Critique your article of choice using the Research Critique Rubric and following components:Identification of the research question/problem/hypothesis. Identification of topics explored in review of

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Abstract

Full T ext

AIM The purpose of this study was to examine, on a national le vel, nursing students' per ceptions after

experiencing a patient death. BACK GROUND Death is a highly stressful experience for nursing students.

Debriefing, which routinely occurs with a patient' s demise in the simulation setting, typically does not happen in

actual death situations. METHOD A mixed-methods design using quantitativ e and qualitative questions as par t

of an anonymous sur ve y was sent to the membership of the National Student Nurses' Association. Of

appr oximately 55,000 members, 2,480 r esponded to the surve y. RESUL TS Experiencing a patient death as a

student occurr ed for 41 percent of participants in the nationally r epresentativ e sample. Of those who

experienced a patient death, 64 per cent did not receive any debriefing. CONCL USION Most nursing students did

not feel pr epared to car e for a dying patient and the patient' s family. Students need and want mor e education on

end-of-life nursing car e.

Headnote

Abstract

AIM The purpose of this study was to examine, on a national le vel, nursing students' per ceptions after

experiencing a patient death.

BACKGROUND Death is a highly str essful experience for nursing students. Debriefing, which r outinely occurs

with a patient's demise in the simulation setting, typically does not happen in actual death situations.

METHOD A mix ed-methods design using quantitativ e and qualitative questions as par t of an anonymous sur ve y

was sent to the membership of the National Student Nurses' Association. Of appr oximately 55,000 members,

2,480 r esponded to the sur ve y.

RESUL TS Experiencing a patient death as a student occurr ed for 41 percent of participants in the nationally

repr esentativ e sample. Of those who experienced a patient death, 64 per cent did not receive any debriefing.

CONCL USION Most nursing students did not f eel prepared to car e for a dying patient and the patient' s family.

Students need and want mor e education on end-of-life nursing care.

My Patient Died: A National Study of Nursin g

Students' Perceptions After Experien cing a P atient

Death

Heise, Barbara A ; Wing, Debra K ; Hullinger, Amy H R .

Nursing E ducation P erspectives ; New York Vol. 39, Iss. 6, (No v/Dec 2018): 355-

359.

DOI:10.1097/01.NEP .0000000000000335

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KEYWORDS Death E ducation - Debriefing - Nursing E ducation - Nursing Students - Death E ducation - Debriefing

Most nurses experience patient death during the course of their car eers. The nurse is the primary health care

provider inv olved in caring for patients and their families at the endof-lif e (EOL) and throughout the dying

process, including postmor tem care (Bryant, 2008). Nurses pr omote a "good death " by pr oviding physical,

emotional, and spiritual car e while also advocating for the cultural pr eferences of dying patients and their

families.

Death is an emotionally char ged issue for anyone. For register ed nurses, death is also a high-str ess situation

(Leighton & Dubas, 2009; Zheng, Lee, & Bloomer , 2016), with most experienced nurses able to vividly r ecall their

first death of a patient (Anderson, Kent, & Owens, 2015; Kent, Anderson, & Owens, 2012). F or nursing students

who are just learning the RN r ole and responsibilities, the death of a patient is often a for eign, frightening, and

over whelming experience that ma y have long-term eff ects on their pr ofessional and personal liv es (Kent etal.,

2012).

LITERATURE REVIEW

Patient death is a commonly r eported sour ce of stress and anxiety for nursing students (Allchin, 2006; Carson,

2010; Edo-Gual, T omásSábado, Bar dallo-Porras, & Monfor te-Royo, 2014; Gallagher et al., 2014; P arry, 2011; Zheng

et al., 2016). Nursing students' r eactions to their first patient death often include negativ e emotions, such as fear,

sadness, frustration, anxiety , helplessness, and guilt (Neiderriter , 2009; Parry, 2011; P oultney, Berridge, & Malkin,

