Published July 29, 2016
By Sarah Goldthrite
“I still remember everything about my first patient death – his name, his room number, his plaid flannel pajamas – every little detail. It was very traumatic. I’ve heard many medical residents say the same.”
Kelly Foltz-Ramos, clinical lab coordinator and clinical assistant professor in the UB SON, says inadequate preparation for dealing with death is a contributing factor in turnover for medical and health care professionals who may not know how to cope with the death of a patient – and this educational gap could have a damaging effect on patients and families. Her recent study, “Education about Death across the Professions,” explores the efficacy of methods used to prepare students of medical and human services fields to cope with death.
“Nursing students have insufficient training in death and dying,” says Foltz-Ramos. “This inadequate education negatively affects patient care and patients’ families – how professionals communicate death can have a lifelong impact on survivors.”
Although lecture has been shown to cause death anxiety, 75 percent of death education is still delivered through lecture.
Another reason this is problematic, says Foltz-Ramos, is that if a student doesn’t want to talk about death, and that student is learning via lecture, then the student doesn’t necessarily have to be engaged.
She also found that the most cited model used in death and dying instruction – and the model Foltz-Ramos learned as a nursing student – is Kübler-Ross’ “Grief Cycle,” which may not be the most appropriate model for teaching students about coping with and understanding death and grief.
“The Kübler-Ross model is very much anticipatory,” Foltz-Ramos explains. “It is somewhat linear, though individuals can shift back and forth between the stages. From my observation, Stoebe and Schut’s ‘Dual Process Model of Coping with Bereavement’ aligns more with a survivor’s experience.”
The model includes two states, loss-oriented and restoration-oriented, and says that an individual coping with death experiences a dynamic, rather than linear, grieving process.
“An individual coping with death could be in a good state – a restoration-oriented state – then see a reminder of the person who died and enter back into a loss-oriented state. It's an oscillation rather than a movement through stages.”
This process speaks to the necessity of self care, as it allows individuals to cope in ways that are most helpful to or productive for each individual – at times people need distraction from grief, while at other times they may feel the need to deal with grief more directly. And it’s person-centered, as it provides a clearer picture of an individual’s grieving process.
Foltz-Ramos says integration of self-care and experiential learning with high-fidelity simulation in curricula would help students address their own feelings about death and dying.
This will ultimately improve coping skills, both personally and in practice, for nurses and other professionals who encounter death. Improved coping skills and a more developed understanding of the grieving process ultimately means better communication with families and patients themselves and better self and patient care.
“Experiential learning is an important aspect of death education,” Foltz-Ramos explains. “Students who receive experiential education have the opportunity to reflect on death and dying versus someone telling them how to act and what they will experience. The most important part of this is that students have an opportunity to reflect on and talk about their experience and feelings. If we can provide education about death appropriately, we can change the students’ attitudes, behaviors and intentions in a positive way.”
For her dissertation, Foltz-Ramos, who is working toward a doctorate in education, is planning to design nursing curriculum for experiential death education.