050 undergraduate nursing students. From this pool, 414 students, spanning from all nursing and midwifery programs from all four provinces of Ireland, participated in the study.

METHODS

A 23-item knowledge survey, The Knowledge Questionnaire (KQ) was developed with input from experts and validated for accuracy, relevance, essentiality, and reliability. Further reliability testing of the tool was done in this study.

RESULTS

The Knowledge Questionnaire (KQ) was found to be reliable showing a Cronbach's alpha coefficient of 0.873 in the national study. The findings highlighted a significant lack of knowledge regarding death rituals across the religious groups. Most students reported seeking information about these rituals from sources outside of formal nursing education.

CONCLUSION

Based on these results, the authors strongly recommends the inclusion of mandatory cultural education in nursing programs to better prepare students for end-of-life care in diverse cultural contexts.

RELEVANCE TO CLINICAL PRACTICE

This study provides an informed starting point from which specifically tailored education programmes could be developed and implemented. The goal is to foster culturally competent care in both clinical and academic settings to meet the needs of increasingly culturally diverse patient populations in a variety of health care settings nationwide.

Being Here and Now: An Evolutionary Concept Analysis of Nursing Presence in End-of-Life Care

Nursing presence is an important therapeutic and diagnostic modality in patient-centered care and decision-making during end-of-life (EOL) care. Nurses cultivate presence through intentional awareness and actions to support patients, yet there is a paucity of relevant literature regarding nursing presence in EOL care. An evolutionary concept analysis employing Rodger's techniques was conducted with 20 international research studies and nine analyses of nursing presence between 1992 and 2023. The attributes, antecedents, and consequences of nursing presence in EOL care were described, a theoretical definition was proffered, and suggestions for its clinical application and future research directions were offered. As evidenced by this concept analysis, nursing presence in EOL care is an intentional, temporal, spatial, and intrapersonal relationship. More research and analysis of this concept are needed, especially in long-term care settings given continued growth in the long-term care patient population and the prevalence of nurses leading EOL care in that setting.

Understanding nursing students' first experience of patient death in clinical practice: A qualitative systematic review and meta-synthesis

BACKGROUND

Witnessing patient death for the first time poses significant challenges for nursing students. Understanding their experiences can inform improvements in educational and support strategies within nursing programs.

AIM

This qualitative systematic review aimed to examines nursing students' initial encounters with patient death, emphasizing their perceptions, emotional responses, and coping mechanisms.

DESIGN

Qualitative systematic review.

REVIEW METHODS AND DATA SOURCES

A comprehensive search was conducted across ten electronic databases from their inception until February 16, 2024, with an update on October 30, 2024. Eligible studies were evaluated for quality using the Joanna Briggs Institute Critical Appraisal Checklist. Data extraction was performed using the standardized tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. The findings were synthesized, and the ConQual tool assessed the confidence in the results.

RESULTS

This systematic review included 16 studies involving 285 nursing students. Qualitative analysis identified 154 findings, categorized into six themes: (1) holistic support for patient comfort and dignity in dying, (2) perceptions of death, (3) confronting the challenges of patient death, (4) emotional impacts on students, (5) adjustments following patient death, and (6) witnessing death through novice perspectives.

CONCLUSIONS

The first encounter with patient death during clinical practice significantly impacts nursing students. Comprehensive death education and robust support systems are essential for enhancing students' coping abilities. Educators and clinical practitioners should implement support strategies that address students' needs, helping them confront patient death with composure and professionalism.

Emotional and psychological experiences of nursing students caring for dying patients: an explorative study at a national referral hospital in Uganda

BACKGROUND

Caring for dying patients is associated with psychological trauma, strong emotions and enormous stress for nursing staff and nursing students who are reliable health care providers in such difficult situations. Nursing students involved in End-of -life care need to work through these emotions during clinical placements. This study explored the lived experiences of nursing students caring for the dying patients at Mulago national referral hospital.

METHODS

An explorative study was conducted using in-depth interviews among fifteen 3rd and 4th year undergraduate nursing students of Makerere University college of Health sciences. Data was audio recorded, verbatim transcribed and thematically analyzed using Atlas. ti version 6 software.

FINDINGS

Two themes emerged from students' narratives of their emotional and psychological experiences while caring for dying patients; (1) Psychological and emotional reactions, (2) Coping mechanisms. The sub-themes under Psychological and emotional reactions were; feelings of anger, triggers of anxiety symptoms, triggers of sadness and guilt feelings. The sub themes under coping mechanisms were; peer to peer support through interacting with each other about the experiences, engagement in problem solving, distancing from patients, spirituality and engaging in personal stress reducing activities.

CONCLUSION

Nursing students experience various negative psychological and emotional reactions but devise different coping mechanisms to overcome them. There is need for development of clear guidelines on orientation of nursing students caring for dying patients, emphasis on building their emotional intelligence and more research on effectiveness of end of life educational interventions to mitigate the anticipated negative psychological and emotional reactions.

Online education in palliative care - A national exploratory multimethod study

BACKGROUND

With an increased number of people living with multiple progressive diseases, online education courses have been created to address the growing need for competence in palliative care. However, there is limited knowledge about the form and content of these courses, or of participants' experiences. This study aims to map the status, content, and evaluation of online palliative care courses in Sweden.

METHODS

This exploratory study used both quantitative and qualitative methods. The study process involved searching for online palliative care courses on the web and through contact with Swedish palliative care organisations, and then participating in these courses, surveying education providers, and analysing and validating responses. Quantitative data were analysed using descriptive statistics, while thematic analysis was applied to the free-text responses.

RESULTS

Nine online courses provided by five different organisations were mapped. These courses educated over 30 000 healthcare professionals, predominantly assistant nurses and registered nurses. There was a large discrepancy between the number of people who enrolled in and the number who completed the online courses. Shortcomings identified related to lack of systematic evaluation from the participants' perspectives, if and how knowledge was integrated into clinical practice, and difficulties in making the courses sustainable.

CONCLUSION

Overarching and national systems for online education are needed. These would require sustainability considerations and guidelines for implementation, evaluation and follow-up of non-university-based online educational initiatives in palliative care. In addition, it is crucial for employers to support professionals undergoing such education, ensuring that they are given opportunities to share their feelings and discuss any challenging thoughts that arise during and after the course.

Emotional and Psychological Experiences of Nursing students caring for Dying Patients: A phenomenology study at Mulago National Hospital, Uganda

Introduction

Caring for dying patients is associated with psychological trauma, strong emotions and enormous stress for nursing staff and nursing students who are relied on by patients and relatives in such difficult situations. Although nurses have an ability of self-control and calm approach towards death, there are still some emotions they need to "work through". Research studies have documented limited exposure of nursing students to end-of-life care and inadequate understanding of the psychological and emotional experiences they encounter during clinical placements. This study explored the psychological and emotional experiences of Ugandan student nurses on caring for the dying patients at Mulago national referral hospital during clinical placement.

