Teaching nursing students about death

Meg Bluto, Palliative Care Nurse, Marie Curie Cardiff

In our interviews with would-be nurses, we always ask if there is anything they might find challenging or hard to deal with about studying nursing or the placements.

More often than not, the answer is ‘someone dying’.

Death is a subject most people are frightened of and nursing students are no exception.

'How should I react, what should I say, how will I cope' they ask. These are all normal questions, and important ones.

In the first few weeks of a student's nurse training, before they go out on clinical placement, we make sure we tackle these questions to remove some of their fears.

What to do when someone dies

We look at what to do when someone dies. What they need to do to that person and for their partner or family. We go through what to expect, what they might see and what they may say - or as is frequently appropriate, what they may choose not to say.

We use a question and answer session and we have a short DVD to help us get the main points across.

Another method we use is to ask patients and family members to come along to talk about their experiences. They talk to the students about what they expect from them as nurses, particularly around what to say and what not to say.

Of course, there is no script here. Every patient and every death is different and you have to look at each person or family as it happens.

But the most fundamental advice I give students is to think about what they would expect for their own family. How would they want them to be treated and spoken to? While seemingly basic advice, this is often the most powerful and reliable guide for students as it comes from a place of compassion and caring.

We need to remember that unlike many nursing skills that we can keep trying until we get right, there are no second chances with death. This will be the only time the family will lose their mother, father, brother so the memory of what happened will stay with them for a very long time, possibly forever. As nurses, can we really afford to get it wrong?

What we’re asking for are not high-tech skills. Yes, there is an underpinning evidence base, but supporting a person and their family through death calls for compassion, empathy, the verbal and non-verbal skills nurses possess. These can speak volumes to a person sat with a dying relative.

Our own experiences are so valuable whether these are from our personal or professional life. I have been lucky enough to have several memorable experiences of death, and I share these in class to help my students learn from them.

How we, as individuals, can cope

Nurses have lives outside of work, ones where we experience our own struggles and bereavements. Being able to help and support others while managing our own grief and memories is vital, so we have to develop coping mechanisms.

What do I do? Simply, to talk. So, teaching about death on my father’s birthday, his death date or, recently, a few days after my mother-in-law died.

I always explain to my students what a privilege it is to be part of a family’s very personal moments. We would say that if it was the birth of a child, wouldn’t we? Well, I feel the same way when I am there and part of someone’s death.

The fear here is that it will be awful; some deaths, like some births, can be traumatic but some can be very controlled and peaceful. As nurses, if we are more prepared then the control is with us, and that can remove the fear.

We can also remove the fear by talking about death much more openly. We shy away from it as if by talking about it, it will somehow make it more real and more likely.

Death will happen, whether we talk about it or not. But having the choice about what we would like to happen means we have to make plans, and that means talking about it.

My daughter knows exactly what I want at the end of my life and in my death. I want this to be a normal conversation and as nurses we are in an enviable position to start to make this happen.

This area of nursing can be one of the most rewarding. To work in it, you don’t have to be calm, quiet or serene –anyone who knows will say this is not me! It is simply (and hopefully) about helping someone to have the death that they want.

Where to find out more

Twitter can offer valuable resources and research. Try Dying Matters, NCPC and The Good Grief Trust just to name a few.

 

About the author: Maria Parry, award leader for undergraduate nursing at USW, specialises in end-of-life and palliative care nursing.