By Brad Coughlin
When Dannielle Baynton was 18 weeks pregnant, her doctor informed her that her son would be born with gastroschisis, a life-threatening birth defect where an opening in the abdominal wall permits the intestines to protrude.
After an induced birth, the premature baby was rushed to the neonatal intensive care unit at McMaster Children’s Hospital. In the following weeks, Baynton’s son underwent multiple surgeries and remained under close observation, with his young mother never leaving his side.
Three weeks passed before Baynton, anxious and sleep deprived, held her son for the first time. A compassionate nurse, stepping outside her boundaries, allowed the embrace. That nurse, and others like her, influenced Baynton’s career choice.
“The nurses there are what inspired me to become a nurse,” said Baynton, now a student in Conestoga College’s personal support worker (PSW) program. “They treated my son like their own and it really touched my heart.”
Many students entering into health-care professions have been affected by death or near-death experiences in their personal lives. But, patient death in medical centres should be far less intimate than that of a loved one.
Nursing and PSW programs at Conestoga College don’t have specific courses about death. From a healthcare provider’s perspective, the dying process is a small part of the life cycle as a whole. However, preparation to personally and emotionally deal with patient death is very much embedded within a student’s education.
Student nurses in the four-year bachelor of science (BScN) program test their medical skills by way of problem-based learning in which they’re given hypothetical cases. Students research and diagnose the patients, and learn how a nurse in the field would approach the case. The topic of the life cycle and death is often brought up in these cases.
“We talk about old age and what happens at the end of life, different things a person might be going through and how they might view life,” said Andrea Miller, an instructor in Conestoga’s BScN program.
Instructors, also being career nurses, are an irreplaceable resource in a curriculum that prepares students for nearly everything. Easily accessible to students, nursing teachers allow insight into their own experiences and feelings about death.
“I usually share my stories about long-term care,” said Sarah Pottier, a PSW program instructor. “Death doesn’t have to be such a negatively perceived thing … but I don’t think anything will ever prepare (them) for the first time that (they) have to go through it.”
Their first time in a hospital might be during a clinical placement which allows students to work in real-life situations but, for some, it might be overwhelming. Again, instructor and preceptor role modelling comes into play.
Coaching inexperienced students through basic day-to-day routines and procedures, Miller said she works closely with students on a day when their patient might die. She assesses how they’ll cope and what they’ll need from her to make it through the situation, which depends on previous experiences and each student’s own maturity.
“The last breath – that is a distinctive noise that you will never forget,” said Baynton, who experienced death while volunteering at a palliative care facility. “I don’t think I was really ready for it then.”
Barbara Kraler, a counsellor at Conestoga’s Counselling Services, said three triggers may cause students to be upset after the loss of a patient. It may be the first time a student has seen a body, it may trigger losses in their own life or it may be an unusually graphic experience.
“You need to seek out a support system,” said Karen Bertrand, a member of the board of directors for the Ontario Nurses Association (ONA). “In particular for nursing students it would be talking to their preceptor … the experienced nurse that they’re with.”
A nurse for 37 years, Bertrand has seen a change in health-care providers’ attitude toward grieving patient death. While nurses may have felt the need to be stronger and stoic in dealing with death 40 years ago, they’re now more open about emotional needs. Progress can be partially attributed to Elisabeth Kubler-Ross’s 1969 book, On Death and Dying, in which she introduced the five stages of grief.
All nurses are unique in the way they deal with death. For some, spirituality and the thought of life after death, which is often a common thought process after the first death experience, is vital to coping. For others, reflection or discussion with a support system, be it counsellors or co-workers, is important.
“Often as a team we’ll have a debriefing to talk about it,” said Jackie Young, a PSW at Lisaard House, a palliative care facility where she estimates 150 to 200 patients die each year. “To say that none of the deaths effect me would be a lie because sometimes you have people younger than yourself or parents with children dying.”
While some might think it’s common for nurses to eventually become desensitized to deaths, those in the field say it never gets easy; it just gets easier to distance themselves.
“Death takes its toll on all of us, that’s for sure, and you have to develop some coping mechanisms,” said Bertrand. “It’s so important that you’re able to leave work at work.”
Death is part of life and, depending on the profession, some will see it more than others.
“It’s a journey everyone needs to get through – whether they’re dying themselves or whether they’re losing someone,” said Mary Carley, an instructor in Conestoga’s BScN program.
By Brad Coughlin