192 institutions and schools of nursing offering undergraduate education; respondents were tutors in nursing schools; response rate for institutions was 64% and 88% for schools.
Cross-sectional survey; data collection 1984.
To gain an overview of the nature and extent of teaching about death and dying in UK nursing schools.
Time reported ranged from 2–42 hours with an average of 9.8 hours focus on palliative care.
Short questionnaire with only 8 questions so, limited amount of data was gathered and some questions remain unanswered.
Grounded theory longitudinal qualitative study; questionnaire applied at start of training with participants followed up at two further points during training period.
To explore student experiences of death throughout preregistration training and to what extent theory actually supported clinical practice.
Death was a predominant feature in students’ images of nursing; concern about inability to cope and lack of support to deal with patients’ death.
Very small convenience sample known to researcher.
To identify and describe death education curricula; content amount, topics, and assessment.
Canada: 26% schools offer elective and 7% compulsory courses; average 24 hrs in classroom and 36 hrs clinical practice. UK: overall 97% programmes offer death education; 17% schools offer elective and 33% compulsory course; average 44 hrs in classroom and 100 hrs clinical practice.
Small sample; results not generalizable. Possibility of curriculum changes since study reported.
2033 nurses responded to adverts; 300 nurses were randomly selected.
Cross-sectional survey distributed via mail, professional journal, and internet.
Description of nurses views about care of terminally ill.
62% nurses rated education on EOL care as inadequate; 71% said pain management was inadequate; 59% rated symptom management inadequate; less than 35% rated bereavement and spiritual support to patients as effective.
Self-selected sample so result may be skewed as only those with a particular interest may have responded.
Convenience sample of 40 students and 12 carers. Response rates of 91% and 48% respectively.
Methods used: semistructured interviews, participant observation, focus groups and in-depth interviews.
To evaluate regular one day palliative care workshops held out with clinical setting where carers share their story with students.
Students gained insight, knowledge, communication, and team working skills.
Educator self report. Participants were interprofessional groups including nursing, social work, medicine, occupational therapy, and physiotherapy students but no data on percentage of each.
Sample of 77 nurses asked to reflect upon their experiences.
Phenomenological study with thematic analysis of the critical incidents.
To describe experiences of newly qualified nurses.
Most frequently cited critical incident while in training was “facing death nurses”. felt their communicating skills were inadequate to deal with dying patients and grieving relatives.
Educator self-report. Reflexive study so issues of memory and accuracy of recall may have influence reliability of results.
Convenience sample of 33 third year student nurses.
Mixed methods study, Pretest and posttest questionnaire.
To evaluate an optional palliative care module comprising 50 hours of classroom teaching plus one week, hospice placement.
Significant increase in knowledge especially of pain and symptom control but also deficits identified, leading author to conclude that module should be compulsory.
Senior tutors () responsible for degree and diploma nursing courses in UK. Response rate of 40%.
Mailed survey with structured questionnaire
To explore extent of palliative care teaching to undergraduate preregistration students in UK.
During training, students received 8–12 hrs of palliative care teaching; an apparent reduction since earlier study (Field and Kitson 1986 [45]).
Overestimation of provision possible because only those with an interest in this area may have responded to questionnaire. Relatively low response rate so cannot generalize results.
8 national training courses based on core curriculum implemented in 5 undergraduate curricula.
Developed core curricula and training materials to improve evidenced based care.
Overall evaluation of End-of-life Nursing Education Consortium (ELNEC) training project; comprises result of individual studies reported elsewhere.
Implementation of ELNEC curricula results in increase content in nurse education; improves effectiveness of new graduates; encourages expertise in specialist area of nursing.
Educators self-report of larger project with multiple strands of activity.
28 newly qualified nurses working in acute medical words in two hospitals in England.
Qualitative study used in-depth interviews; set within a stress-coping paradigm.
To explore nurses experiences of death in order to develop effective support.
Nurses felt theoretical learning made little contribution to way they cared for dying patients: that experiential learning more important and that pre-registration training failed to address relevant issues.
Unable to generalize as data gathered from small sample.
Descriptive qualitative study; data collected via single interviews.
To explore and describe nursing students’ experience of care of dying during adult clinical placement.
Care of dying patients is challenging for students; advocates death education theory and practice to be integrated in all nurse programmes; that one class should focus on specific client groups; students need clinical experience of EOL care
Very small sample so findings not generalizable; interviews very short in length 15–45 minutes.
134 students at end of first year of study. Response rate 88%.
Quantitative study using self-report questionnaire and semi-structured interviews with 15 students.
To explore student perceptions of education and clinical inputs that were helpful in preparing them to care for cancer patients.
Students reported lack of classroom input and felt their communication skills inadequate; 80% said learnt most from clinical practice rather than classroom theory; 77% said didn’t have enough clinical skills to care for cancer patients during clinical placement.
