Nursing Students and End-of-Life Care: A Play
Welsh, Darlene, Lowry, Regina C., Nursing Education Perspectives
Care providers often do not know what to say or how to act with patients who are dying. They may cope with their uncertainties by avoiding patients and failing to provide adequate physical and emotional care (Ferrell, Virani, Grant, Coyne, & Uman, 2000). Many do not feel they have been adequately trained for end-of-life (EOL) situations (Cohen, 2001; Deeny, Johnson, Boore, Leyden & McGaughan, 2001; Main, 2002), and lack of experience in caring for clients who are dying intensifies the problem (Main; Weigel, Parker, Fanning, Reyna & Gasbarra, 2007).
Of all the health care professions, nurses are most likely to spend the last hours of life with hospitalized individuals. However, few nursing students are prepared to care for dying patients (Al-Sabwah & Abdel-Khalek, 2005-2006). Wass (2004) reports that "less than a fifth of students in the health professions are offered a full course on death" (p. 297).
Data from an international sample of nursing students showed that caring for dying patients and watching patients suffer were among their top five stressors (Burnard et al., 2008). Some of that stress may be due to the fact that hospitals are not designed to facilitate a peaceful, comfortable dying experience. There may be no private spaces for family members to grieve; resources may not be expended to support family members during the dying process; and the nurse/patient ratio may be too high to allow nurses to spend time with dying patients and their families (Heaston, Beckstrand, Bond, & Palmer, 2006).
To better prepare senior-level undergraduates for the complexities of EOL care, nurse faculty at the University of Kentucky developed a play that models best nursing practice for this specialty. Although a three-credit elective course on death and dying is offered at the university, few undergraduates take the course. Students have a one-day home hospice clinical visit and occasionally have the opportunity to care for a dying patient during clinical rotations.
The project described in this article was developed to respond to the needs of senior nursing students whose journals, kept during their clinically focused capstone course, frequently reflect concerns about caring for dying patients and their families. Approximately 45 to 48 senior nursing students participate in this learning activity each semester as part of their course work in the Synthesis (clinical capstone) course.
Background Social cognitive theorists believe that much of human behavior is learned by observing, retaining, and reproducing the modeled behaviors of others (Bandura, 1997). Role playing and theater techniques have been employed to teach genetics (Newcomb & Riddlesperger, 2007), improve interdisciplinary communication skills (Cartright, 2007), and review principles of oncology (Wilkinson, Leliopoulou, Gambles, & Roberts, 2003) to nursing and other health care professionals during career development. Drama is also a mechanism for modeling behavior. Deeny et al. (2001) describe drama as a mechanism that enables students to better understand the feelings of others and empathize with them, and develop new approaches to challenging situations.
Given the potential for drama to educate nursing students about the emotional aspects of death and dying, faculty wrote a play, "Terry's Dilemma," for implementation with senior-level students. Each semester, faculty and staff in the college of nursing are recruited to depict various roles in the play. (See Sidebar 1.)
Terry's Dilemma In order to realistically portray a near-death scene, the production is performed in a nursing laboratory with access to monitors. While a formalized script has not been developed, descriptors of emotions and physical symptoms commonly experienced at the end of life are given to each volunteer. (See Sidebar 2.) Actors select the emotions and symptoms that fit with their personalities and experiences. …