Nursing Education in Thanatology

A Curriculum Continuum

Florence E. Selder, Virginia W. Barrett, Marilyn M. Rawnsley, Austin H. Kutscher, Carole A. Lambert, Marcia Fishman, Mary Kachoyeanos

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317736608
• Edition: 1
• Topic: Education
• Subtopic: Education General

Nursing Education in Thanatology is an excellent source book for planning thanatology courses or for integrating concepts of thanatology into a nursing curriculum. As the formal teaching of thanatology in schools for health care professionals is generally overlooked and ill-defined, many students and professionals will learn to deal with dying and grieving upon their first encounter with death. This practical book will aid educators in planned inclusion of thanatology in curriculum to insure the preparedness of health care professionals in assisting patients and/or their families during an emotionally difficult period. There are many suggestions presented for beneficial methods of integrating thanatology education into existing courses or offering thanatology as a single course for education professionals.A vital resource for inservice coordinators working with clinicians in oncology, hospital staff, and health professionals in community or outpatient health centers, Nursing Education in Thanatology is excellent reading for helping professionals working with elderly people.

Section I:
Teaching Aspects and the Thanatology Curriculum Content

Considerations in Teaching Thanatology

Florence E. Selder

The formal teaching of thanatology in schools for health care professionals is generally overlooked and ill-defined. It is assumed to be taught when “it” happens. The “it” may be the first time a student is confronted with the death of a patient. A deliberate, purposeful inclusion of thanatology in the curriculum will insure prepared health care professionals are ready to assist patients and/or their families during an emotionally difficult time. Utilizing a specific approach, a context of language and intervention strategies will facilitate the effective teaching of thanatology. Furthermore, an awareness of caregiver behaviors and factors of student supervision will strengthen the teaching program.

Considerations of what and when (content) and how and where (process) to teach thanatology, are functions of the approach. The content, or didactic material, may be fixed exclusively in a course on death and dying. It may be integrated into related courses such as an ethics course, a course on terminal diseases, intensive care or E.R. nursing, or a discussion of disabilities. It may also be informally interwoven throughout the curriculum according to spontaneous student interest or need.

Process, or the context in which the information is transmitted and learning acknowledged, can include a lecture presentation, an experiential program, or a combination of both. Decisions as to which orientation to employ will be influenced by parameters such as class and room size, time available for both content and experience, the availability of experimental resource materials, and the student’s familiarity and practice with aspects of thanatology.

The very minimum information for any one curriculum should include a description of at least one theory of individual response to loss, the impact on family members and the caregiver, and one’s particular professional role and responsibility relating to the physiological process of dying, care of the patient, and, impact on survivors. The minimum provision of context or process should be an opportunity for students to respond to the didactic information presented.

If, in the curriculum, only lecture is allocated to thanatological study, the recommended approach for the novice or inexperienced student is to provide many process experiences. Beginning students have an absence of clinical experience and will be less able to comprehend and utilize the content in a meaningful way. The use of a film or participatory exercise compensates for this experiential deficiency. Most students do have personal experiences with loss in their individual histories and relationships. Through process activities, these experiences can be drawn upon in reflection and inquiry for greater understanding of thanatology.

In contrast, students who have had clinical experience may best be served with the presentation of a specific conceptual framework (e.g., stages of dying) within which to integrate their experiences.

An effective approach that meets a variety of students’ back ground and knowledge, is to integrate content and process in a three-credit course. One credit may be allocated to required attendance at lectures and films during a weekend seminar. The remaining two credits may be allocated to participation in various small group activities such as writing farewell letters or epitaphs, making videotaped messages for loved ones, creating clay or art products, or dramatizing the experience of being dead.

Placing the content in a conceptual framework of language is vital to the student’s ability to organize the many facts or notions about loss, death and dying. Providing a language for students furnishes them with a map to understand the complexity of thanatology. The particular framework chosen is less important than the fact that one needs to be selected. Whatever the selected framework, students will share a common base of knowledge through which they will be able to communicate their experiences. The framework can be further utilized for assessment interventions.

