Letting go: A class on the end of life

Letting go: A class on the end of life

By

Dr. Ernie Lapierre, A.P.R.N.

Psychiatric mental health nursing coordinator

Change comes with rewards and challenges.

In 2008, students at Norwich University entered the nursing undergraduate degree program with a new curriculum map. One significant change was a required course in the fall semester of their senior year, “Care of Patients and Families at End of Life.” Why were students being asked to study death?

As faculty members, it is our job to bring students through the stages of patients’ lives, including its beginnings, challenges of adolescence, medical complications people sometimes experience in adulthood and the process of aging in older adults. Given that belief, we decided to bring all of our knowledge and experience together to help students learn about the dying process, including sudden, prolonged and natural death.

While I was given excellent direction, support and advice from the faculty regarding the general content for the course — how to teach it and how to evaluate results of my efforts — I also was given academic freedom. When it came to content, I turned to the nursing faculty gurus in the field, Barbara Ferrell and Nessa Coyle, and used their textbook the Oxford Textbook of Palliative Nursing (3rd Ed.).

I gratefully turned to our nursing faculty and invited scholars with expertise in specific areas to share their knowledge with our students in the classroom. However, the problem of how to evaluate the application of knowledge by our students became a source of periodic insomnia. While tests and quizzes were always an option, that seemed like an easy but not necessarily comprehensive technique that did not satisfy my creative itch. I wanted the student to look beyond the tubes, noisy machines, lab tests/results, diagnoses and documentation of care to really look at the person in front of them. I wanted them to get to know that person as they were dying and tell me what they thought and felt about this process.

One evaluative technique the students and myself found invaluable was journaling. Each week, student chose one of two chapters from either Ira Boyck’s book Dying Well (1998) or Maggie Callanan and Patricia Kelly’s book Final Gifts (1992). They addressed the chapter topic and shared how their personal story related to that chapter. Since only I read the journal entries and there is complete confidentiality regarding their content, students get credit for being honest.

Once I read their entries and offer comments, we talk, laugh, cry, pray and share; whatever it takes for them to “get” that dying person in front of them. Can the student speak to the issue of the “map for the journey” that people often talk about when they are dying? Can they articulate what saying “goodbye” means when you think of someone who is dying? Can you define “letting go” when someone is dying? These students can.

Students tell me they could never have learned these important concepts without reading these books. These concepts also helped them to listen more effectively to each person in front of them; know that what they said was important and know that they had something important to give to each patient. Given this new knowledge, they also could educate and support these patients’ families and caregivers.

Knowing comes first from self-reflection. That is the goal of this class and it is exactly what I want to happen. These critical skills enable our students to provide the best nursing care to every patient, from birth to death.