2013; Zheng et al., 2016). Although many students experience a patient death during their education, f ew feel

adequately pr epared to interact with a dying patient and his or her family in the clinical setting and to cope with

the experience (Gallagher et al., 2014; Zheng et al., 2016). Curr ent nursing education is generally considered

inadequate to prepare nursing students for EOL car e (Cava ye & W atts, 2012; Gillan, v an der Riet, & Jeong, 2014;

Kent et al., 2012; Schlair et, 2009; Wallace et al., 2009). After their first death experiences, students fr equently

state that they were not r eady to pr ovide EOL car e, expressed difficulty communicating with the dying patient or

family, and did not r eceive sufficient suppor t from clinical instructors and staff. Nursing students r eported

increased str ess and anxiety due to f eelings of inadequacy and lack of pr eparation (Cava ye & W atts, 2012; Dos

Santos & Bueno, 2011; Gallagher et al., 2014; Huang, Chang, Sun, & Ma, 2010; P arry, 2011; Zheng et al., 2016).

Nursing students who had positiv e first death experiences indicated that helpful factors included a suppor tive

clinical instructor or staff member , role modeling, and postclinical debriefing (Carson, 2010; Gallagher et al.,

2014; Huang et al., 2010). Debriefing is commonly included in simulated EOL training but often does not occur in

the clinical setting (Thompson, 2005). The oppor tunity to discuss the death experience with an instructor ma y

help nursing students cope with the experience and increase competence and confidence for future care of dying

patients.

Nursing students must r eceive adequate pr eparation and suppor t to provide quality EOL car e in the clinical

setting and be equipped to cope with patient death. Most studies on nursing students and their experience with

patient death have inv olved small samples of nursing students. This sur ve y is the first to examine nursing

students' per ceptions of their first experiences with patient death on a national le vel. By understanding students'

experiences and the need for suitable pr eparation, support, and debriefing, nurse educators ma y be better able to

guide nursing students through their first experiences with EOL car e and patient death.

THEORETICAL FRAMEWORK

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Benner's (1982) seminal work, F rom No vice to Exper t, delineates fiv e levels of nursing pr oficiency. Although

Benner's theor y of nursing did not include nursing students, her delineation pr ovides insight on a pr elicensure

nursing student who could be classified at a pr enovice le vel. Le vel 1 is the no vice RN who has no experience in

clinical situations such as EOL car e. At this le vel, the no vice nurse does not ha ve the discr etionary judgment to

determine which par ts of the situation are most relevant. The no vice nurse f eels most comfor table with objectiv e

tasks, such as taking vital signs, rather than a mor e advanced skill of helping the dying patient and family to

cope. Le vel 2 is the adv anced beginner who has mar ginally acceptable performance. Nurses at Le vels 1 and 2

need mentoring b y expert nurses.

At Le vel 3, the competent nurse has been pr oviding EOL car e for approximately two to thr ee years. T ypically , this

nurse pr ovides conscious, deliberate planning to achie ve efficiency and or ganization, and no mentoring is

needed. However , the competent nurse is still unable to r ecognize which par ts of the EOL situation ar e most

important.

At Le vel 4, the pr oficient nurse is able to see EOL car e for the dying patient and the family as a whole. This nurse

knows what to typically expect during EOL car e and can modify the plan as needed.

Finally, at Level 5, the nurse is an exper t who intuitively hones in on salient issues. Exper t nurses have a deep

understanding of EOL car e and the many ways that dying patients and their families appr oach death. They offer

many wa ys to understand, cope, and accept the final phase of lif e, which, for most people, is a totally uncharted

passage. Expert nurses in EOL car e often stay in this field because the y feel the y can coach patients and families

through a v ery difficult and often not discussed par t of life.

Nursing students do not ha ve the experience to per form the advanced roles of an exper t nurse caring for the

dying person and family . Along with competent clinical skills, exper t nursing skills required during EOL car e

include advanced communication skills to determine patient pr eferences, adv ocacy for patient and family to

promote dignity , advanced pain management skills, compr ehensive suppor tive car e to the patient and family to

alleviate suff ering, constant assessment to ensur e interventions ar e congruent with patient wishes, and

promoting the dying patient' s autonomy and right to self-determination.

