Student Dietitians’ Experiences of Patient Death Whilst on Placement.
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Date
2014-07
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Abstract
Background: Evidence suggests that health care students experience a degree of trauma
after experiencing a patient death [1] and they keep their feelings and concerns about
patient death to themselves [2]. Rivers, Perkins and Carson [3] suggest that students may
be inadequately prepared to deal with patient death during their placements. The aim of
this study was to explore dietetic students’ experiences of patients dying whilst on
placement.
Methods: A qualitative phenomenological approach was used to explore the experiences
of 4th year undergraduate student dietitians. Recruitment was opportunistic and data was
collected using semi-structured interviews with topic guide and field notes to capture nonverbal
communication. Ethical approval was given by Coventry University’s ethics
committee and written consent was obtained from all participants. Interviews were
audiotaped and transcribed verbatim using thematic analysis as guided by Braun and
Clarke [4]. Peer review of findings was undertaken with the second author.
Findings: Three female students were interviewed. The main themes identified were: the
reaction to patient death, support, personal experience and personal beliefs. The reaction
to patient death included feeling shock and upset, as the patient death was unexpected.
Participants reported feeling unprepared for their patient’s death. ‘…he was palliative …I
didn't really think… he is going to pass away… that was a really difficult one …’ P3.
Support was obtained from debriefing to friends or educators or by formal reflection on
their experience, which was aided by presenting the patient as a case study. ‘…writing the case study…helped…it’s kind of like you’re thinking about all your actions...almost
reflecting on what I’d done… it’s nice to be reassured that I did everything that I should
have done.’ P3. However, the students found it difficult to open up to their educators
without being prompted to do so. Patient confidentiality was identified as a barrier to debriefing
to friends. Reflection was found to be helpful for participants who found it difficult
to approach their educators. Participants felt that preparation could only be achieved
through personal experience rather than class room discussion. ‘I don’t think the university
can prepare you, it’s more about life experience … it’s something you can’t learn in a class
room ...’ P1. Personal beliefs helped some participants cope with the experience.
Discussion: Students reported being unprepared for death, which was partly due to a lack
of experience and because they felt the death was unexpected. Students anticipated
patient’s death by the way the patient looked and acted, rather than using the clinical
information which indicated the patients ill health; this was a strong contributing factor to
the feeling of shock. Student preference for learning about death was through experience
is in line with Rivers, Perkins and Carson [3]. The shock of patient death might be reduced
by honest discussion by the educators of how ill patients are. The research is limited by a
small sample size due to a low response rate; therefore data saturation is unlikely to have
been obtained.
Conclusion: Students may require support from clinical educators when faced with a
patient death but may find this support difficult to access. Clinical educators have a role in
supporting students through debriefing, but students may find it difficult to show their
feelings. Inviting the student to talk through their experience and offering reassurance may
be helpful.
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Keywords
Student dietitians, experience, death, dying, patient, placement
Citation
Macdonald J, Tighe B. Student Dietitians’ Experiences of Patient Death Whilst on Placement. European Journal of Nutrition & Food Safety. 2014 Jul-Sept; 4(3): 181-182.