First-semester associate degree nursing students are taught a variety of subjects and content matter within a short period of time. At this particular community college, end-of-life (EOL) content is taught in the first semester, historically after the midterm for approximately 160 minutes. The lecture instructor has the option and ability to construct the day as he or she deems necessary.
The material has been taught with the use of PowerPoint slides, case studies, and a 30-minute video depicting a woman with breast cancer who eventually dies from the disease. Typically most students, more than half, have not dealt with a patient death or postmortem care while in the hospital setting. This may be the first time they are learning about EOL content.
The lecturer noted that EOL content was met with trepidation, emotional distress, and discomfort from the students. Thus, the students and faculty did not perceive this as a positive experience. An attempt was made to provide a positive EOL teaching experience for first-semester nursing students.
APPROACHING THE PROBLEM
The lecturer was unable to change the date or time of the lecture content, and therefore, it was still given directly after the midterm. However, several changes were made to the day. First, students were required, prior to class, to respond to a series of questions put together by the Institute for Healthcare Improvement (IHI) called "The Conversation Project." This project was developed to facilitate EOL conversations with family and friends (IHI, 2015). A PowerPoint was provided to students with lecture content to address the topics of grief, loss, caring for oneself, and the bodily changes evident when human life is ending. It also covered postmortem care and specific coroner cases.
Students were then shown a video produced by the Cleveland Clinic titled "Empathy: The Human Connection to Patient Care" (Cleveland Clinic, 2013). Following the video, the lecturer then introduced a guest speaker, a former student, to share her recent experience having to do with the death of a patient. This death occurred in the hospital setting while the student was in her last semester of nursing school. The lecture ended with the showing of a Make-a-Wish Foundation video and a discussion regarding the ways students can give back to the community (Make-A-Wish Foundation, 2015).
EVALUATION
After the lecture, the students were given a seven-question evaluation; they were instructed to not include their name or any other identifying information. The form was completed by 57 students (one student did not submit an evaluation). It was found that 98 percent of the students found the course to be either "extremely valuable" or "very valuable" (only one circled "somewhat valuable").
The responses to the question "What struck you the most on a personal (human) level" included "Listening to the former nursing student and seeing how her experience has really affected her"; "I want to volunteer for Make a Wish"; "The guest speaker struck me the most"; "When the professor mentioned that we need community with others and to give back"; "Hearing other people's stories"; "The different levels of grief, coming from personal experiences"; and "It was very personal and helped on a human level."
A week later, 55 students were given a 10-point quiz testing their knowledge of the material. Two versions of the quiz were made with the same content but a different sequence to decrease the potential for cheating. Findings from one quiz are discussed. The reliability coefficient (KR-20) was 0.38; therefore, the test was not found to be difficult. There were no negative point biserial correlations, and point biserial results ranged from 0.00 to 0.62. All 10 questions were above the recommended cut point of 33 percent, and the median score was 8.50 or 85 percent correct.
REFLECTION
The changes made to this lecture were found to be very successful, and the day was seen as an overall success. The class discussion and input from students were more than had been observed in the past. Many talked about their experience with the IHI starter kit and how easy they found the subject matter to be.
The lecture instructor found that the biggest impact came from asking a former student to speak. Over half the comments from the survey related directly to the speaker and how she dealt with a recent loss of life in the hospital. Several students revealed that they could relate to her story because she was not a teacher. While having a prior student take part in the EOL lecture in the future would be ideal, it is understood that it may not be possible because of scheduling issues. This particular guest speaker was free on the day of the lecture and open to speaking on this difficult topic.
Although EOL content continues to be an emotional and difficult topic for students, the lecture does not have to be mundane or overwhelmingly emotional. By implementing a few small changes with a focus on EOL content, positive outcomes were noted by both the nursing students and the lecturer.
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