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According to Meier et al., (2016), it is difficult to define the concept of a good death, as there is no external criterion and is more dependent on the perspectives of the dying individual. The word “death” is often associated with being a bad thing, as no-one has control over that phase of life. However, in major religious traditions, death is accepted as the natural end of the gift of life and as a point of transition to another, yet unknown, existence. Therefore many patients, don’t fear death itself but being abdandon (Mermann, 1992). These patients don’t fear the unexpected but rather dying alone, and not surrounded by the people that love and care for them.
Thus, last year, during my third week of my final block, one of my assigned patients was lying on the bed and she sadly passed away. It was a new patient that I got for the day, before I went on lunch, I read through the patient’s file. Therefore, after lunch, I thought it would be easier to continue with the subjective and objective assessment process of the patient. Upon, going through the patient’s folder, I introduced myself to the patient and explained to her the assessment process that I would be doing with her after lunch. When I returned from lunch, I entered her room and noticed the curtains were drawn closed. Then the doctor came out of the curtains and I went in, not registering what the doctor was saying to nurses outside the room that the patient has passed away. As I went in the patient was lying on her side, her eyes were still open but she was not breathing, only then did it register what was going on. The patient was dead. Before the two nurses came into the room and asked me to help them to re-position the body, I just stood there frozen as I could not believe what has happened. As I helped to re-position the body, I noticed how the nurses were nonchalant as to what was happening. As though this was normal for them but as for me I did not know how to react to this situation. As I was helping to move the patient’s body I noticed I was starting to cry but I quickly wiped them away as I did not want to seem unprofessional in front of the nurses.
It felt as an outer body experience, one moment I was helping to re-position the patient’s body in bed and the next moment I found myself sitting in a room secluded from other people. I ended up crying and tried to absorb and re-evaluate what has just happened. After the shock started to wear off, I started to think about how the patient was alone when she died, how sorry I felt for her family, how suddenly it had happen. I spoke to her an hour ago and there seem to be nothing out of the ordinary when we conversed. I also thought about how wrong I was when I was thinking, I was lucky to not have been busy with the assessment before the lunch break. As I felt that would have been 10 times more traumatic for me, had I seen her, take her last breath. After this happened I carried on with my next patients, as I did not want to seem unprofessional in the clinical environment and let the clinicians see me crying.
Hence, this experience made me realise in class we are taught how to treatment patients and we should act professionally when working with patients. But we are not taught how we should act when it comes to dealing with the death of a patient. In class we are not taught how we, as students, can prepare for something as traumatic as seeing a patient die or a dead patient. How to deal or cope with, when you see a dead patient. However at the end of the day dealing with the death of patients, a lecturer cannot really prepare you for it. According to Toms & Powell (2014), one cannot prepare students for experiencing patient deaths and how to cope with it in a class based teaching environment. As each person will have a different reaction to their patient’s death, some will be able to carry on as though nothing has happened while some would not have the ability to carry on with their duties due to the shock.
A traumatising situation like this can leave a student in a clinical setting feeling shocked, upset and sad. According to Toms & Powell (2014), students also feel angry and frustrated towards to the other health professionals as it seems they lack emotion when there is a death of a patient. Some students also experience feeling guilty when its a patient that they have been treating. They feel as if the patient was treated by a professional instead of by them, the student, maybe the patient would have been still alive and these are all valid emotions (Toms & Powell, 2014). How to respond in a situation like this is also one of the main concerns, if a student experienced the death of patient for the first time. This was my first experience of being exposed to a death of a patient, which resulted in me not knowing how to react to the situation. My mind went straight into “act professionally and don’t cry”. According to Tom & Powell (2014), there was a need for students to feel professional in a situation like this and suppress their feelings or emotional reactions. As a student you don’t want to feel embarrassed by showing out your emotions to everyone around you and try to cope with what you feeling behind close doors.
