Hospice teaches nursing students about end of life

Program wins national award

The Hospices of Henry Ford, Saint Clair Shores in St. Clair Shores, MI, have developed an extensive nursing education program for area colleges, ensuring many nursing students will have a greater appreciation for hospice and palliative care.

Seeds for the education program were sown in 1996 when a nursing school clinical instructor at an area college met with Ken Grunow, RN, BSN, CHPN, MEd, hospice education coordinator at Henry Ford, to discuss an end-of-life nursing educational course for nursing students. The program won an award for Excellence in a Program Designed to Increase Access to Hospice and Palliative Care, presented by the Alexandria, VA-based National Hospice and Palliative Care Organization in October 2004.

"They could see this would be a valuable service for nursing students, so we put together a one-day conference for nursing students at a community college," Grunow says. "We put it on with great fanfare, and it was videotaped, with several hundred students attending."

Several hospice professionals served as faculty for the program, and they created a syllabus of more than 100 pages of materials for the students, Grunow recalls. "But it was like launching a battleship or a cruiser — it was overwhelming for the students and for us," he says.

After spending time assessing the one-day conference and its success, hospice officials decided it was a good program that would need some adjustments. They also decided to offer it as a one-day course in nursing schools, Grunow says.

The program includes lectures on the philosophy and history of hospice care, pain management, children’s hospice programs, nuts and bolts of hospice care, characteristics of hospice services, role of the hospice nurse, hospice team approach, communication with dying patients, physiological changes during dying, medication, and spiritual and psychosocial services, Grunow says. "We have a social worker talk about communication at the end of life and what patients tell us about when they’re going to die and how they’re dying," he explains.

Grunow provides a summary at the session’s end with an overview of ethics and financial accountability, as well as a list of web sites, books, and other additional resources. When possible, the hospice class is taught by Grunow, a physician who discusses pain management, a nurse, a social worker, and a chaplain.

Although the class initially was designed to fill one day’s schedule, some colleges have requested a half-day version for their nursing students, Grunow notes. "I can cram everything in there in half a day, but I prefer the longer version," he says.

During the one-day class, Grunow shows students a 1996 HBO documentary about the hospice journey and letting go. "It’s an incredible film that follows the lives of three patients, a little boy and two adults, and it shows the services that the hospice team provides, as well as family dynamics," Grunow says. "I think it’s a masterpiece and haven’t found anything better."

The movie is very intense, and Grunow initially showed it to students later in the day. "But it took people’s breath away, and the people I coordinate with would show it in the morning," he says.

After the one-day or half-day class, nursing students are invited to spend some time at the hospice with nurses and other staff, preferably to attend patient visits, Grunow adds.

So far, the hospice has provided the educational program about 15 times a year to six Michigan colleges serving nursing students, he says. "We do this as a free service," Grunow says. "We think it’s important to help these young nurses get a little more comfortable working with patients at the end of life."

Hospice managers also hope the nursing students they help train may one day become willing and knowledgeable referral sources when they come across dying patients in hospitals or other locations, Grunow says. Some of the students have expressed enthusiasm for working for a hospice some day, he notes. "We recommend they get a couple of years of clinical and hospital experience before they come to us, because there’s a fair amount of autonomy needed in home care," Grunow adds.

The feedback has been very positive, he says. "Clinical instructors have told me that they found their students [after the course] were more comfortable with talking with people about end-of-life questions," he says.