Methods

A qualitative phenomenological study was conducted among fifteen undergraduate nursing students of Makerere University in clinical placement at Mulago hospital. An In-depth interview guide was used to gather data on nursing students' emotional and psychological experiences and coping mechanisms. Data was audio recorded, verbatim transcribed and thematically analyzed using Atlas. ti version 6 software.

Results

The nursing students emotional and psychological experiences when caring for dying patients were emerged into two themes; (1) Psychological and emotional reactions, (2) Coping mechanisms. The sub themes were; anger, anxiety and depression which is triggered by a combination of issues of pressure from relatives, failure to save the dying patient, thoughts of wasted efforts to reverse the dying process, limited resources, limited technical and emotional support. The students cope by seeking help from peers, engagement in problem solving, distancing from patients, spirituality and engaging in personal stress reducing activities.

Conclusion

Insights from this study provide educators with a snapshot of student encounters, emotions, and coping strategies when facing dying patients and their families. Nursing students experience various negative emotional and psychological stressors triggered by a combination of issues that need to be addressed during care of dying patients. However, they devise different coping mechanisms to continue with provision of necessary end of life care as the clinical placement contributes to their learning, experience and builds confidence among student nurses.

Teaching to prepare undergraduate nursing students for palliative care: nurse educators' perspectives

BACKGROUND

Education in palliative care for undergraduate nursing students is important for the competence of general nurses. Newly graduated nurses have reported challenges in coping with their own emotions when encountering dying persons. They express a wish for more education before they graduate, particularly in psychosocial and existential areas, such as having difficult conversations and supporting grieving persons. Despite awareness of the importance of palliative care education for nurses, there is a lack of knowledge on how to effectively convey this knowledge to students. The aim of the present study was to explore how teaching to prepare undergraduate nursing students for palliative care practice is conducted in Sweden.

METHODS

Educators from 22 Bachelor of Science nursing programmes in Sweden were interviewed about how they conducted palliative care education, with a focus on teaching situations that have been successful or less successful. The interviews were transcribed and analysed using qualitative inductive content analysis.

RESULTS

Educators described that they play a crucial role in preparing undergraduate nursing students to face death and dying and to care for persons at the end of life. In the main theme, "Transforming person-centred palliative care into student-centred education", educators described how they incorporated the person-centred palliative approach into their teaching. Educators used a dynamic style of teaching where they let the students' stories form the basis in a co-constructed learning process. The educators trusted the students to be active partners in their own learning but at the same time they were prepared to use their expert knowledge and guide the students when necessary. Discussion and reflection in small groups was described as being essential for the students to achieve a deeper understanding of palliative care and to process personal emotions related to encountering dying and grieving individuals.

CONCLUSIONS

This study suggests that palliative care education for undergraduate nursing students benefits from teaching in smaller groups with room for discussion and reflection. Furthermore, gains are described relating to educators taking the role of facilitators rather than traditional lecturers, being flexible and ready to address students' emotions. Educators also draw on their experiences as palliative care nurses in their teaching practices.

Undergraduate nursing students' experiences of palliative care in the intensive care unit

BACKGROUND

The terminal ill patients in the Intensive Care Unit had physical, mental, social, and spiritual suffering. Nursing students must be aware of own feelings to be able to deliver humanistic care and enable patients to live the rest of lives with dignity. The aim of the study was to investigate experiences of providing palliative care in the Intensive Care Unit (ICU).

METHOD

This study is a qualitative case study research. In-depth interviews were conducted with the key informants. The key informants were nine Thai third-year nursing students were purposively selected.

RESULTS

The experiences of providing palliative care involved two Themes: (1) self-perception while providing care for terminal ill patients and (2) providing care for terminal ill patients with respect in the patients' dignity.

CONCLUSION

These results can be applied to create learning activities to promote nursing students' self-awareness and enable them to provide humanized care for terminal ill patients.

Death, dying and caring: exploring the student nurse experience of palliative and end-of-life education

BACKGROUND

Undergraduate education and training are fundamental in preparing student nurses for working in palliative and end-of-life care.

AIM

This article explores the experiences of student nurses in their palliative and end-of-life undergraduate nurse education.

METHODOLOGY

Sandelowski and Barroso's (2007) framework for undertaking a metasynthesis was used. Initial database searches returned 60 articles of interest. Re-reading the articles in the context of the research question identified 10 studies that met the inclusion criteria. Four key themes emerged.

FINDINGS

Student nurses voiced concerns regarding their feelings of unpreparedness, and lack of confidence and knowledge when dealing with the complexities of palliative and end-of-life care. Student nurses called for more training and education in palliative and end-of-life care.

CONCLUSION

Flexible nursing curricula responsive to the needs of student nurses and the changing landscape of healthcare provision, including care to ensure a good death experience, should be prioritised at undergraduate level.

Death Anxiety and Associated Factors Among Oncology Nurses and Physicians

Background: Providing care for dying patients is a stress-inducing, complicated, as well as essential responsibility for health care providers. Furthermore, end-of-life care is associated with intense personal emotions such as grief, anxiety, depression, frustration, and guilt. Moreover, caring for terminally ill patients is a challenging task that confronts physicians and nurses with the psychological concerns of dealing with death, which is accompanied by a high level of physical and psychological discomfort.Objective: This study was aimed to measure the level of death anxiety among oncology nurses and physicians and to determine the associated factors that influence their level of death anxiety.Method: A cross-sectional descriptive design was used to guide this study, a non-probability convenience sampling method was used to recruit 200 oncology nurses and physicians from one specialized cancer center in Jordan. Data were collected using an electronic self-reported questionnaire include demographic data sheet and Collett-Lester fear of death scale, as well as all participants were invited via email for voluntary participation in this study.Result: The results revealed that the oncology nurses and physicians exhibited a moderate levels of death anxiety (CLDFODS = 91.07), furthermore, the result showed that female nurses and physicians exhibited a higher level of anxiety than male. Further, there were statistically significant differences in nurses' and physicians' level of death anxiety according to years of experience, receiving previous education on death and dying, and religious beliefs. On the other hand, there is no statistically significant differences in nurses' and physicians' level of death anxiety based on present or previous experience with loss of someone close to them.Conclusion: Jordanian oncology Nurses and physicians exhibited a moderate levels of death anxiety and fear of death, therefore, they have to address the inevitability of mortality since they are caring for dying patients frequently. They have to understand and acknowledge their thoughts regarding death and dying, as well as their death anxiety level before interacting with dying patients.

