Coping with Death and Dying
Nurses are respectably known for aiding sick patients back to health and promoting health in their community. Many people picture nurses as an energetic, compassionate, and emotionally stable group who can help patients’ through their greatest struggles. On the other side of that, nurses take pride in knowing that they are able to advocate for and provide care to a sick patient. The feeling of helping someone along their road to recovery is transcending. However, many nurses find themselves in situations where the road to recovery is off limits and the road to death is the only other option. Student nurses spend countless hours studying anatomy, physiology, pharmacology, and other sciences. What these students cannot fully prepare for is learning to cope with a dying patient. Sure, students can take classes about death and dying, but no amount of studying can prepare you to effectively cope with death. This issue is important to professional practice because nurses ill-prepared to cope with death may have a tendency to cower away from a dying patient and their needs. Thus, the patient and their family will not receive the high quality, competent nursing care that they are entitled to. The question that remains is how can nurses learn to cope with death in order to provide competent end of life care? Considering that dealing with death is stressful, aren’t nurses more likely to burn out earlier if they are constantly exposed to death and cannot effectively cope with it?
Application to Patient Scenario
A few weeks ago in clinical, I was assigned to care for my first terminally ill patient. This was a kind-hearted 42 year old man in end stage renal disease as a complication of type 1 diabetes. When I was listening to report on this patient, the nurses on the unit used the cliché phrase that “this man had 9 lives.” Apparently, he was well known by the nurses because he was in the hospital for frequent complications of his type 1 diabetes and for dialysis treatments. I was nervous to go into the room and conduct my initial assessment. I thought, “How can I look this man in the eyes when I know he is actively dying? What happens if he tries to talk about his impending death with me? I am not prepared for this.” Given his diagnosis, I made an assumption that this man would be unpleasant and I was willing to deal with that considering all he had been through. Contrary to my belief, he spent his day playing board games, laughing with his loved ones, and reading to keep his mind off his pain. He was handling his situation with such elegance that it ripped my insides apart. I genuinely felt this man’s pain even though he was not expressing it. I asked a nurse on the unit how he could be so strong and her response was “We all love that man. There have been times he has come close to dying, but he pulls through. He scares us, but then he comes back fighting. Once, he was so close to dying, that we were all in tears.” I was taken aback by the relationship the nurses had developed with this man. Certainly it was emotionally taxing for the nurses and I could not believe that they did not shy away from the situation. They fought hard for this patient to remain comfortable in the end of his life and effectively addressed his concerns about dying. These nurses were humans that had taken on the role of angels. I admired their strength and determination and hope that I can provide this type of care to dying patients in the future. I can acknowledge that I am new and nervous when it comes to dealing with death and dying, but I know that, just like an art, that coping with death is a skill I will continue to mold and sculpt through my years working as a nurse.
Discussion of the Literature
Peterson et al. (2010), examined the experiences of nurses, and their particular concerns about caring for a dying patient. The researchers believe that a clearer understanding of the concerns in this situation can lead to more effective training and coping services for nurses. In this way, nurses can be guarded against burnout. In order to examine their research question, the researchers conducted and taped interviews with 15 nurses and nursing students. This article concluded that several communication challenges proved to be the primary concern of the nurses when caring for dying patients. In order to help nurses cope more effectively in this situation, the article suggests that communication training programs are needed.
Birkholz, et al. (2004) looked at baccalaureate nursing students designing their own death and dying curriculum. This research article acknowledge that studies of nursing curricula are limited and nursing students may have little supervised experience with dying patients, receive minimal guidance in addressing their personal reactions. This article goes on to conclude that nursing students, as well as national organizations, should recognize the need for adequate end-of-life education that is both didactic and experiential, to prepare nurses to assist dying patients and their families.
Walsh and Hogan (2003) focused on nursing students’ commitment of “presence” with the dying patient and the family. The research in this article aims to help eager students obtain information about how to educate support, and communicate effectively with dying patients and their families. The article stated that “nurses, although usually present and watchful at the bedside of the dying patient, are often ill prepared to assist family members” (Walsh and Hogan, 2003, p 87). The conclusion of this article was that developing skills to deal with patients in the end of life takes time. How nurses handle situations, especially situations dealing with dying, what unique talents they bring to the dying person and their family during difficult times, will be remembered forever.
Dunn, Otten, and Stephens (2005) examined relationships among demographic variables and nurses’ attitudes toward death and caring for dying patients. This study found that nurses who reported spending a higher percentage of time in contact with terminally ill or dying patients reported more positive feelings. The article points out that the growth of the population continues to increase and the demand for nurses to develop expertise in caring for dying patients will increase accordingly. The researchers believe that developing continuing education programs that teach nurses to cope with death anxiety may benefit nurses who have had little experience with dying patients. Also, “identifying barriers that can make caring for dying patients difficult and developing interventions to prevent or eliminate unnecessary death anxiety may make the journey from novice to expert a gratifying and rewarding experience” (Dunn, et al., 2003, p 103).