A number of conceptual frameworks exist. The stages of dying framework is one example of a language context and includes Kiibler-Ross’s (1969) stages of dying. Further, life transition theory (Selder, in press) is useful to examine persons’ responses to loss. Each of these models provides a means to understand and verbalize experiences in response to loss. An eclectic approach which encompasses multiple frameworks can be utilized with increased experience and understanding.

Appropriate intervention strategies stem from and are determined by the selected conceptual framework. To illustrate, examples are presented here relating to the life transition theory concepts of of strategies Reactivation and Missed Options. Reactivation is the awareness of thoughts, feelings and sensations reminiscent of those that occurred earlier. For instance, a woman may hear noises upstairs and momentarily conclude her husband is getting up. Immediately, she realizes her husband is dead and has been dead for the past few weeks. When the phenomenon of reactivation occurs it is disconcerting to the individual; the woman feels as she did when she first discovered her husband had died. In addition to the distress of reliving the loss, people view reactivation as a sign that they have not made any progress with their grieving.

Appropriate interventions in this example are to describe the phenomenon of reactivation as a common response to loss. In addition, indicating that it is a repeated experience that decreases in intensity with subsequent episodes, provides comfort and assurance to the patient.

Another intervention illustrated from life transition theory to missed options. Missed options are those behaviors in which a person previously claimed competency. For instance, a missed option for a person with a spinal cord injury is the option of walking again. The point at which a person realizes a missed option varies from individual to individual. Arriving at the realization is a process in itself that causes much uncertainty, fear and distress.

Appropriate interventions in this instance are to assist the person in identifying unavailable options. In addition, helping the person discover a means to minimize the intrusiveness of the missed option will reduce the fear and uncertainty.

Caregiver behaviors have a significant influence on intervention strategies and health care professionals’ beliefs about loss. Wright’s (1960) concepts of spread effect and requirement for mourning demonstrate this point. The spread effect results when any deviation of person’s behavior and personality is seen as being more than just one deviation. For instance a student may assume that because a blind person cannot see, he also cannot hear, though there is no connection. Similarly, we speak very loudly to older clients, assuming that they have lost hearing along with aging. Requirement for mourning implies that whomever we consider unfortunate is suffering. Assumptions that a person has can have a spread effect on patient care. Thus, a student may assume that all patients who are dying will always feel devastated. Hence, they will not allow for the possibility that the patient may have found some meaning in his or her dying and is not devastated. In addition, a patient’s care will be influenced by a student who assumes that a dying person is hard of hearing or doesn’t hear at all, who is unable to laugh, tell jokes, have cognitive functioning or feel empathy for others.

It is necessary to emphasize that the caregiver has the responsibility to care for himself/herself. In working with persons who are dying, bereaved, or who are dealing with loss, it is likely that one may become depleted or overwhelmed. There are many strategies to support oneself and these may be discussed in the curriculum. Essentially, it is the responsibility of caregivers to care for themselves so that their care of others is not depleting.

Supervision is the final consideration in teaching thanatology concepts. Supervision in a clinical setting is self-evident and in existence. Supervision is less evident in a classroom setting. Supervision guarantees that a means is established to ensure that students’ responses are known by the teacher. Subsequent guidance may be provided if appropriate. Reaction papers are one-page self-reports on course content, films, exercises and guest speakers. Reaction papers will indicate to the faculty the status of students’ experiences, concerns and responses. For instance, a student in one reaction paper did indicate that she goes to the cemetery to talk to her mom and she wonders if this is normal behavior. Students can be reassured in the faculty’s written response to their reaction paper about their concerns. If numerous students have these concerns, then the comments can be used as a basis for class discussion.

In summary, there are several practical considerations to be addressed when deciding to include thanatology concepts in a curriculum. Including a determined approach, language, and interventions will maximize teaching efforts. Awareness of caregiver behaviors and student supervision will further ensure successful teaching of thanatology in the health care curriculum.