Bereavement and Professional Competencies: Exploring the Personal Experience of Death Among Nursing Students - A Qualitative Study

Purpose: To explore the death experiences of nursing students in their personal lives. Methods: This study employed a qualitative descriptive design using the semi-structured interview approach. A purposive sampling method was used to recruit 24 nursing students from September 2020 to July 2022. Data were analyzed using Colaizzi's analysis method. Lincoln and Guba's criteria was used to evaluate the trustworthiness of the data. Results: Four main themes emerged from the interviews: (a) reactions to encounters with death; (b) adjustment strategies; (c) personal growth induced by the death experiences; and (d) professional reflections for preparing nurse role. Conclusions: Although the death of a loved one makes nursing students suffer from grief and emotional distress, we show that the experience promotes the personal growth and professional competencies of nursing students and thereby, developing their overall aptitude towards the profession. Death experiences of nursing students have shown to allow them to reflect on both life and death, to consider the demands of the nursing profession, and to provide foundation for nursing students to be more empathetic and compassionate when facing death in the future. Exploring death experiences of nursing students is vital in better providing better quality education and personal support for nursing students.

Knowledge about Palliative Care and Attitudes toward Care of the Dying among Primary Care Nurses in Spain

Objective: To analyze the knowledge in palliative care and the attitudes toward caring for the dying of nurses who carry out their professional activity in primary care in Spain. Design: A cross-sectional descriptive observational study was carried out among Spanish primary care centers. Participants: A total of 244 nurses who had completed their primary care work and agreed to participate in this study were included. Main measurements: The level of knowledge in palliative care was analyzed using the PCQN-SV scale, and attitudes toward care of the dying were measured with the FATCOD-S scale, both of which are instruments that are validated in Spain. Results: Regarding the level of knowledge in palliative care, at a global level, the results revealed that 60% of the answers in the PCQN-SV were correct, with different results for each of the three subscales that compose it. When analyzing the attitudes of primary care nurses toward the care of the dying, an average of 132.21 out of 150 was obtained, representing a positive attitude. On the other hand, when analyzing these results in terms of knowledge and attitudes according to the population’s characteristics, we see that participants with both experience and training in palliative care present a better level of knowledge and a higher score regarding their attitudes toward care of the dying. However, the differences are only significant regarding the level of knowledge in palliative care. When analyzing the data from the two scales together, it is noteworthy that the participants with the most positive attitudes (highest scores on the FATCOD-S) also have the highest percentages of correct answers on the PCQN-SV.

Nursing Students’ Experiences With Patient Death and Palliative and End-of-life Care: A Systematic Review and Meta-synthesis

AIM

To synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settings BACKGROUND: Nurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.

DESIGN

A qualitative systematic review and meta-synthesis METHODS: PubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012-25 Feb 2023. Qualitative studies of any design reporting nursing students' experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso's 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.

RESULTS

The review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.

CONCLUSIONS

While caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.

"Do Not Protect Us, Train Us."-Swiss Healthcare Students' Attitudes Toward Caring for Terminally Ill Patients

Positive attitudes and a sense of competence toward end-of-life care are the key to adequately support terminally ill patients. This qualitative study aims to explore healthcare students' attitudes toward caring for terminally ill patients. Eleven students from the University of Applied Health Sciences in Switzerland participated in focus groups. Attitudes were overall positive. Most participants felt that supporting dying patients was a way to achieve professional fulfillment. However, most students felt not competent in palliative care and lacking experience. They wanted to receive better training, more specifically in good practices and appropriate behaviors. Our study fills a knowledge gap regarding the opinions and pedagogical needs of healthcare students, and highlights the importance of experiencing end-of-life care during the educational process. We recommend early exposure to terminally ill patients and appropriate attitudes toward death and dying as part of the bachelor's curriculum, accompanied by benevolent guidance from teachers and health professionals.

Student nurses' end-of-life and post mortem care self-efficacy: A descriptive study

BACKGROUND

Student nurses providing end-of-life care reported that caring for a person dying created anxiety, fear, and increased stress and reflected low self-efficacy. New nurses felt unprepared academically and emotionally. High self-efficacy is necessary to handle adverse emotional reactions. However, the literature lacks an instrument to evaluate nursing students' self-efficacy in caring for someone who is dying.

OBJECTIVE

The study aims to investigate the reliability and validity of the "End-of-Life and Postmortem Self-Efficacy Scale" and explore nursing students' self-efficacy associated with the nursing duties and responsibilities of caring for individuals during the active phase of dying and immediately after death.

DESIGN

The study was a quantitative descriptive, cross-sectional design.

PARTICIPANTS

National Student Nurses' Association members enrolled in undergraduate registered nurse associate's, bachelor's degree programs, or a nursing diploma program.

METHOD

National Student Nurses' Association members responded to an electronic survey containing 18 items related to end-of-life and post mortem nursing responsibilities.

RESULTS

A total of 498 responses were analyzed. Cronbach's alpha (α = 0.938) showed high reliability of the 18 items on the instrument. The Kaiser-Meyer-Olkin was 0.925 and indicated sampling adequacy. Bartlett's test of sphericity was highly significant (p = .001). The nursing students' mean end-of-life and post mortem self-efficacy score was 62 (scale of 0-100).

CONCLUSION

The "End-of-Life and Postmortem Self-Efficacy Scale" showed high reliability in evaluating the latent concept of end-of-life and post mortem self-efficacy. The low mean self-efficacy score indicated that nursing students might be underprepared to provide EOL and post mortem care as new graduates. Faculty can use the "End-of-Life and Postmortem Self-Efficacy Scale" to assess student readiness and identify gaps in knowledge in the care of someone who is dying. Future research is needed to determine how increasing nursing students' end-of-life and post mortem self-efficacy influences the perception of end-of-life preparedness.

Student Nurses' Perception of Good Death and Religious Coping Styles

This research aims to examine the perception of the good death and religious coping styles of student nurses. The research is a correlational descriptive study. The research was conducted with 358 nursing students at a state university in the east of Turkey. It was found in the study that students had a good perception of death (58.83 ± 6.12) and mostly used positive religious coping styles (positive/24.55 ± 3.71, negative/13.31 ± 4.21). As a result of the correlation analysis, a weakly significant positive relationship was determined between good death perception and positive religious coping (p < .001).This study observed that students' perceptions of good death increased along with their positive religious coping styles.

A qualitative study of phenomenology of perspectives of student nurses: experience of death in clinical practice

Aim

To describe the experiences of student nurses in confronting the death of their patients, and to understand how they cope with these events and to what extent there are unmet needs that can be addressed in their trainings.

Methods

Semi-structured interview method was used to collect data from Chinese nursing students and then Colaizzi’s seven-step analysis method was applied to identify recurrent themes in their responses to patient deaths. We listened the tape repeatedly combined with observations of their non-verbal behaviors, then transcribed them with emotional resonance, and entered them into Nvivo. After that, we extracted repeated and significant statements from the transcriptions, coded, then clustered codes into sub-themes and themes which were identified by the comparation with transcriptions and re-confirmation with our participants.

Results

After confirmation from the interviewees, five themes emerged: emotional experience, challenge, growth, coping and support.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00846-w.

