Nursing Students’ First Clinical Experience with Death: A Pilot Study

Dr. Barbara Heise, Associate Professor

The term “empathy” is used to describe a wide range of experiences. One definition is the ability to understand and share the feelings of another. This topic will be addressed this week in various ways. You should visit the blog every day this week as we consider death, compassion, and kindness in both serious and light-hearted ways.

First up in our empathy week series is a reprint of an article from our 2013 fall college magazine:

Two years ago professor Barbara Heise learned of an incident with Laura C. Gilpin (BS ’13), a BYU nursing student, who had a clinical patient die suddenly in a hospital. Death, especially the sudden death of a patient, is an emotionally charged, high-stress situation for any nurse. This, however, was Gilpin’s first clinical experience with death and neither her clinical instructor nor the hospital staff sought to help her cope. Debriefing in simulation laboratories occurs routinely and is a key component of the learning experience. In the real-life clinical setting with an actual death, Gilpin felt she was on her own with no support. She finally discussed her experience with her mother—who is also a nurse—and with Heise.

It was at this time that Heise began researching how many other students within the college had similar experiences. After a quick literature search, she discovered a lack of information on this topic and decided to start her own assessment of the issue. Gilpin joined Heise and applied for a BYU Office of Research and Creative Activities (ORCA) research grant. They began a pilot study to learn nursing students’ perceptions of their first Nursing Students’ First Clinical Experience with Death: A Pilot Study experience with death in the clinical setting and to determine if curricular changes were warranted.

An online anonymous survey was sent to the College of Nursing students (n=306) asking about their first experience with death in the clinical setting; approximately 8 percent completed the survey. The study found that a patient’s death is extremely challenging to student nurses; it results in a range of emotions (e.g., shock, sadness) that students may have trouble reconciling. Fifty percent of the respondents who experienced a patient death did not receive any debriefing from their coworkers or clinical instructor following the event. Students’ qualitative comments revealed feelings of discomfort around dying patients and their families, and they felt discussion with team members or their clinical instructor after the death would have improved their understanding.

In March Heise sought the opinions of nursing students nationwide. She partnered with assistant teaching professor Debra Wing (MSN) and professor Renea Beckstrand (AS ’81, BS ’83, MS ’87) to survey the National Student Nurses Association’s 55,000 members. As a result, 5 percent (n=2,804) responded to the revised survey with 41 percent (n=1,148) of respondents encountering a death in a clinical setting—the majority within the first year of their program. The data also showed that 66 percent of those experiencing a death were not debriefed following the patient death. Students repeatedly stated their unpreparedness in end-of-life care or the dying process and a lack of ability to communicate with the dying patient or the patient’s family.

The findings also include 787 students sharing their stories of their first patient death. Ann Rogerson (BS ’10), a graduate student now working with Heise, will analyze this information over the next year; it will be the focus for her master’s thesis and future studies.

Heise needs to collect additional information before pursuing national curricular changes, but she believes the preliminary results support debriefing in the clinical setting. Clinical instructors may need to be educated in debriefing strategies rather than depending on the instructor’s discretion or on students handling the situation independently. In April Gilpin shared her project as a poster presentation at the Western Institute of Nursing Research Conference and the Utah Conference on Undergraduate Research. In August Heise gave an invited podium lecture on the national study at the University of Oxford in England.

The article is reprinted from the Learning the Healer’s Art 2013 Fall Magazine.

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