Some nursing students ha ve pr eviously experienced the death of a family member . However , the death of a

patient is diff erent and ma y requir e a le vel of r esponsibility that was not pr esent for the family member. In

addition, caring for someone who is dying, as well as caring for the dying patient' s family, requir es adv anced

clinical skills that a nursing student does not y et possess.

METHOD

A cr oss-sectional descriptiv e surve y design was used for this study . Following appr oval fr om the univ ersity

institutional r eview boar d and National Student Nurses' Association administration, nursing student members of

National Student Nurses' Association (appr oximately 55,000 members) wer e emailed a brief description of the

resear ch project and an invitation to par ticipate with a link to the online questionnair e. An implied consent form

was available to be viewed b y participants befor e beginning the sur ve y. P articipant r esponses wer e collected

using Qualtrics online sur ve y softwar e.

Par ticipants wer e asked to answer six demographic questions and 14 sur ve y questions about their experience

regar ding a patient death during their time as a nursing student. T wo open-ended questions asked participants

to describe their experience and indicate what the y would have lik ed to be taught r egarding EOL car e of a patient.

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Estimated time commitment for par ticipants was 15 to 20 minutes. This ar ticle reports the r esults of the

quantitativ e questions in the sur ve y.

After the r esponse period had ended, quantitativ e data were downloaded fr om Qualtrics to SPSS v ersion 22 (IBM

Corp., 2013). Quantitativ e data were reviewed for missing v alues and outliers befor e further analysis using

appropriate descriptiv e statistics and plots. Descriptiv e statistics for demographic variables and surve y

questions wer e calculated. Chi-squar e test of association was used to examine r elationships of selected

categorical variables.

RESULTS

Descriptiv e statistics for demographic characteristics of the par ticipants are repor ted in table form in T able 1.

Sample

A total of 2,804 individuals r esponded to the invitation to par ticipate and started the surve y. A total of 2,480 (88.4

per cent) completed the sur ve y. Most r espondents (80 per cent) were female, half wer e under age 27, and the

majority were white (67.6 per cent). A majority of the r espondents (60.7 percent) reported being single, and about

a quar ter (26.8 per cent) reported being married. Most (57.6 per cent) of the students said they were in bachelor 's

pr ograms; about a quar ter (25.9 percent) reported being in associates pr ograms. Participants came fr om ever y

state in the United States as well as the District of Columbia with mor e populous states (e.g., CA, FL, NY, P A, and

TX) pr oportionally r epresented in the sample.

Descriptiv e statistics for questionnair e items are repor ted in T able 2. A majority (65.8 per cent) of respondents

repor ted being pr esent at a death outside of their nursing experience; almost 41 per cent reported being pr esent

at a death as a nursing student. The majority of those who experienced a patient death (62 per cent) experienced

that death early in their nursing programs.

Responses for Students Who Experienced a Death

The remaining questions wer e directed specifically towar d those who reported experiencing a patient death as a

student (n = 1,148). Slightly mor e than a quarter of those respondents (26.8 per cent) said they needed help

coping. Only one thir d of these students r eceived debriefing.

A chi-squar e test of association was used to examine the r elationship between reporting the need for help

coping with a patient death and r eceiving debriefing. Of the 1,148 students r espondents, 33 (2.6 percent) had

missing data and were excluded fr om the test. The test was not significant, x2(df = 1, n = 1,115) = 1.19, p = .275,

indicating that ther e did not seem to be an association between needing help coping and r eceiving debriefing

after experiencing a patient death as a student. A majority (194/306, 63.4 per cent) of those who reported

needing help coping did not r eceive debriefing.