Finnish nursing students' perceptions of the development needs in palliative care education and factors influencing learning in undergraduate nursing studies - a qualitative study

BACKGROUND

Nurses have an essential role in providing high-quality palliative care to patients and their families. Hence, they require adequate palliative care education. However, there is only limited insight into how final-year nursing students perceive palliative care education in undergraduate nursing programs. This study aimed to describe nursing students' perspectives of the development needs of palliative care education. An additional two aims emerged based on the collected data, namely, to describe the preferred education for palliative care and the factors which promote or hinder palliative care learning during undergraduate nursing studies.

METHODS

The research was guided by a descriptive qualitative approach and applied inductive content analysis. The frequencies (f) of identified codes (reduced expressions) were counted to show the noteworthiness of each category in relation to the entirety. The participants were final-year nursing students (n = 766) who had participated in a national survey.

RESULTS

The inductive content analysis identified three unifying categories. The first was 'Development needs and views of palliative care education' (f = 524), which consisted of the main categories 'the need to develop palliative care education' (f = 414) and 'meaning of palliative care and its education' (f = 110). Secondly 'Preferred types of palliative care education' (f = 1379), including the main categories 'teaching contents in palliative care education' (f = 905), 'teaching methods for palliative care learning' (f = 393), and 'placement of palliative care studies' (f = 81). Thirdly 'The facilitators and barriers to palliative care learning' (f = 401), consisting of the main categories 'factors facilitating palliative care learning' (f = 66) and 'barriers to palliative care learning' (f = 335).

CONCLUSIONS

This study provides detailed information about nursing student's perspectives of palliative care education and its development needs. Hence, the results are relevant to decision-makers who want to develop undergraduate nursing curricula. This study highlights that palliative care education should be developed by ensuring that all students have equal access to palliative care education provided by highly competent teachers. Possibilities for clinical placements or visits to palliative care units during the education should also be improved. The participating students felt unprepared to provide high-quality palliative care even though they responded that palliative care is an important topic in their nursing studies.

Nursing Students' Views of the Content of Palliative Care in Undergraduate Education and their Self-assessed Palliative Care Competence-A Nationwide Cross-sectional Study

BACKGROUND

The importance of integrating palliative care (PC) education into undergraduate nursing studies has been recognized. Still, there is considerable variation in the PC education of nurses.

OBJECTIVE

To study the nursing students' views of the PC contents during the nursing education; students' self-assessed levels of PC competence; and whether prior education or work experience influence these views.

METHODS

A cross-sectional study. Data were collected using a questionnaire which was tested for its content and construct validity and internal consistency. The sample consisted of final-year undergraduate nursing students (n = 1331) from Finland.

RESULTS

The response rate was 94%. Of the students, 94.4% considered PC education to be quite or very useful, but only 51.9% reported the achieved PC teaching as quite or very good. Teaching on mental symptoms, existential issues and multicultural aspects were considered incomplete. Over half of the students wanted more education on pharmacological- and non-pharmacological pain management. Students with previous education assessed their PC competence as quite or very good more often than other students (70.1% vs. 54%, P < .001), and more often felt that these competencies are relevant to their profession (72.2% vs. 57.6%, P < .001).

CONCLUSION

PC was considered as a useful subject, still only about half of the students reported the received PC education and their competence on PC as sufficient. Previous education or experience may enhance PC competence highlighting the need for divergent teaching. The results identify development needs for the contents of PC education in undergraduate nursing studies.

Teaching about death and dying-A national mixed-methods survey of palliative care education provision in Swedish undergraduate nursing programmes

BACKGROUND

In coming decades, the number of people affected by illnesses who need palliative care will rise worldwide. Registered Nurses are in a central position in providing this care, and education is one of the necessary components for meeting coming requirements. However, there is a lack of knowledge about palliative care in undergraduate nursing education curricula, including the extent of the education provided and the related pedagogical methods.

AIM

The aim was to investigate the extent, content and pedagogical methods used and to explore lecturers' experiences of being responsible for teaching and learning about palliative care for undergraduate nursing students on nursing programmes at Swedish universities.

SETTING

All 24 universities responsible for providing undergraduate nursing education in Sweden participated.

PARTICIPANTS

One lecturer with in-depth knowledge about palliative care or end-of-life care education participated in the quantitative (n = 24) and qualitative (n = 22) parts of the study.

METHOD

A mixed-method research study with an explorative design was used. Descriptive statistics were used to analyse quantitative data, and content analysis for qualitative, with both also analysed integratively.

RESULTS

Few undergraduate nursing programmes included a specific course about palliative care in their curricula, however, all universities incorporated education about palliative care in some way. Most of the palliative care education was theoretical, and lecturers used a variety of pedagogical strategies and their own professional and personal experience to support students to understand the palliative care approach. Topics such as life and death were difficult to both learn and teach about.

CONCLUSIONS

There is a need for substantial education about palliative care. Lecturers strive on their own to develop students' understanding and increase the extent of palliative care education with innovative teaching strategies, but must compete with other topics. Palliative care teaching must be prioritised, not only by the universities, but also by the national authority.

Development of the Spirituality in Palliative Care Scale for nursing students in the context of Thai culture

BACKGROUND

Nursing students form part of the healthcare team who care for patients who are living with a terminal illness and facing physical and spiritual suffering. However, there is a lack of suitable indicators to measure a nurse's spirituality when they are providing palliative care.

AIM

To develop a way of measuring the spirituality of nurses who provide palliative care.

METHOD

The participants consisted of 312 third-and fourth-year nursing students of two nursing colleges from southern and central Thailand.

FINDING

The 12-item Spirituality in Palliative Care Scale had the reliability of .804. The measurement model was consistent with the empirical data and had unidimensional quality (X2=50.94, df=45, p-value=0.25, root mean square error of approximation (RMSEA)=0.044, Single Resolution Mechanism Regulation (SRMR)=0.044, Adjusted Goodness of Fit Index (AGFI)=0.95, Corporate Finance Institute (CFI)=0.97, goodness of fit (GFI)=0.97). The items' factor loadings were in between .48 and .84.

CONCLUSION

The spirituality in palliative care scale can measure nursing students' spirituality in palliative care and nursing educators can use the measurement to support nursing students to develop greater awareness of spirituality in palliative care.

Nursing students' attitudes towards death and caring for dying patients

Aim

To examine the attitudes of undergraduate Jordanian nursing students towards death and caring for dying patients.

Design

A cross‐sectional correlational design.

Methods

The Frommelt Attitude Toward Care of the Dying and Death Attitude Profile‐Revised scales were used in this study with a convenience sample of 555 students from nursing schools in Jordan.

Results

Nursing students had positive attitudes towards death (M = 153.7, SD = 21.5) and a positive attitude towards caring for dying patients (M = 98.1, SD = 9.2). Fear of death, escape acceptance and death avoidance were significant negative predictors, while neutral acceptance, higher academic level and female gender were significant positive predictors of caring for dying patients (F = 4.5).

