Enhancing the Affective Domain in Order to Reduce Fear of Death in First-Year Student Nurses
Goode, Kim Patricia
This study seeks to investigate fear of death in first-year student nurses. It considers how this might be ameliorated through teaching and learning interventions that involve addressing emotional and spiritual intelligence within the affective domain. Fear of death, for this study, is defined as fear of death and of caring for dying people and their families. A pragmatic paradigm and a mixed method approach were used to explore the feelings and experiences of newly recruited student nurses in relation to fear of death and the care of the dying person and their families. Quantitative and qualitative methods were used to examine the impact of two different interventions intended to reduce the fear of death. A questionnaire was used to measure aspects of fear of death. The students were then randomly allocated to three groups. The members of two of the groups experienced an intervention, either a psychological self-help programme called ‘Do Something Different’, (Fletcher and Pine, 2009) or a weekly group meeting that explored relationships and the use of spiritual strategies based on Family Constellation theory (Hellinger, 2006). The third group acted as a control. After a period of time in clinical practice, the questionnaire was administered again and the results analysed and interpreted. The relationship between the students’ fear of death and their age, previous experiences, ethnicity and spiritual beliefs was explored. Findings indicate that the interventions had a positive influence on reducing the students’ fear of death. The qualitative part of the study involved semi-structured interviews with fifteen of the students who had completed both questionnaires. Their experiences of preparation for caring for dying people and of being in an intervention group were discussed. The interviews were analysed using interpretive phenomenological analysis (IPE). Influencing factors from home, such as cultural issues, and from within the clinical context, such as mentorship, were identified. The thesis contributes to nursing education and practice by showing that early preparation for caring for dying people can be effective in reducing fear of death. Results demonstrate that there is value in using strategies to help the student to develop emotional and spiritual intelligence in order to prepare for aspects of dying, before they experience the death of a patient. This preparation enhances the quality of the therapeutic relationship between student and patient. Another outcome is that students need a particular quality of support, at home and in clinical practice and that there are particular implications for Black, Asian and Minority Ethnic (BAME) students. Mentors of students need to be trained to be sensitive to the students’ needs when caring for people who are dying. Greater attention to preparation for death and care of the dying is likely to enhance the provision of end of life care and may also reduce attrition in first-year student nurses.