Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Nurse Educ Pract. 2023 May;69:103625. doi: 10.1016/j.nepr.2023.103625. Epub 2023 Mar 28.
To synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settings BACKGROUND: Nurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.
A qualitative systematic review and meta-synthesis METHODS: PubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012-25 Feb 2023. Qualitative studies of any design reporting nursing students' experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso's 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.
The review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.
While caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.
综合护理学生在临床环境中遇到死亡患者、姑息治疗或临终患者及其家属的经历，以及对他们的护理。
护士在照顾临终患者和患者家庭方面起着关键作用。据报道，护理学生在照顾临终患者和处理患者死亡方面感到准备不足。了解他们的经历将更好地告知如何改进姑息治疗教育，以及如何更好地在临床环境中支持学生。
定性系统评价和元综合
检索了 2012 年 1 月 1 日至 2023 年 2 月 25 日期间发表的同行评议文章和以英文发表的关于护理学生在临床环境中遇到死亡患者、姑息治疗、临终或患有有限期疾病的患者的经历的定性研究。纳入了任何设计的研究，报告了护理学生在临床环境中遇到死亡患者、姑息治疗、临终或患有有限期疾病的患者的经历，以及对他们的护理。使用批判性评估技能计划工具评估研究质量。使用桑德洛斯基和巴罗索的 2 步框架通过主题分析进行数据综合，然后使用事件时间线将其整合到元综合中。
该综述包括来自 26 个国家的 71 项研究（n=1586 名护理学生）。元综合包含 8 个主题和 23 个子主题：（1）与患者和家属的沟通经历，（2）对患者和家属护理的满意度，（3）COVID-19 大流行对死亡和临终的影响，（4）对死亡和临终的看法，（5）死亡的影响，（6）姑息治疗和临终关怀护理的护理教育，（7）支持系统和应对方法，（8）学习成果。元综合描绘了护理学生在遇到临终患者、家庭和患者死亡之前、期间和之后的经历。还为护理教师和临床工作人员提供了如何在临床环境中为学生提供必要技能和知识以及支持他们的建议。
虽然照顾临终患者和家庭对护理学生的学习和专业发展有益，但他们也遇到了许多挑战。在面临患者对姑息治疗和临终关怀需求不断增加的情况下，政府、临床和学术护理领导人必须将姑息治疗内容纳入护理学校的课程中。护理学校应通过设计文化和社会经济相关课程、整合理论和实践学习以及使学生全面了解姑息治疗和临终关怀来确保学生得到充分准备。临床工作人员和护理教师应在情感上支持学生，并指导他们进行患者护理。