Conclusion

Nursing students had positive attitudes towards caring for dying patients that was influenced by university type, academic level and gender. Nursing education must further focus on death, dying and end‐of‐life care across the core courses of nursing curricula, theory and practicum.

Nursing students perceptions of death and dying: A descriptive quantitative study

BACKGROUND

Nurses are frequently present during the dying process as a support for the dying person and the family. Experiencing death in this capacity can cause emotional and psychological stress to the nursing staff as they work to help others. Nursing students as the upcoming generation of nurses, need the knowledge and self-awareness to support others through these often traumatic events. Many students may not have experience with death or dying and when combined with lack of knowledge will be a great barrier once students graduate.

OBJECTIVES

The purpose of this study is to determine how sophomore, junior, and senior undergraduate nursing students enrolled in one University setting perceive the concept of death and dying.

DESIGN

A descriptive quantitative study was designed to explore the various perceptions that sophomore, junior, and senior nursing students have about death and dying.

RESULTS

The Frommelt Attitudes Toward Care of the Dying scale showed students have a positive attitude toward caring for dying patients. The Death Attitudes Profile-Revised scale indicated the presence of all profiles, though most students identified with Neutral Acceptance profile.

CONCLUSIONS

Nursing students often fear caring for clients with death or dying. Additional targeted education along with end of life care simulations can improve students improve their attitudes and beliefs to better care for patients.

Italian nursing students' attitudes towards care of the dying patient: A multi-center descriptive study

BACKGROUND

International literature reports that nursing students feel unprepared when facing patients and families within dying care. They consider their curricula inadequate in teaching end-of-life care and promoting the attitudes required to care for dying patients. Findings of recent studies exploring nursing students' attitudes towards care of the dying patient are often contradictory.

OBJECTIVES

To explore Italian nursing students' attitudes towards caring for dying patients.

DESIGN

A multicenter cross-sectional study was conducted.

SETTINGS

The Bachelor's Degree in Nursing courses of four Universities of the Lazio Region.

PARTICIPANTS

The sample included 1193 students.

METHODS

Data were collected between September 2017 and March 2018 using the Italian version of FATCOD-B-I. The differences between the mean scores were compared through t-test or ANOVA. Associations between scores and participant characteristics were evaluated through generalized linear regression.

RESULTS

The mean score of FATCOD-B-I was 115.3 (SD = 9.1). Higher scores were significantly associated with training in palliative care (p < 0.0001) and experience with terminally ill patients (p < 0.0001). Students manifested more negative attitudes when they perceived patients losing hope of recovering, and patient's family members interfering with health professionals' work. Uncertainties emerged around knowledge of opioid drugs, decision-making, concepts of death and dying, management of mourning, and relational aspects of patient care.

CONCLUSIONS

Italian nursing students seem to have more positive attitudes towards care of dying patients than most other countries. They believe that caring for a terminal patient is a formative, useful experience but they do not feel adequately prepared in practice. Deeper palliative care education, integrated with practical training, would prepare students better, enabling them to discover their own human and professional capacity to relieve suffering.

A genealogy of what nurses know about 'the good death': A socio-materialist perspective

In this article, we report the outcome of a sociological inquiry into nursing knowledge of death and dying, specifically 'the good death'. A genealogical approach informed by actor-network theory and appreciative inquiry were used to compose a broad socio-material account of how nurses concern themselves with the care of the dying and end-of-life care. Our enquiry revealed similarly to other studies, that there was no shared or overarching model of care. Key themes derived from nurses' translations of 'the good death' were re-presented pictorially as six pillars and two processes to comprise a new diagram of The Personalised Ideal Death.

Nursing student attitudes toward dying patient care: A European multicenter cross-sectional study

Background and aim of the work:

Nursing education plays a key role in preparing future nurses to deal with dying patients, which represents one of the most emotionally involving aspect of nursing. The aims of the study were to explore nursing students’ attitudes towards care of dying patients in three different European contexts and to analyze the variables that can influence them.

Methods:

We conducted an international multicenter cross-sectional study. We administered the Frommelt Attitude Toward Care of the Dying Scale form B (FATCOD-B) and a demographic form to 569 students, enrolled in three Nursing Programmes in different countries (Italy, Spain and United Kingdom), who accepted to participate in the study. The data were analyzed using SPSS software version 26.0.

Results:

Median total FATCOD-B scores indicated intermediate levels of students’ attitudes towards care for dying patients, with a statistically significant difference among the three student groups. The median total FATCOD-B scores did not statistically significantly change in students with different age, gender, year of study, religious beliefs, nursing education on palliative care, previous experiences of dying patient care and personal grieving.

Conclusions:

In our study, nursing students feel partially prepared in caring for dying patients and their attitudes do not change as the course of study progresses. No selected variables had an impact on students’ attitudes towards palliative care. Since nurses play a vital role in ensuring the quality of care, education on end-of-life care should be offered as a core part of undergraduate nursing programs. (www.actabiomedica.it)

Nurses' Attitude Toward Caring for Dying Patients in a Nigerian Teaching Hospital

Introduction

Death and the dying experience are common phenomena in all clinical settings. Death and the dying presents physical and emotional strain on the dying patient, his relations and professional caregivers.

Objective

The study therefore assessed the sociodemographic determinants of nurses’ attitudes towards death and caring for dying patient.

Method

A cross–sectional design was used to study 213 randomly selected nurses, working in one of the tier one teaching hospital in Nigeria. Attitude towards death and the dying was collected with Frommelt Attitude Care of the Dying and Death Attitude Profit–Revised questionnaire. The data collected was analysed with SPSS version 20 and inferential analyses were considered statistically significant at p < 0.05.

Results

The study revealed that most of the nurses had negative attitudes toward the concept of death (76.5%) and caring for dying patient (68%). Furthermore, a chi-square test revealed significant associations between the nurses’ years of working experience (χ² = 24.57, p <.00) and current unit of practice (χ² = 21.464; p = .002) and their attitude towards caring for the dying patient. Also, nurses’ age (χ² = 13.77, p = .032), professional qualifications (χ² = 13.774, p = .008), and current ward of practice (χ² = 16.505, p = .011) were significantly associated with their attitudes to death. Furthermore, the study observed a significant association between nurses’ attitudes to death and caring for the dying patient (χ² = 11.26, p < 0.01).

Conclusion

This study concluded that nurses had negative attitudes towards death and dying and therefore prescribes, as part of continuing professional development strategy, the need for requisite positive value – laden, ethnoreligious specific education regarding end of life care.