Note

© 1990 by The Haworth Press, Inc. All rights reserved.

References

Kiibler-Ross, E. (1969). On death and dying. New York: Macmillan Co.

Selder, F. (In press). Women and loss: Dealing with uncertainty. In Tallmer, M. et al. (Eds.). Implications of death and loss for women. New York: Foundation of Thanatology.

Wright, B. (1960). Physical disability-a psychological approach. New York: Harper & Row.

Concepts of Thanatology in the Nursing Curriculum

Rinda Alexander

In the past two decades much attention has been focused on the concepts and dynamics of thanatology. The burgeoning literature in the study of death and dying has, however, tended to focus on the narrow view. As a consequence the large view of the human condition tends to be fractured (Jackson, 1979). At the same time, significant advances have been achieved in the area of medical diagnoses and treatment of the terminally ill. What is unfortunate, however, is that emotional support for the individuals and the survivors (including health care providers) has not kept pace with the technical and medical advances made in treating the terminally ill.

The dying process and the state of death affect both the social and psychological roles of the dying individual. Nonetheless, it is significant that when the individual health professional comes into contact with the dying client, considerable insecurity still exists as to how to appropriately deal with the social and psychological needs of both dying clients and their significant others. Therefore, an understanding of the concepts of thanatology is essential to the terminally ill, their significant others, and holistic health care providers. This is particularly salient for the nurses who provide long term care and have intensive contact with the dying person. Through providing the student nurse with such concepts, better holistic care can be given throughout their careers.

Death education should be very much concerned with the process of living as well as the process of dying. Thanatology in the nursing curriculum can therefore motivate health care providers to take the holistic view of death and dying not only for the client, but also for themselves. Most importantly, educated nurses can then focus on the quality of life for themselves and for others in a less stereotypical manner (McGrory, 1978).

Nurses react to death personally before they react professionally. Attitudes toward death are culturally learned, and in the American culture there is the tendency to deny death. Other personal reactions have their basis in the psychological maturity and personality characteristics of the individual nurse. Care given the client is influenced by this personal reaction. The nurse, along with the physician, serves as the gatekeeper for many clients during the dying process, and, in the role of gatekeeper, the nurse can help the client achieve a peaceful death. However, whether or not the nurse can help the dying client achieve a peaceful death largely depends on the nurse’s orientation toward this role and how he or she has personally experienced death and the dying process.

The therapeutic use of the self is not necessarily in conflict with therapeutic use of technology (Feifel 1959). The holistic nursing professional combines care addressed to the disease process with care addressed to the person. It is important that the terminally ill be provided an opportunity to continue their positive self-growth as long as they live. Death education within the nursing curriculum can therefore be a strong stimulus to accept the terminally ill as being alive until they are actually dead. It is imperative that nurses as primary health care providers avoid an “already dead” approach to both clients and their significant others. The process of death education can prepare the health care provider to be better prepared to assume the technical and emotional advocacy role for the terminally ill and their survivors.

It is important to note that nurses in every clinical setting will inevitably encounter the dying process. Even nurses working in health maintenance areas care for the chronically ill, the dying and the recently bereaved survivors.

Learning to help dying clients and their families demands personal involvement of the health care professional. The professional health care provider who has been educated about the concepts of thanatology and effective living as well as dying, can provide consistent and compassionate care for both the dying individual and his or her significant others. This process will enable the dying individual to complete the process of dying with less trauma to both him/herself and others (Alexander 1979).

In recent years a trend toward multidisciplinary education has emerged (McGroiy 1978). With the increase of such educational offerings, the value and contributions of each profession can be used more r...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• SECTION I: TEACHING ASPECTS AND THE THANATOLOGY CURRICULUM CONTENT
• SECTION II: COPING APPROACHES AND THE THANATOLOGY CURRICULUM
• SECTION III: CLINICAL IMPERATIVES
• AFTERWORD