Most nurses in their work care for patients who are dying. A study of more than 200 students has shown that many nurses in training feel unprepared and anxious when faced with the prospect of meeting patients during end-of-life care.
Scientists from the Sahlgrenska Academy have interviewed 222 nursing students at the University of Gothenburg, the University of Skövde and the Ersta Sköndal University College. The interviews dealt with their thoughts about caring for dying patients, their ideas about how to support and meet the patient in dialogue, and their own feelings when faced with dying patients.
The interviews showed that even though many students view death as a natural part of life, many find the idea of death to be frightening, and beyond understanding.
"Death awakens feelings of helplessness, insecurity and insufficiency in most nursing students. Some find it natural to talk about death, while others consider it to be the worst thing that can happen and have difficulty coping with the need to talk about it," says Susann Strang, scientist at the Sahlgrenska Academy.
A nurse´s responsibility
Many students described how they did not know how to answer the patients' questions, and desired to change the subject when patients brought death up. At the same time, a large fraction of the students consider it to be the responsibility of nurses to appear strong in front of patients.
"Our study shows that the students have an ideal of a competent nurse and perfect care that differs significantly from the actual situation. The issues of death and dying have much to do with the students' own fear and lack of experience, while at the same time they place high demands on themselves to be good caregivers," says Susann Strang.
"Many hope that this will become easier with time, and that one day they will have the courage required to care for dying patients and dare to engage with them. Nurse education can play a more active role here by discovering at an early stage which students experience strong anxiety about meeting and caring for dying patients, and offering these students guidance, training and support."
The article Swedish nursing students' reasoning about emotionally demanding issues in caring for dying patients will be published in the International Journal of Palliative Nursing.
VOICES FROM THE STUDENTS
"I'm frightened about it, and I was terribly upset during my work placement whenever a patient died. The whole situation can be frightening, and the dead body..."
"A nurse is expected to be strong. It may very well be tragic to see a person who I have cared for dying in front of my eyes. It may affect me emotionally. But I am to support the family of the dying person. So I have to be strong."
"Well, I think it's really awful to deal with the cold body. I can manage to sit there and wait, and be present as long as the patient is breathing, but once he or she is dead I find it extremely upsetting."
"Of course it's difficult, but as a caregiver and fellow human being I regard it as my duty not be afraid or uncomfortable when faced with difficult situations. I regard it as a benefit to be able to hear another person's thoughts about something so great that affects me not only professionally but also personally."
"I'm not uncomfortable when it comes to spending time with people who are dying. But I do feel unsure about how to talk to them, the questions they pose. I don't have very much experience of giving existential counselling to people who are dying."
"For me, death is the worst thing that can happen, but it is at the same time a part of life, so we have to be able to talk about it."
- Susann Strang et al. Swedish nursing students' reasoning about emotionally demanding issues in caring for dying patients. International Journal of Palliative Nursing, September 2014
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