Registered nurses and undergraduate nursing students' attitudes to performing end-of-life care

Registered Nurses (RNs) are in the immediate position to provide End-of-life (EOL) care and counselling for patients and families in various settings. However, EOL-care often creates feelings of uncertainty and inadequacy linked to inexperience, lack of education, and attitude. To identify and describe factors associated with RNs' attitudes towards EOL-care, and to identify whether and how these attitudes differ from undergraduate nursing students' (UNSs) attitudes, a descriptive and comparative, quantitative study was performed. The FATCOD-instrument, focusing on attitude towards EOL-care, was used and the results analysed with descriptive and nonparametric statistics. In total, 287 RNs in 14 different specialist programmes, and 124 UNSs participated. A statistically significant difference (p = 0.032) was found in attitude towards EOL-care based on clinical experience. RNs in "Acute Care" and "Paediatric & Psychiatry Care" specialist programmes had a less positive attitude towards EOL-care (compared to RNs in other specialist programmes), while RNs attending the Palliative Care programme had the most positive attitudes. RNs and UNSs' scores differed statistically significantly in 17 out of 30 FATCOD variables. Finally, the results imply that there is a need for greater emphasis on further continuing education within EOL care for RNs working in all types of clinical specialities to encourage RNs talking about death and to enhance attitudes towards EOL care.

Embodied good deaths and disembodied bad deaths: Undergraduate nursing students narratives of experience

BACKGROUND

The concept of "good and bad deaths" has been widely addressed in the literature. However, little is known of undergraduate nursing students' experiences with death in clinical practice or how they perceive good and bad deaths.

OBJECTIVE

To explore undergraduate nursing students' personal and professional/clinical experiences of death and dying.

DESIGN

A qualitative narrative inquiry design.

SETTING AND PARTICIPANTS

Eighteen third year Bachelor of Nursing students participated in the study.

METHODS

Data was collected through individual participant interviews and analysed using Clandinin and Connelly's three dimensions of narrative inquiry (temporality, sociality and place).

RESULTS

A key finding of the study revealed that students' death experiences are shaped by the role of others, especially experienced nurses in clinical practice. Embodied good death experiences were influenced by the presence of nurses who guided students through the experience. Disembodied bad death experiences were influenced by undignified care, ritualistic post-mortem care and the physical coldness of the deceased and the environment.

CONCLUSION

Nursing students need meaningful preparation to undertake end of life care in clinical practice, including post-mortem care and the possibility of bad deaths. End of life care education and end of life care simulation play a role in preparing students for end of life care in clinical practice. End of life care education needs to be commenced early in the undergraduate degree. Furthermore, nursing clinicians need to be aware of the impact that they have in shaping good and bad death experiences for undergraduate nursing students, the Registered Nurses of the future.

Mayan & Swedish attitudes and practices toward death

This study explores how Mayan people from Guatemala and Swedes view and behave toward death. Using an interpretative phenomenological analysis, 10 participants from each culture were interviewed to elucidate the most relevant and important emerging themes. The Mayan approach to death is based on a collective perspective in which consultations with Elders, ancient traditions, and rituals help provide answer to most existential inquiries surrounding death. In contrast, the Swedish approach is based on an individualistic, rational analysis with a focus on life instead of death, but also showing openness to new perspectives on death.

Nursing students' first experience of death: Identifying mechanisms for practice learning. A realist review

OBJECTIVES

Many studies regarding nursing student's first experience of facing the death of a patient have focused on classroom methods or exploring attitudes towards death and related fears or anxieties. This review is the first to identify the mechanisms that facilitate practice learning as a result of students' first time experience of handling a patient's death.

DESIGN

A realist review as a form of a systematic review of the literature.

DATA SOURCES

The literature search focused on the earliest death experience of baccalaureate nursing students and end-of-life care, using databases MEDLINE, CINAHL, SCOPUS, ERIC, PSYCINFO.

REVIEW METHODS

Three research questions were addressed following a five-step process of (1) defining the scope of review and developing a theoretical framework, (2) conducting a theory-driven purposive search for evidence, (3) appraising evidence and extracting data, (4) synthesizing data and drawing conclusions, and (5) disseminating findings; with iterative expert consultation and discussion to answer the five questions of any realist review: 'what works, for whom, in what circumstances, how and why'.

RESULTS

Thirteen publications were included. Practice learning involves both changes and context improvements to be assessed and discussed by managers, leaders, nurse educators-facilitators and students. The environment and nursing role models are an inherent part of practice learning. Further work is needed to theorize the twelve key outcomes laid out in this review. These proposals require further consensus and the inclusion of inputs from both students and nurses.

CONCLUSION

The student nurse receives contradictory messages during the first experience of facing the death of a patient under their care. Considering the importance of this experience, specific indicators should be developed to track and guarantee and the optimal achievement of required competencies.

Analysis of Spanish nursing students' knowledge in palliative care. An online survey in five colleges

Along their professional career, nurses can find patients who require palliative care (PC). It is necessary to have at least a basic education in this area, that should be acquired during their university education. The objective of this descriptive online-survey set in five nursing Colleges was to analyze Spanish nursing students' knowledge in PC, offering an image of the status of education in PC. 619 students took an online questionnaire with the Spanish version of the Palliative Care Quiz for Nurses (PCQN-SV), which also collected information about their education in the field of PC. Univariate and bivariate analyses were performed, and a predictive binary logistic regression model was developed. Students obtained an average 45.65% of right answers in PCQN-SV, with differences related to the college and academic year in which they were enrolled and to their education in PC. In the regression model having theoretical education in PC (OR = 1.70) and academic year (OR = 1.35) showed to be both predictors of getting a result in PCQN-SV over 45% of correct answers. This study showed that Spanish nursing students have a medium-low level of knowledge in PC, and it also supports the need to develop a common framework for nurses' education in PC.

Nursing Students' Experiences With Death and Terminal Patients During Clinical Education

The aim of this study is to explore nursing students' experiences with death and terminal patients during clinical education. A secondary analysis of qualitative data that were collected through 11 focus group interviews with nursing students was performed. Data obtained from the interviews were analyzed using thematic analysis. There were a total of 9 themes across 3 contexts. Data were grouped under the following themes: feelings experienced when encountering death for the first time, reactions to the first encounter with death, factors affecting the reactions to death, involvement in terminal patient care, being informed about the physical process that terminal patients are going through, students' approach toward terminal patients and their relatives, health professionals' approach toward terminal/dying patients/their relatives, changes in the ideas about death, and changes in the ideas about terminal/dying patients. The study shows a lack of guidance on the part of teachers who also avoid patients and families who are considered terminally ill.

Using High-Fidelity Simulation to Introduce Communication Skills about End-of-Life to Novice Nursing Students

Background: High-fidelity simulation is being considered as a suitable environment for imparting the skills needed to deal with end-of-life (EOL) situations. The objective was to evaluate an EOL simulation project that introduced communication skills to nursing students who had not yet begun their training in real healthcare environments. Methods: A sequential approach was used. The "questionnaire for the evaluation of the end-of-life project" was employed. Results: A total of 130 students participated. Increasing the time spent in high-fidelity simulation significantly favored the exploration of feelings and fears regarding EOL (t = -2.37, p = 0.019), encouraged dialogue (t = -2.23, p = 0.028) and increased the acquisition of communication skills (t = -2.32, p = 0.022). Conclusions: High-fidelity simulation promotes communication skills related to EOL in novice nursing students.