Intervention group consisted of 26 students at pretest, 15 at T1, 11 at T2, and 12 at T3. Control group 34 at T1, 22 at T2, and 15 at T3.
Quasi-experimental longitudinal survey completed prior to and 3 times after intervention. Used Revised Death Anxiety Scale.
To evaluate educational intervention aimed at influencing death anxiety attitudes and knowledge over time.
Death anxiety decreased but effects not long lasting; levels returned to premodule levels at 12 months. Authors conclude that repeated interventions are needed to effect long-term change in attitudes.
High-attrition rate with only 12 students completing study. Data collection coincided with start of Iraqi war and increase in terrorist alerts so possible environmental bias.
Convenience sample of 52 students, 32 in experimental and 20 in control group.
Quasi-experimental longitudinal study. Pre and post test with control group.
To evaluate new optional companionship programme, 4 hours theory, 20 hours contact with dying patient in clinical setting.
Programme did not produce significant improvement in knowledge and concerns compared to control group. Intervention group describes its participation as a meaningful learning experience.
Educator self-report. Participants reported that during the programme, other experiences may have influenced their knowledge and responses.
410 nursing and 99 medical schools in US. Response rates of 70% and 81%, respectively.
Mailed survey with structured questionnaire used to collect data on curricula content, teaching methods, hours of EOL care in curricula, and number of students spending time with hospice patients.
To gain an overview of palliative care education provided by medical and nursing schools in US.
Majority of nursing schools (88%) offer something, 5 had no formal death education; 18 had full semester course; average teaching hours 14; Only 1/10 nursing schools have a complete course in palliative care.
No attempt was made to assess effectiveness of provision or students views. Overestimation of provision was possible because only those with an interest in this area may have responded to questionnaire.
Sample of 14 students on each presentation of the module.
Case study design incorporates participant observation. Data collection 2001–06.
To evaluate the evolution of an interdisciplinary end-of-life elective which uses a story-telling approach, presented in classroom for 4 hrs a week for 15 weeks.
Course had significant impact on students’ lives but was challenging to implement.
Lack of clarity about actual sample size; seems small but text alludes to multiple presentations of module. Report is from educator so draws on personal experience.
A quasi-experimental, longitudinal repeated measures design was used. Data collected 2005 to 06; tools included (FATCOD) and student journals.
To evaluate end-of-life content integrated into nursing curriculum and its effects on students attitudes towards dying patients.
Education programme positively influenced attitudes of students towards care of dying. Age and previous experience of terminally ill were predictors of attitude change; previous education on death was not.
Educator self report. Convenience sample from one university site decreases the generalizability of results. Attrition rate of 23%.
Mixed methods study; used questionnaire with open questions, reflective journals, focus group and adapted version of FATCOD scale applied at end of course.
To evaluate a mandatory 4-week end-of-life course set in classroom, which used clinical case studies, lectures, seminars, and reflective activities; focus on affective domain of learning.
Course had positive effect on student attitudes and development of interpersonal skills. Revealed difficulties for educators and students when formally assessing outcomes derived from affective learning activities and their perceived usefulness.
Poor student participation in reflective activities. Educator self-report highlights lack of preparedness of teaching staff, which may have affected outcomes.
Mailed survey: structured questionnaire used to collect data on curricula.
To gain an overview of palliative care education provided by nursing schools in UK. Data collected on teaching methods, literature used, topics covered, number of hours of teaching, and percentage of students undertaking elective and/ or mandatory modules.
All nursing schools had some provision: 24 had full semester course; average teaching hours was 45; 95% of students participated in palliative care education; 3/5 programmes included hospices visits; pain, communication, and attitudes were covered by all curricula.
No attempt was made to assess effectiveness of provision or students views. Overestimation of provision was possible because only those with an interest in area may have responded to questionnaire.
Purposive sample of 58 fourth year students and key informant educators.
Cross-sectional survey; use of open-ended questions, PCQN and FATCOD scales.
To examine current curriculum content and learning needs of senior students related to EOL care in two university sites in Canada.
Found that one third of students did not feel adequately prepared to care for dying patients and had modest knowledge levels. Concludes that more EOL care and experiential learning should be integrated throughout curriculum.
Number of educators included in sample is not disclosed but low response rate was reported. Possibility that only students interested in EOL care completed the survey. The retrospective nature of the study relied on students’ memory of their experiences over four years so inaccuracies possible.
39 Deans of Nursing or equivalent invited, of which 26 participated. Response rate of 76%.
Descriptive survey which is phase one of a longitudinal mixed method study. Mailed survey self-administered by participants generated descriptive statistics.
To explore death and dying education in Australian undergraduate nursing curricula.
Death education is included in all undergraduate curricula but it is poorly designed; few attempts were made to link clinical placements to theory; few students had opportunity for experiential learning. Concludes that reform is required to enhance preparation for practice.