Par ticipants wer e asked to rate their le vel of pr eparation on a scale of 1 to 4 (1 = pr epared, 2 = somewhat

prepar ed, 3 = pr epared, 4 = v ery pr epar ed) in se veral ar eas related to death and dying: pr ocess of death and dying,

EOL care, and wa ys to cope with the death of a patient.

* Thirty-six per cent of nursing students ask ed if they felt pr epared with the pr ocess of death and dying r eported

they wer e less than pr epared (not pr epared or somewhat pr epared).

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* Perceptions of being pr epared to pr ovide EOL car e resulted in 45 per cent feeling less than pr epared (not

prepar ed or somewhat pr epared) and 47 per cent felt prepared or v ery pr epar ed.

* Ask ed if the y felt pr epared to cope with the death of a patient, most nursing students (45 per cent vs. 35

percent) f elt less than pr epared (unpr epared or somewhat pr epared).

Only 24 per cent of the nursing students r eported that their nursing curriculum (what the y learned in class)

prepar ed them in general EOL car e. Only 17 percent felt that the curriculum pr epared them to cope with the death

of a patient. P articipants wer e asked who helped them pr epare to deal with issues surr ounding patient death

(process of death and dying, EOL car e, and ways to cope with death of a patient); options for each categor y were

as follows: no one, clinical instructor , clinical staff, other nursing students, friend or family member , and learned

in nursing class. Learned in nursing class and clinical instructor wer e among the top-ranked answers in most

categories. The top answer to who pr epared respondents to cope with the death of a patient was " no one."

Clinical instructors wer e referr ed to as pr eparation r esources for EOL car e (19 percent), process of death and

dying (17 per cent), and coping (17 per cent) in these areas.

Par ticipants wer e asked to rate their le vel of pr eparation on a scale of 1 to 4 (1 = unpr epared, 2 = somewhat

prepar ed, 3 = pr epared, 4 = v ery pr epar ed) in se veral ar eas related to communication: communication with dying

patient, communication with patient' s family, and communication with members of the health car e team. The

majority (57 percent) of nursing students f elt less than prepared (unpr epared or somewhat pr epared) to

communicate with a dying patient; only 23 per cent reported f eeling pr epared or v ery pr epar ed. Again, the majority

(64 per cent) of par ticipants felt unprepared or somewhat pr epared to communicate with the dying patient' s

family. Howe ver , par ticipants f elt more prepar ed to communicate with members of the health car e team (45

percent vs. 35 per cent).

Par ticipants wer e asked who helped them pr epare to deal with issues surr ounding communication

(communication with dying patient, communication with patient' s family, and communication with members of

health car e team); options for each categor y were as follows: no one, clinical instructor , clinical staff, other

nursing students, friend or family member , and learned in nursing class. The top answer to who pr epared

respondents for all the communication questions was " no one." Students r esponded that their curriculum

prepar ed them to communicate only 18 per cent of the time when communicating with the dying patient, 20

percent of the time when communicating with the family of a dying patient, and 18 per cent of the time when

communicating with the health care team. Clinical instructors helped pr epare students to communicate with the

dying patient (15 per cent), the family of the dying patient (14 per cent), and the health care team (18 percent) of

the time.

Nursing students wer e asked specifically about what the y would like to be taught about EOL car e. The number

one answer from students was mor e education on how to communicate with the dying patient and family .

Students wanted more education on EOL car e in general, including the activ ely dying process and suppor tive

resour ces for the family and the patient. Students also wanted education on postmor tem care of the patient.

Students r equested debriefing and education on how to cope with a patient death. The y suggested more

education on EOL car e earlier in the nursing curriculum with mor e educational activities involving death and

dying through simulation scenarios, faculty experiences, and e ven a hospice clinical.

DISCUSSION

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It is significant to note that the sample was fairly r epresentativ e of nurses in the United States, both in terms of

geography and in terms of race. P articipants came fr om ever y state and the District of Columbia. Nearly one thir d

(31.9 percent) identified with racial gr oups other than Caucasian.

