Learning about death within the curriculum
'Learners should be prepared to meet the death of patients in a positive, open manner'
The word 'death' does not appear in the Project 2000 curriculum. Instead it is camouflaged by surreptitiously introducing it into other identified areas of the curriculum such as ethics, psychology and communication skills. I believe that death should be given its own place, and that learners should be prepared to meet the death of patients in a positive, open manner. This learning about caring for the dying should be a theme that is begun before students go to clinical placements, and built upon according to the needs of students. The responsibility of teachers should be clearly and unambiguously stated. Hannah (1987) too, suggests that the basic curriculum should place more emphasis on care of the dying, supplementing students' ward experiences with more lectures, discussion groups, talks by experts and by giving tangible support. It is feared by some that students will become socialised into the ward culture instead (Carlisle, 1992). Unless schools take responsibility for teaching about all aspects of death, I can see a future where death care will be ignored as more and more Project 2000 students, tutors, and future clinical staff choose to opt out of knowing about caring for the dying. Student nurse Paul puts my fears into words:
'I don't think we have explored death in any great depth. We briefly spoke about loss in general. I can see a situation where a student could go right through their training, qualify, and never learn anything about death. There could be a problem there.'
Recommendations
There are aspects of caring for the dying that should be explored with every learner, and not be left to trial and error.
Death Education is best carried out by teaching staff and clinical staff who have developed clear expertise in this field.
Teaching about death should be given before clinical placements and be of an experiential nature suited to the students learning styles and needs.
'It's a nurses' natural response to ignore the dying because we don't know what to say'
As Paul put it: 'We need more direct teaching about how to communicate specifically with the dying. We are not taught to talk to the dying, so we tend to ignore death. It's a nurses' natural response to ignore the dying because we don't know what to say. So we walk all around the garden "step and toe". If you knew what to say you could get more out of the experience.'
The Personal Tutor role should be used to give individual support, so that each student is enabled to learn positively, cope with feelings, and learn to build on experiences to cope effectively with administrating appropriate care to the dying.
Trained staff need to be educated and prepared for their mentorship and supervisor role in relation to exposing the students to death experiences, and practical procedures such as Last Offices.
'A separate skilled counselling service available for student, teachers and ward staff, in their struggle to support each other, after experiences of death'
Inconsistency and lack of expertise by Tutor, Supervisor and Mentors in giving support has led me to believe that an argument could be made for having a separate skilled counselling service available for student, teachers and ward staff, in their struggle to support each other, after experiences of death. Some may argue that provision of formal counselling services are too expensive, but if nurses are leaving nursing because they are unable to cope with the stress arising from caring for the dying (Fields 1989), I would counter argue that losing staff is more expensive in the long term. My opinion is that good support is an essential feature of terminal care.
Death is a topic that should receive serious attention in future Project 2000 curricula.
There should be no 'opting out' clause for anyone. Death involves us all. Students must know how to care for the dying. One day we all will be recipients of that care.
Pam Williams, 40 Walesmoor Avenue, Kiveton Park, Sheffield S31 8RG (tel 0909 773507).
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