Experiences of nursing students participating in end-of-life education programs: A systematic review and qualitative metasynthesis

OBJECTIVE

The aim of this review was to explore the experiences of nursing students participating in end-of-life education programs.

DESIGN

A systematic review.

DATA SOURCES

Exhaustive literature searches were performed using seven electronic databases: Medline, Scopus, Web of Science, CINAHL Plus, Dialnet Plus, Eric and Cuiden Plus.

REVIEW METHODS

In total, 6572 studies published from 2008 until 2018 were examined. The Critical Appraisal Skills Program was used to assess the quality of the studies included in the review. The findings were synthesized using meta-aggregation.

RESULTS

Seventeen studies were included in this systematic review, representing a sample of 606 nursing students. Simulation methods were most common among the educational programs analyzed. The analysis of qualitative data allowed us to identify 260 illustrations which were grouped into 14 categories and three themes: feelings and emotions during the performance of the pedagogical activity, end-of-life education among nursing students and competencies acquired on death and end-of-life. The most highlighted communication skills were learning to listen and building confidence to speak with the patient, family and the general public.

CONCLUSIONS

End-of-life programs generally helped students acquire communication skills, learn concepts and improve the administration of this type of care. In addition, they perceived the experience as an opportunity to learn more about oneself, gain trust and support critical thinking. Nonetheless, the evidence available in this field is limited due to the small number of studies, plus the limited data reported. Thus, further studies on this subject are necessary.

Caring for patients in the end-of-life from the perspective of undergraduate nursing students

BACKGROUND

Caring for patients in the end-of-life is an emotionally and physically challenging task. Therefore, undergraduate nursing students (UNS) need opportunities to learn to care for the dying patient. This study aimed to describe UNS' experiences of caring for patients at end-of-life.

METHODS

Interviews with 16 UNS in their last semester of nursing education were conducted. Data were analyzed with a phenomenological approach.

RESULTS

The UNS created a professional relationship with the dying patient. It meant that when the patient was unable to speak for themselves, the UNS could still meet his/her wishes and needs. The UNS believed they could take responsibility for the patient who was no longer able to take responsibility for themselves. Meeting with the patient's family could be experienced with anxiousness but was dependent on the personal chemistry between the patient's family and the UNS.

CONCLUSION

The UNS creates a relationship with the patient and their family. To be knowledgeable about the patient's physical and psychosocial needs means that the UNS can support the patient in the end-of-life phase. Being close to the patient and the family results in an intensity of emotions in the care situation. The UNS can receive support from their colleagues during processing their emotions and creating an experience from their encounters with patients in end-of-life care.

Nursing students’ experiences of caring for dying patients and their families: a systematic review and meta-synthesis

Objective

Nurses play important roles in caring for dying patients and their families. Difficulties students confronted when facing dying patients challenge the quality of nursing education. A better understanding of students’ experiences would enhance teachers’ ability in helping students. This study aims to describe available evidence about nursing students’ experiences when caring for dying patients and their families.

Methods

A review of qualitative studies published between 2005 and 2017 was undertaken using the following databases: MEDLINE, CINAHL, ProQuest Central, ScienceDirect, and CNKI. The keywords included were nursing students, experience, care, end-of-life, and dying. Qualitative Assessment and Review Instrument was used to assess the quality of the studies by two independent reviewers. The data from the studies were analyzed by meta-synthesis.

Results

Eighteen English and two Chinese studies were selected in this review. Four themes were emerged: (1) Students with dying patients: students did not have enough ability in symptoms control, comfort supply, and therapeutic communication for dying patients. (2) Students with the patients’ families: students advocated more caring for patients’ families. (3) Students with the surroundings: professional medical staffs, especially the nursing preceptors, were key roles in constructing a supporting system for students. (4) Students with themselves: nursing students underwent various negative feelings and adopted both negative and positive strategies to cope with such feelings; students experienced professional and personal development during the caring for dying patients.

Conclusions

Nursing students’ abilities in terminal symptom control, comfort supply, and therapeutic communication should be improved by more theoretic learning and simulation practice. The nursing preceptors were key roles in constructing a supporting system for students and helping them to control the negative emotions when facing dying patients.

Undergraduate nursing students' transformational learning during clinical training

BACKGROUND

Undergraduate nursing students encounter patients at the end of life during their clinical training. They need to confront dying and death under supportive circumstances in order to be prepared for similar situations in their future career.

AIM

To explore undergraduate nursing students' descriptions of caring situations with patients at the end of life during supervised clinical training.

METHODS

A qualitative study using the critical incident technique was chosen. A total of 85 students wrote a short text about their experiences of caring for patients at the end of life during their clinical training. These critical incident reports were then analysed using deductive and inductive content analysis.

FINDINGS

The theme 'students' transformational learning towards becoming a professional nurse during clinical training' summarises how students relate to patients and relatives, interpret the transition from life to death, feel when caring for a dead body and learn end-of-life caring actions from their supervisors.

IMPLICATIONS

As a preparation for their future profession, students undergoing clinical training need to confront death and dying while supported by trained supervisors and must learn how to communicate about end-of-life issues and cope with emotional stress and grief.

Person-centred end-of-life curriculum design in adult pre-registration undergraduate nurse education: A three-year longitudinal evaluation study

BACKGROUND

The need to provide quality end-of-life care is universally accepted. International research and policies encourage innovative ways that effective culturally appropriate care can be provided. Higher education institutions and practice settings are tasked with ensuring that nurse graduates have the knowledge, skills and insight to deliver person-centred end-of-life care.

RESEARCH AIMS AND OBJECTIVES

The aim was to explore student evaluation of end-of-life care learning within a three-year undergraduate adult nursing degree programme. Objectives were to assess student perceptions of the content and level of learning achieved, explore usefulness of learning, highlight areas that were most useful, and identify suggestions to improve learning.

DESIGN

A 3-year quantitative longitudinal design was used. A questionnaire containing open and closed questions was designed to incorporate the personal and professional learning strategies indicated by the Nursing and Midwifery Council (NMC) (2010).

SETTING AND PARTICIPANTS

The evaluation was completed at the same time point over a three-year period from April 2015-April 2017. The participants were year three student nurses, from 3 consecutive years, enrolled on a pre-registration adult nursing course at one university. There was a 66% response rate (n = 336).

METHODS

Participant information sheets and questionnaires were distributed and time to complete them facilitated. Responses from closed questions were coded and analysed using descriptive statistics (SPSS 24) and thematic analysis used for open questions.