Nationally, nursing students (41 per cent) reported being pr esent at a patient death. This high per centage of

individuals who experience a patient death as a student highlights the impor tance of death education. Despite

the sensitive nature of the topic of death itself, nurses need to be pr epared for the almost ine vitable death

experiences they will encounter. Current recommendations str ongly encourage nursing schools to educate

students about EOL car e (Ferrell, Mallo y, Mazanec, & Virani, 2016). Death education ma y be integrated into

nursing curricula, particularly for concept-based nursing pr ograms.

More work needs to be done to help students cope with patient death. Ask ed who helped them cope with the

death of a patient, the top answer was "no one." Clinical instructors wer e repor ted to pla y a leading r ole in the

training of nursing students in all ar eas regarding death and dying. Giv en that clinical instructors ar e frequently

adjunct faculty who r eceive lower le vels of pr ofessional de velopment than r egular faculty in the academic

setting, it is possible that many clinical instructors ar e insufficiently prepared to guide students in matters of

death and dying, communication with family and medical staff, and debriefing. Clinical instructors spend mor e

one-on-one time with students than almost any other instructor in nursing school. They are also uniquely

positioned to obser ve student interactions with patients and patients' families.

The Institute of Medicine (2015) publication Dying in America specifically identifies a lack of communication

skills, interpr ofessional education, and curricula focused on palliativ e and EOL care in nursing education. The

American Association of Colleges of Nursing (2016) r ecommends competencies and curricular guidelines

regar ding EOL issues, including communication with dying patients and families and assisting the patient, family ,

colleagues, and one's self to cope with the dying pr ocess, grief, and bereavement. Role modeling, simulation, and

debriefing ma y be the most efficacious wa ys to prepare students to deal with the challenges associated with

patient death (K eene, Hutton, Hall, & Rushton, 2010). In addition, intr oducing students to critical reflective

practice early in their academic endea vors ma y increase their r esilience while cr eating cultural meaning for the

dying process (Hodges, K eely, & Grier , 2005). As Benner (1982) noted, no vice nurses (and we would add prenovice

nurses) need mentoring, par ticularly in the advanced skills needed for EOL car e.

LIMITATIONS

It ma y be noted that a siz eable proportion (11.6 per cent) of those who began the sur ve y did not complete it. It

ma y also be noted that many of the questions dir ected to those who experienced a patient death as a student (n

= 1,148) had high rates of missing data (around 20 percent). Patterns of missing data for those questions wer e

examined. Most individuals completed all of the questions (n = 902, 78.6 per cent). It was found that a large

majority of missing answers wer e attributed to a consistent set of individuals (n = 224, 19.5 per cent), who, it

seems, simply did not complete most of the questions. A small per centage of individuals (n = 22, 1.9 percent)

chose not to answer between one and six questions but completed the others.

Although it is not possible to determine specific r easons for noncompletion, it may be possible to speculate. The

topic of experiencing a patient death during schooling has the potential to be emotionally difficult to think about

and discuss. It may be that the emotionally difficult natur e of the topic led some individuals to not complete the

questions. This surve y also ask ed several open-ended questions in the format of typed r esponses. It may be that

additional time r equired to think about and formulate r esponses led some individuals to giv e up rather than

complete the entire surve y.

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IMPLICATIONS FOR NURSING EDUCATION

Students need and want mor e education on EOL nursing car e as well as how to communicate with dying patients

and their families and postmortem care. Most nurses, at some point in their car eers, will encounter a patient who

is dying. Although death is often not discussed in many societies, it is a conv ersation that needs to be held in

order to ensur e that the dying patient' s wishes are known.

The Conversation Pr oject (http://theconv ersationproject.org), which is dedicated to helping individuals talk

about their EOL issues, giv es individuals the words to say to family members and to health car e providers to star t

the conversation on what the y would like at EOL. Nurses pr ovide the majority of car e and are uniquely positioned

to help star t the conversation of patient pr eferences and assist the patient and family thr ough the dying process.

