Oncology Nursing Education: Nursing Students' Commitment of "Presence" with the Dying Patient and the Family

Article excerpt

ABSTRACT During an elective oncology nursing course, students expressed uncertainties about activities that would offer patient and family support during end-of-life care. Following a chaplain's lecture, students in a class reaction paper identified appropriate nurse responses and actions that would offer supportive care to the dying patient and the family. Six processes were extracted from student comments. A core category was identified as the importance of "nurse presence" at the bedside of the dying patient.

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WHILE STUDENTS REPORT FEELING CONFIDENT IN THEIR BEDSIDE NURSING SKILLS, MANY ARE EAGER TO OBTAIN INFORMATION ABOUT HOW TO EDUCATE, SUPPORT, AND COMMUNICATE EFFECTIVELY WITH DYING PATIENTS AND THEIR FAMILIES (1-5). "Topics in Oncology Nursing," developed as an elective for seniors and graduate students at the University of Miami School of Nursing, was designed to promote increased awareness among new nurses of the positive, and unforgettable, influence that a nurse may have when a patient nears the end of life. > The enrollment of 26 students the first time the course was offered was indicative of high student interest. On their final evaluations, students rated the course as excellent and, in written comments, indicated that they now felt more comfortable in approaching and caring for dying patients and their families. Because of their enthusiasm and requests from current students, the University awarded an instructional advancement grant to strengthen the course and ensure its continuation. THIS ARTICLE PRESENTS AN ANALYSIS OF STUDENT RESPONSES TO END--OF-LIFE ISSUES FOLLOWING A GUEST LECTURE BY A CHAPLAIN, WHO SHARED HER FIRST EXPERIENCES WITH A DYING PATIENT.

Related Literature Within the health delivery system, the lack of communication with family members and terminally ill patients near the end of life has been well documented (6-11). It is distressing to note that a general lack of consideration of family rights and patient autonomy continues, despite efforts to improve end-of-life (EOL) care (5,9,10,12,13). Recent studies indicate that providers of care often make incorrect assumptions regarding what information and activities may be desired or needed by patients and families (14-19).

In both medical and nursing education texts, the amount of content that deals with the wide range of EOL care issues continues to be minimal (14,16,20). Therefore, nurses, although usually present and watchful at the bedside of the dying patient, are often ill prepared to assist family members (21,22). It has been noted that of all health professionals, nurses are in the most immediate position to provide care, comfort, and counsel at the end of life for patients and families (23). Yet, how we teach novice nurses to provide appropriate and supportive care remains a problem for educators.

Approaching the Problem As the course progressed, the faculty were aware that students remained uncertain about how to help patients and families when medical treatments appeared futile and death seemed imminent. Although most students were about to graduate, they expressed confusion about their role in providing EOL care. Indeed, the only option students agreed upon as appropriate in this situation was "leaving the family and patient alone to provide privacy."

Because chaplains are considered vital members of the interdisciplinary team, the faculty invited a chaplain from a regional comprehensive cancer center to speak during one of the last class sessions. Because of the students' apparent responses to this session, the decision was made to formally evaluate what students felt and what they learned that was most effective.

Asking students for qualitative feedback provided faculty with two opportunities. In addition to providing a timely evaluation of the speaker, it was considered important to assess what information would be valuable for teaching this content in future classes. …