However, if we were taught in class of coping strategies or heard about other health professionals experiences with patient’s death. It won’t be such a daunting experience, where it feels like you can’t carry on treating your other patients in the fear that something like that will happen to your other patients. “Coping can be defined as ‘a process by which a person deals with stress, solves problems or makes decisions” (Man, 2009, pg 28). According to Toms & Powell (2014), a way to effectively cope with the death of a patient is through experience. Only with time and experience will the progress of coping with patients’ deaths become somewhat easier. Another way of coping with a patient’s death is creating an environment where students feel they are able to express their emotions after a patient’s death and are able to discuss it with the clinicians. One of the main coping strategies among students who experienced the death of a patient is discussing their experience with peers or discussing with those who had gone through the same experience. With regards to my experience, I did not speak to anybody about what I experienced, as I didn’t want to feel unprofessional and be a burden. Thus I think an environment should be created where it is normalised to talk and discuss death of patients and experiences of patient’s death and not something a student should be coping behind a closed-door.
References:
Man. W.L. (2009). Coping Strategies in the Face of Death. Newsletter of Hong Kong Society of Palliative Medicine. Retrieved from http://www.fmshk.org/database/articles/hkspmnewslettersep09p2832copingstrategiesinthefaceofdeath.pdf on 12 March 2019.
Meier, A.E., Gallegos, V.J., Montross-Thomas, P.L., Depp, A.C., Irwin, A.S., & Jeste, V.D.(2016). Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue. Am J Geriatr Psychiatry . 24(4): 261–271. doi:10.1016/j.jagp.2016.01.135.
Mermann A. C. (1992). Spiritual aspects of death and dying. The Yale journal of biology and medicine, 65(2), 137-42. Retrived from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2589523/ on 12 March 2019.
Powell, S. & Toms, J. (2014). Passing Away: An Exploratory Study into Physiotherapy Students’ Experiences of Patient Death whilst on Clinical Placement. International Journal of Practice-based Learning in Health and Social Care. 2 (1): 108-121. doi:10.11120/pblh.2014.00026
2 thoughts on “How does a student cope with a death of a patient in a clinical setting?”
Thanks Jamie-Lee, for sharing your piece. By reading your piece I can tell that it really had quite an impact on you and I do agree with you completely, one cannot be prepared for these events and students can definitely be prepared for these situations in an academic setting. I think that anyone in your position would have reacted in the same way. I really enjoyed your piece! In the first paragraph as well as the third I noted that there are grammatical errors which merely requires restructuring of the sentence as well as a few spelling errors in the second paragraph. Furthermore, have you considered consulting literature that looks at the impact death has on students should they experience such events within a clinical setting or literature that places emphasis on strategies that may potentially assist students to cope with these type of events? Perhaps by looking at various strategies you could potentially utilize them as coping mechanisms should you find yourself in a similar situation. Thank you so much for sharing this incredible writing piece! Your descriptions of your emotions at that point in time enabled me to experience those emotions as well merely by reading this piece which is amazing.
Hi Jamie-Lee, apologizes for the late comment.
Thank you very much or sharing this piece, it was clearly a traumatic experience for you.
The content reflects the topic you have chosen. This piece made me think about my first experience of death and I could relate as I had the same emotions and questions. It also gave me a clear insight to how deeply things affect you. I like the picture as it gives me comfort that even though patients tend to be alone at their last hour, the angels will always be there to hold their hand. The picture also links with your piece nicely. I really liked the way you shared your emotions, as it made me experience them as well, well done!
I agree with your argument as I feel we are not always prepared for the things we have to deal with in the clinical setting. With that said, I also agree with the fact that we can’t be prepared for something like death in a teaching environment. I do agree that we will largely benefit from coping mechanisms as my first thought is also always to “remain professional”.
I think you referenced your work well and also made your arguments stronger by using the literature. I liked reading that the literature stated that the emotions you and I experienced was normal and to be expected.
Your grammar and spelling was overall good. I would however suggest that you scan through your work as I noted one or two small errors. Your text was a very easy read and I found it easy to understand and see your argument.
I would suggest that you include how this experience has changed the way you look at death as well as how you would react if this situation presents it self in the future. In other words, how this experience will change your clinical approach.
Other than that, a very well written piece! Well done!
Kind Regards,
Ruve