Dying is a deeply personal experience. F or nursing students, the death of a patient, at the v ery beginning of their

car eer path, is often a str essful and over whelming experience. Although debriefing and mentoring tak e place

routinely in simulation, the y do not happen most of the time in r eal life. It is a double-edged swor d to tell novice

nurses to car e about their patients while asking those same nursing students to turn off caring when the patient

is dying or has died. Experienced nurses do a disser vice to novice nurses when the y tell them to "toughen up, "

rather than discuss their views of the dying experience. This lack of discussion and acknowledgement of salient

issues during the dying process may lead to nurse burnout and compassion fatigue.

In the clinical setting, nurse educators, par ticularly adjunct clinical faculty, need to be trained in debriefing

techniques, critical reflection, and mentoring nursing students as the y provide car e for those in the last phase of

life. Students need to be exposed to the dying experience, but with exper t nurse mentors to role model and guide

them through an often challenging situation (Österlind et al., 2016).

For nursing students, as suggested b y the respondents to this study , more simulation experiences with patient

demise and debriefing need to be par t of the nursing curriculum. Allen (2018) points out that, e ven in an EOL

simulation setting, nursing students caring for dying patients experience incr eased stress. In our study , students

requested mor e EOL experiences thr ough simulation and thr ough clinical experiences, such as hospice and

palliative care with mentoring fr om their nursing faculty .

Sidebar

The authors have declar ed no conflict of inter est.

doi: 10.1097/01.NEP .0000000000000335

References

REFERENCES

Allchin, L. (2006). Caring for the dying: Nursing student perspectiv es. Journal of Hospice & Palliative Nursing, 8,

112-117.

Allen, M. (2018). Examining nursing students' str ess in an end-of-life care simulation. Clinical Simulation in

Nursing, 14, 21-28.

> 6/17/2019 My Patient Died: A National Study of Nursing Students' Perceptions After Experiencing a Patient Death - ProQuest

https://search-proquest-com.ezproxy.brenau.edu:2040/docview/2132190303?accountid=9708 8/10

American Association of Colleges of Nursing. (2016). P eaceful death: Recommended competencies and

curricular guidelines for end of life nursing care. Retrieved fr om

www .aacn.nche.edu/elnec/publications/peaceful-death

Anderson, N., K ent, B., & Owens, R. (2015). Experiencing patient death in clinical practice: Nurses' r ecollections of

their earliest memorable patient death. International Journal of Nursing Studies, 52(3), 695-704.

Benner, P. (1982). F rom no vice to exper t. American Journal of Nursing, 82(3), 402-407.

Bryant, H. (2008). Maintaining patient dignity and off ering support after miscarriage. Emer gency Nurse, 15(9), 26-

29.

Carson, S. (2010). Do student nurses within an under graduate child health programme feel that the curriculum

prepar es them to deal with the death of a child? Journal of Child Health Car e: For Pr ofessionals W orking With

Children in the Hospital and Community , 14, 367.

Cava ye, J., & W atts, J. (2012). End-of-lif e education in the pre-registration nursing curriculum: P atient, carer, nurse

and student perspectiv es. Journal of Research in Nursing, 17(4), 317-326.

Dos Santos, J. L., & Bueno, S. M. (2011). Death education for nursing pr ofessors and students: A document

re view of the scientific literatur e. Revista da Escola de Enf ermagem da USP, 45(1), 272-276.

Edo-Gual, M., T omás-Sábado, J., Bar dallo-Porras, D ., & Monfor te-Royo, C. (2014). The impact of death and dying

on nursing students: An explanator y model. Journal of Clinical Nursing, 23(23-24), 3501-3512. Retrie ved fr om

http:// onlinelibrar y.wile y.com.erl.lib.b yu.edu/doi/10.1111/jocn.126602/abstract

Ferr ell, B., Mallo y, P ., Mazanec, P ., & Virani, R. (2016). CARES: AACN' s new competencies and recommendations

for educating undergraduate nursing students to impr ove palliativ e care. JournalofPr ofessionalNursing, 32(5),

327-333.

