Improving teaching about death and dying for nurses

Pam Williams

Adapted extracts from a study about the Project 2000 training for nurses, entitled 'Knowing About Caring for the Dying' by Pam Williams, which is the winner of the £50 Natural Death Centre Award for the best paper from a nurse on how to improve care of the dying in hospitals.

Learning about death on the ward

Student nurses need to be prepared for the fact that some patients do die. However if wards do not have a philosophy for care of the dying, I would argue that it would be difficult for students to achieve competence in maintaining a good standard of practice by working towards achievable goals. Learning about Last Offices appears to have been of particular importance as a clinical skill to be achieved by the students I interviewed.

'Student nurses need to be prepared for the fact that some patients do die'

Student nurse John commented: 'I think it's like most clinical procedures, a great big milestone to get over but once you've done them you think, well, that wasn't so bad.' Some students, however, were using their student status to choose not to become involved in learning opportunities to perform Last Offices, under the premise that they were not yet ready. Last Offices is seen by Zane Robinson Wolf (1988) to have a deeper symbolic meaning than just washing the body before it is removed to the mortuary. She puts forward the idea that 'after-death rituals' rest in the nurses' own needs to remove 'the manifestations of suffering, to purify the patients body of the profanity of death, and to gradually relinquish their tenure of responsibility for the patient'. Last Offices is a part of nursing tradition concerned with laying on of hands, and I am a traditionalist in that I would like future nurses to continue to care, touching the dead with gentleness.

Like Speck (1992), I feel that as well as bringing comfort to the nurse, knowing someone has taken care of the person since the time of death can be very comforting to the bereaved.

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