Peterson et al. (2010) conducted a qualitative study to examine the resources nurses use when coping with the death of a patient. The article affirms that the most common clinical stressors experienced by nurses include watching a patient suffer, the death of a patient, and talking with a patient about their imminent death. Because this is something nurses may experience many times in their career, the article talks about the importance of nurses learning to cope with this stress in order to avoid early burnout. The article concluded that by understanding the sources that nurses turn to when caring for a dying patient is a preliminary step toward addressing coping with the stresses of end-of-life care.
Terry and Carroll (2008) examined first-year nursing students’ encounters with patient deaths. They found that the two major themes were abandonment and emotional impact. The theme of abandonment recognized that students may encounter their first death in clinical practice early in their training and could feel abandoned by staff. They could also feel guilty of abandoning the patient or relatives. The theme of emotional impact is directly connected to abandonment. Emotional distress often resulted from the feelings of abandonment. The researchers concluded that further research is needed to know more about the problem of nursing students experiencing flashbacks following death in clinical practice. Clinical faculty need to consider how they are supporting students because, to the student, every death in clinical practice is a learning experience a potential source of distress.
To tie it all together, these articles all stress the importance of nursing students and nurses to find effective ways to cope with death. All articles touch upon the fact that nurses will face death once, if not many times in their career. Each article also talks about how coping with death is a stressor that many nurses face as well. While nurses go through vigorous training, they still need additional coaching regarding how to cope with death. In many of these articles, different courses and classes that nurses can take are found effective in helping nurses cope with death and thus decrease their stress and enhance their care of dying patients.
After reviewing the literature regarding this topic and finding numerous related articles, I realize that this subject raises great concern in the nursing community. Because patients and their family are entitled to appropriate care at the end of life, it is important that nurses be properly prepared by developing effective coping mechanisms. In order for nurses to do this, research must be done to determine the most effective coping strategies for dealing with death and dying. Considering that there is already a great amount of research related to creating effective end-of-life care courses, I can find comfort in the fact that nurses in the future will experience less stress, anxiety, and burn out related to inability to cope with death and dying.
Based on these findings, the care I provided for my patient on that day would have been somewhat different. I recognize that just because I read those articles does not mean I will be able to care for my next terminal patient with great ease. However, these articles brought to my attention that it takes time and practice to deal with death. Interventions mentioned in these articles that would have helped me provide better care to my patient include therapeutic communication and presence.
In one of the articles, a patient’s family member said that because the nurse was afraid to enter the room and face the dying patient and that this created even more anxiety for the patient and their family. Although it may be difficult to find ease in caring for a dying patient, this story shows that simply being present with the patient will make the situation more comfortable. I learned about therapeutic communication in the basics of nursing classes, but I was not exactly sure how to apply it to a dying patient. After reading this article and seeing examples of conversations between dying patients, their families, and nurses, I have a better understanding about how to therapeutically approach these types of conversations. It was also brought to my attention that communication training programs geared toward this subject could help nurses to make their therapeutic conversation interventions more effective. One may think that a dying patient and their family would simply want to be left alone. A nurse may truly believe that by avoiding the patient’s room, she is providing the patient with respect and privacy and reducing awkwardness. However, one family member stated that saying “I am sorry” or “I don’t know what to say” is more honest and appreciated by the family. Knowing that you can truly be present and helpful without saying anything is important. Had I realized this importance, I would have spent more of my free time that day at my dying patient’s side.
When I began researching this topic, I had not expected to find as much research as I did. Because I personally have never had a close friend or family member pass away, I feel that I have increased amounts of death anxiety. Originally, I had been under the impression that I was the only nursing student that felt completely uneasy when it came to death. I felt that talking to other students or instructors about my fears would make me seem vulnerable, weak, and an incapable of being a nurse. In turn, my decision to keep these concerns to myself only created more anxiety.
Not only did finding these articles make me realize that I was not alone in my struggles, but reading them helped me learn different ways that I can overcome this barrier and thus provide better, effective care to my patients and their families. I am somewhat surprised, but extremely pleased that such consideration is taken when planning death and dying classes for undergraduate nursing students. While these classes can effectively prepare students and teach them how to cope with death, I recognize that it will be a matter of time before I am able to do this. Knowing that I can confide in my fellow colleagues makes me feel more comfortable.
In closing, I do not consider my first encounter with a dying patient a failure. Rather, a consider it an opportunity for improvement. I consider it an encounter that gave me the chance to fully understand how anxious death makes me. Most importantly, I consider it a chance for me to reflect on my actions that day, find relevant nursing research that addressed my concerns, and learn suitable ways that I can approach this situation in the future. Now, I have a greater understanding of death and what it means to the patient, their family, and nurses. No longer do I want to shy away from death. In the future, I will embrace it and consider it an opportunity for me to be involved in a sacred event. As Robert Donne once elegantly said, “Death, be not proud.”