Gallagher , O., Saunders, R., T ambree, K., Alliex, S., Monter osso, L., & Naglazas, Y. (2014). Nursing student

experiences of death and dying during a palliativ e care clinical placement: T eaching and learning implications. In

In Transformativ e, Innovativ e and Engaging: Pr oceedings of the 23r d Annual Teaching Learning F orum, 30-31

January 2014. P erth, Australia: Univ ersity of Western Australia.

Gillan, P., van der Riet, P ., & Jeong, S. (2014). End of lif e care education past and pr esent: A review of the

literatur e. Nurse E ducation T oday, 34,331 -342.

Hodges, H. F ., Keele y, A. C., & Grier , E. C. (2005). Pr ofessional r esilience, practice longe vity, and P arse's theor y for

baccalaur eate education. Journal of Nursing E ducation, 44(12), 548-554.

Huang, X. Y., Chang, J. Y ., Sun, F. K., & Ma, W . F. (2010). Nursing students' experiences of their first encounter with

death during clinical practice in T aiwan. Journal of Clinical Nursing, 19(15-16), 2280-2290.

IBM Corp. Released 2013. IBM SPSS Statistics for Windows, V ersion 22.0. Armonk, NY: IBM Corp.

Institute of Medicine. (2015). Dying in America: Impr oving quality and honoring individual pr eference near the

end of lif e. Washington, DC: National Academies Pr ess.

> 6/17/2019 My Patient Died: A National Study of Nursing Students' Perceptions After Experiencing a Patient Death - ProQuest

https://search-proquest-com.ezproxy.brenau.edu:2040/docview/2132190303?accountid=9708 9/10

Keene, E. A., Hutton, N., Hall, B., &Rushton, C. (2010). Ber eavement debriefing sessions: an inter vention to

suppor t health car e professionals in managing their grief after the death of a patient. P ediatric Nursing, 36(4),

185-189, quiz 190.

Kent, B., Anderson, N. E., & Owens, R. G. (2012). Nurses' early experiences with patient death: The r esults of an

on-line surve y of r egister ed nurses in New Z ealand. International Journal of Nursing, 49(10), 1255-1265.

Leighton, K., & Dubas, J. (2009). Simulated death: An inno vativ e appr oach to teaching end-of-lif e care. Clinical

Simulation in Nursing, 5, e223-e230.

Neiderriter , J. (2009). Student nurses' per ceptions of death and dying (Doctoral disser tation). Cleveland State

Univ ersity , Cleveland, OH. ISBN:9781109278040.

Österlind, J., Prahl, C., W estin, L., Strang, S., Bergh, I., Henoch, I., & Ek, K. (2016). Nursing students' per ceptions of

caring for dying people, after one year in nursing school. Nursing Education Today, 41, 12-16.

P arr y, M. (2011). Student nurses' experience of their first death in clinical practice. International Journal of

P alllativ e Nursing, 17(9), 446-451.

Poultne y, S., Berridge, P ., & Malkin, B. (2014). Suppor ting pre-registration nursing students in their exploration of

death and dying. Nurse E ducation in Practice, 14, 345-349.

Schlairet, M. C. (2009). End-of-lif e nursing care: statewide sur ve y of nurses' education needs and eff ects of

education. Journal of Professional Nursing, 25(3), 170-177.

Thompson, G. T . (2005). Effects of end-of-lif e education on baccalaur eate nursing students. AORN Journal, 82(3),

434-440.

Wallace, M., Gr ossman, S., Campbell, S., Rober t, T., Lange, J., & Shea, J. (2009). Integration of end-of-lif e care

content in under graduate nursing curricula: student knowledge and per ceptions. Journal of Professional Nursing,

25(1), 50-56.

Zheng, R., Lee, S. F ., & Bloomer, M. J. (2016). How new graduate nurses experience patient death: Asystematic

re view and qualitativ e meta-synthesis. International Journal of Nursing Studies, 53, 320-330.

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