Nonvalidated researcher-developed survey instrument used. Descriptive study not generalizable to other contexts.
Descriptive survey to determine baseline knowledge about end-of-life care.
To evaluate programme where EOL content is integrated throughout the curriculum using a range of methods including clinical placements in hospices.
Identified need for improved integration of EOL care including: dedicated clinical days using real examples of dying patients, hospice experience, and bereavement classes.
Educator self report is first stage in ongoing curriculum review.
16 undergraduate nursing students from one university taking a 1 hour elective course on death, dying, and bereavement.
A self- completion questionnaire with 10 open questions administered after the simulation intervention followed by thematic analysis.
To evaluate the effectiveness of a simulated end-of-life care scenarios with a high-fidelity mannequin and teaching staff playing the role of family members.
Students reported that they lacked confidence in dealing with dying patients but that the enhanced realism of the simulation exercise improved their learning and helped them relate theory to practice and raised awareness of family matters and gaps in their knowledge.
Descriptive study that only reports on three themes identified: impact of family presence, value of realism, and self-efficacy. Data reflects subjective rather than objective experiences of students. Outcomes not measured.
Undergraduate nursing students at one university. Numbers and characteristics not reported.
Descriptive case study that uses date gathered from students during debriefing sessions.
To evaluate the effectiveness of an author developed module “The Silver Hour” that represents the 30 minutes prior to and immediately after death.
Students value the inclusion of simulation focused specifically on death. They report bewilderment when caring for dying patients but quickly overcome this to address the patient’s needs.
Descriptive case study in which numbers and characteristics of students are not outlined and outcomes are not measurable.
Draws on academic and policy literature to justify implementation of an integrated curriculum.
Descriptive case study.
To describe how palliative care content has been embedded throughout a three year undergraduate nursing degree programme at one Australian university.
Notes the importance of educators being supported to develop the competencies required to support theoretical and experiential learning of students in relation to palliative care.
Some of the literature supporting the case for integration relates to medicine rather than nursing.
Pre-registration nursing students () at different stages of the adult curriculum, data gathered across two years.
Mixed methods design involving evaluation and focus groups. Stage 1 was the thematic analysis of evaluative questionnaires, which then informed the construction of semistructured focus group interviews for stage 2.
To evaluate the effectiveness of a simulation exercise in end-of-life care with a high fidelity mannequin and role play by students
Students felt prepared for practice, that simulation improved their humanistic and problem solving abilities and also help develop psychomotor, technical skills, and overall confidence. Concludes that simulation encourages the integration of theory and practice in a controlled environment.
Educator self-report. Data represents the subjective students' perspective to the expense of objectivity and not focused solely on dying patients.
370 undergraduate students drawn from 4 schools of nursing, 90% of which were female.
4 self-completion questionnaires administered after debriefing session on the simulation intervention. Data analysed using PASW Statistics.
To evaluate a new learning intervention using simulated end-of-life care scenarios with a mannequin and students playing the role of family members accompanied by one traditional lecture.
Results showed significantly enhanced student end-of-life knowledge; high levels of self-confidence in caring for a dying patient; and strong self-reported communication skills in caring for patients and families at the end of life.
No data available on separate contributions of the lecture and simulation intervention. Also difficult to determine the extent to which communication skills were actually improved. Reliability and validity of tools not established prior to study.
Undergraduate nursing students at one university. Numbers and characteristics not reported.
Descriptive case study that used two questions with a 5 point Lickert type scale administered to students after simulation and game play interventions.
To evaluate students responses to 3 hour end-of-life simulation with a high fidelity model and the ‘Seasons of Loss’ board game.
Students better understood interventions and communication techniques used in end-of-life care and death. The board game developed awareness of issues related to terminal illness, death, and loss.
Descriptive case study in which numbers and characteristics of students are not outlined and outcomes are not measurable.
730 medical and nursing students from 7 universities of which, 289 (59%) were 1st year and 194 (40%) were final year nursing students.
Survey with structured 24 item questionnaire and open questions generated descriptive data.
To evaluate student experiences and attitudes after exposure to dying patients and whether exposure influences attitudes.
Majority (94%) of nursing students had positive attitudes to dying patients although they reported finding it arduous. High numbers of final year nursing students tried to avoid affective involvement with dying patients.
No pre-test on attitudes conducted prior to completion of questionnaire so it is difficult to determine to what extent exposure to dying patients changed attitudes.
120 third year nursing students at one university.
Self-completion survey that included quantitative and qualitative questions, administered at the end of an end-of-life care module.
To evaluate a new learning strategy utilising simulated end-of-life care scenarios with high-fidelity mannequin students playing the role of family members.
The majority of students found simulation to be a valuable learning tool in that it; helped prepare them to care for dying patients, to link theory to practice, to communicate with family of dying patients, and to actually observe a death.
Educator self-report and reports only on qualitative data collected.