RESULTS

Students expressed satisfaction with their learning, 88.7-97% of students reported a positive impact on their knowledge. They developed an understanding of the impact the nurse can have on the patient and family experience, reporting more confidence and competence in most aspects of end-of-life care. They noted improved ability to utilise this in their subsequent practice experience 88.1-97%.

CONCLUSIONS

Structured end-of-life care within the curriculum is essential to equip graduate nurses to provide effective evidence informed care. Planning should continue for curriculum development that encompasses person-centred end-of-life care across cultures.

Nursing students' attitudes toward care of dying patients: A pre- and post-palliative course study

Background

Many nursing students are not prepared to encounter death and care for patients who are at the end of life as newly educated nurses. The Frommelt Attitude Toward Care of Dying Scale (FATCOD) has been used to assess nursing students’ attitudes during their education and changes have been noted.

Objective

To examine nursing students’ attitudes towards care of dying patients before and after a course in palliative care.

Design

A descriptive study with a pre and post design.

Settings & participants

Nursing students (n = 73) enrolled in a mandatory palliative course in the nursing programme at a Swedish university.

Methods

Data were collected before and after a palliative care course using FATCOD and qualitative open-ended questions. Data from FATCOD were analysed using descriptive and analytical statistics. The open-ended questions were analysed with qualitative content analysis.

Results

The students’ mean scores showed a statistically significant change toward a more positive attitude toward care of dying. Students with the lowest pre-course scores showed the highest mean change. The qualitative analysis showed that the students had gained additional knowledge, deepened understanding, and increased feelings of security through the course.

Conclusions

A course in palliative care could help to change nursing students’ attitudes towards care of patients who are dying and their relatives, in a positive direction. A course in palliative care is suggested to be mandatory in nursing education, and in addition to theoretical lectures include learning activities such as reflection in small groups, simulation training and taking care of the dead body.

Prepared for end-of-life care: a concept analysis

BACKGROUND

Recent international documents have highlighted the importance of preparing the nursing workforce for end of life care. However, these documents do not make clear what prepared in the context of end-of-life care actually means. Searching the literature failed to retrieve any papers defining prepared in this context.

AIM

A concept analysis, using Walker and Avant's model, was conducted to help address this gap in the knowledge base.

RESULTS

From this analysis many attributes and antecedents were synthesised. These include that a prepared nurse would be confident to: assess the dying patient, communicate with empathy, identify and manage symptoms, recognise and deal with death and dying, understand the holistic elements of dying, be comfortable with the effects of loss and bereavement on patients and self, and be self-competent.

CONCLUSIONS

From this analysis, a clearer idea of what is needed to prepare nurses for end-of-life care is offered and suggestions for future research are made.

Nursing students experienced personal inadequacy, vulnerability and transformation during their patient care encounter: A qualitative meta-synthesis

OBJECTIVES

To identify, appraise and synthesize the best available evidence exploring nursing students' experiences of professional patient care encounters in a hospital unit.

DESIGN

The Joanna Briggs Institute (JBI) guidelines were followed and a meta-synthesis was conducted.

DATA SOURCES

Qualitative research articles were considered for inclusion in the review, and JBI's meta-aggregative approach to synthesizing qualitative evidence was followed. An extensive search for relevant literature was undertaken in scientific databases.

REVIEW METHODS

Data were extracted from the included research articles, and qualitative research findings were pooled using the Qualitative Assessment and Review Instrument. This involved categorization of findings on the basis of similarity of meaning and aggregation of these categories to produce a comprehensive set of synthesized findings.

RESULTS

A total of five research articles met the inclusion criteria and were included in the review. The review process resulted in 46 subcategories that were aggregated into 13 categories. The categories generated four synthesized findings: personal existence; personal learning and development; being a professional fellow human; and clinical learning environment.

CONCLUSIONS

We meta-synthesized that: Nursing students experienced personal inadequacy, vulnerability and a transformation during their patient care encounter.

Third-year nursing students' lived experience of caring for the dying: a hermeneutic phenomenological approach

BACKGROUND

In preparation for practice as a Registered Nurse, it is essential that students are equipped to care for the dying patient and their family.

AIM

To explore nursing students' lived experience of caring for a dying patient and their family.

DESIGN

Hermeneutic phenomenology.

METHODS

Students who had cared for a dying patient in their final year of study were invited to participate in an interview. Participants' narratives (n = 6) were thematically analysed.

FINDINGS

Analysis revealed three themes: being caring, unexpectedness in witnessing an expected death and experiencing loss. Students demonstrated family-centred care but recounted unexpectedness in both the dying trajectory and physical changes in the dying patient. When reflecting on experiencing loss, students questioned their own actions, acknowledged the value of relationships and identified ways to cope.

CONCLUSIONS

Engaging students in the care of dying patients and providing appropriate preparation/support can influence their experience and the care they provide in the future.

Nurses' views on legalising assisted dying in New Zealand: A cross-sectional study

AIMS

This study investigated New Zealand nurses' views on legalising assisted dying across a range of clinical conditions, nurses' willingness to engage in legal assisted dying, potential deterrents and enablers to such engagement, and nurses' perceptions of the proper role of their professional bodies in relation to legalising assisted dying.

BACKGROUND

A Bill for legalising assisted dying is currently before the New Zealand parliament. Of the 16 jurisdictions where assisted dying has been specifically legislated, only the Canadian federal statute provides nurses with explicit legal protection for their performance of assisted dying-related tasks. An absence of policy development and planning for safe nursing practice prior to legalisation of assisted dying results in a gap in professional support and guidance.

DESIGN

Exploratory cross-sectional survey.

RESPONDENTS

A self-selected sample of 475 New Zealand nurses responded to an anonymous online survey disseminated through the newsletters and websites of relevant medical and nursing professional bodies. A sub-sample of nurses who expressed support for or ambivalence about legalisation (n = 356): rated their level of support for legalising assisted dying in New Zealand across a range of medical conditions, and their willingness to participate in a range of assisted dying tasks; identified barriers and facilitators to potential participation; and assessed the responsibility of the professional bodies to provide practice supports.

METHOD

Mixed-method approach using descriptive analysis of quantitative data; qualitative data were analysed thematically.

RESULTS

Nurses supported legalisation at a rate (67%) significantly greater than that of doctors (37%) and for a diverse range of medical conditions. Most supporting nurses were willing to engage in the full range of relevant assisted dying roles. They identified several practical and ethical supports as essential to safe engagement, in particular practice guidelines, specific training, legal protections, clinical supervision and mentoring, and independent review of assisted dying service provision. They saw the facilitation of these supports as primarily the responsibility of their professional bodies.

IMPLICATIONS FOR POLICY

Nursing bodies should proactively facilitate workforce awareness and development of assisted dying policy and practice supports in anticipation of legalisation. This can be done through information campaigns and by adapting assisted dying policy, practice materials and systems already developed internationally. Nursing bodies need to engage in formulating legislation to ensure inclusion of explicit protections for participating nurses and to delegate relevant responsibilities to regulatory bodies.