Teaching to Develop a View of Life and Death in Nursing Students

Friday, 28 July 2017

Chiaki Otsuka, MSN, RN, CPCN1
Mari Hirota, MSN1
Sachiko Teraoka, PhD, MN2
Misae Ito, PhD, MSN, RN3
(1)Department of Nursing, Faculty of Health Science, Hyogo University, Kakogawa, Japan
(2)Department of Nursing, Yasuda womens University, Hiroshima-city, Japan
(3)Department of Nursing, Faculty of Haelth and Welfale, Kawasaki University of Medical Welfare, Kurashiki, Japan

Purpose:  As Japanese society increasingly ages, in 2025 it is estimated that deaths will reach a yearly figure of 1,600,000. Against this background, the Japanese Ministry of Science and Education, Culture, Sports, Science and Technology has established as goals for students graduating from college nursing programs that they should have the ability to relieve and reduce suffering at the end of life, respect, support and be able to offer advice to the dying on an individual basis. This paper clarifies an educational project seeking to develop a view of life and death and foster the ability to support and care for people at the end of their lives amongst nursing students, many of whom have been brought up in nuclear families with little chance to see death or end-of-life nursing at close hand.

Methods:  Subjects: 3rd year nursing majors who had completed basic nursing practicum and who were taking their first classes in palliative care. Research period: 2015.6.17 – 2015.8.31. Methodology: Questionnaire about changes in view of life and death after a course of lessons in palliative care (one 90-minute class a week for six weeks). The content of lessons was Introductory Cancer Nursing, Holistic Pain Relief, Radiation Treatment, Chemotherapy, Team-Approach Medicine, Family Care, Nursing Care. Teaching materials took the form of a DVD about image of cancer patients, spiritual care, and life review of patients as seen by family members. There was a 10-minute discussion with fourth-year students concerning involvement with end-of-life patients. The questionnaire had 27 items and 7 factors. These were [view of what happens after death], [fear and anxiety concerning death], [death as release], [escaping death], [awareness of purpose in life], [concern with death], [feeling about life span]. The 27 questionnaire items were answered using a seven-point Likert scale (1. Applies - 7. Does not apply). Analysis: A parametric statistical test for mean deviance was conducted and the significance level was set at 0.05.


The number of subjects was 89 students before the classes and 95 after, and 89.7% of the participants were female. The average age was 20.9 (19-45). Changes in view of life and death are stated starting with the maximum degree of change. The following showed a positive change. [Death as release], [I think of death as release from the heavy burden of this life] plus three other items showed a value of 0.51; [feeling about life span], [I think life span is already decided from the beginning] plus two other items showed a value of 0.42; [awareness of purpose in life], [I see a clear mission and purpose in life] plus three other items showed a value of 0.33; [escape from death], [I avoid thinking about death] plus three other items showed a value of 0.09. The following showed a negative change. [Concern with death], [I often think “What is death?”] plus three other items showed a value of -0.01. [View of what happens after death], [I think there are such things as “spirits” and “being cursed”] plus three other items showed a value of -0.03. [Fear and anxiety about death], [dying is frightening] plus three other items showed a value of -0.26. Statistical testing of difference before and after the classes had a t-value of 0.505. The mean score before the classes in the measure of view of life and death was 3.6 and after it was 3.8. Amongst the items, the lowest mean score was for [escaping death].

Conclusion:  The variety of teaching methods had an effect in developing students’ views of life and death, but the results for [escaping death] show the need for continued efforts.