{"id":11844,"date":"2024-11-11T10:20:07","date_gmt":"2024-11-11T10:20:07","guid":{"rendered":"https:\/\/magazines.uthscsa.edu\/mission\/?p=11844"},"modified":"2026-02-04T16:34:57","modified_gmt":"2026-02-04T16:34:57","slug":"discussing-death-teaching-students-to-tackle-a-taboo-topic","status":"publish","type":"post","link":"https:\/\/magazines.uthscsa.edu\/mission\/discussing-death-teaching-students-to-tackle-a-taboo-topic\/","title":{"rendered":"Discussing death: Teaching students to tackle a taboo topic"},"content":{"rendered":"

Integrating palliative care competency into nursing curricula prepares students for the complexities of end-of-life care<\/strong><\/em><\/span><\/h4>\n

 <\/p>\n

Few words hold as much weight as the ringing echo of \u201cdeath\u201d uttered in a room.<\/p>\n

Despite the discomfort that can accompany discussions about death and dying, this largely taboo topic lies at the heart of every serious injury, illness and end-of-life journey. Yet imagine a patient\u2019s expectation when facing their most vulnerable moment. They rely on their health care providers to navigate this delicate conversation with grace and expertise.<\/p>\n

Enter Megan Lippe, PhD, MSN, RN, ANEF, FPCN, FAAN<\/a>, a palliative care educator who confronts the silence surrounding mortality head-on. As an associate professor at The University of Texas Health Science Center at San Antonio\u2019s School of Nursing, Lippe champions a bold teaching strategy: Learn to embrace the \u201cD\u201d word.<\/p>\n

\u201cHow can someone talk to their patient about death if they aren\u2019t even comfortable saying the word?\u201d asked\u00a0Lippe. \u201cThe principles of communication are important for this process. We have to balance the need to prepare patients and their families for the possibilities ahead while also understanding the power of silence and giving them space when they are facing these difficult situations.\u201d<\/p>\n

\"Photo
Megan Lippe, PhD, MSN, RN, ANEF, FPCN, FAAN, associate professor, School of Nursing<\/figcaption><\/figure>\n

Lippe\u2019s job \u2014 and her passion \u2014 is to ensure each new graduate leaves their program as a competent member of the health care team. That means they enter professional practice well-versed in addressing not only the physical symptoms of someone enduring a serious illness or injury, but also the psychosocial, emotional and spiritual needs of the patient and their family.<\/p>\n

Need to know<\/strong><\/span><\/h4>\n

In 2021, the American Association of Colleges of Nursing (AACN), an organization that establishes quality standards for nursing education, deemed palliative care an essential competency.<\/p>\n

\u201cThe association updated their curricular guidelines, and as part of that, hospice, palliative and supportive care was named as one of four critical spheres of undergraduate and graduate nursing education,\u201d Lippe said. \u201cIt went from nice to know to need to know.\u201d<\/p>\n

The Essentials: Core Competencies for Professional Nursing Education<\/em>, AACN\u2019s educational framework for baccalaureate and graduate nursing programs, provides specific guidance for the development or revision of a curriculum for each degreed program, including core competences each new graduate must exhibit.<\/p>\n

While AACN deemed palliative care a basic human right and beneficial at any stage of a serious condition, Lippe said \u201cnurses cannot practice what they do not know.\u201d The End-of-Life Nursing Education Consortium, in partnership with AACN, updated its document of palliative care competency statements for undergraduate and graduate students. These statements are known by nurse educators and students as Competencies And Recommendations for Educating Nursing Students<\/em>, or CARES and G-CARES (for graduate education), respectively, and are guidelines essential for enhancing care quality, supporting nurses\u2019 professional growth and ensuring culturally competent care.<\/p>\n

\u201cPalliative care did not change with these updates,\u201d noted Lippe. Rather, the language around competency was updated to better align with the new curricular standards to make them more meaningful for schools of nursing.<\/p>\n

\u201cWe are now really speaking to the role of the nurse when patients are seriously ill or actively dying.\u201d<\/p>\n

One such statement now reads: \u201cProvide culturally sensitive care that is responsive to rapidly changing physical, psychological, social and spiritual needs during the dying process and after death.\u201d Students can now be assessed based on how well they adjust to changing needs during the imminent death period.<\/p>\n

As one real-world example, Lippe recounts a story she often shares with students about taking care of a patient from Mexico.<\/p>\n

\u201cThe chart documented his religion as Catholic, but [he was] Jewish. Someone made an assumption instead of asking about his spiritual or religious beliefs,\u201d said Lippe. \u201cThese details inform how we care and interact with our patients and their families. We can unintentionally do harm by making assumptions. Every person is unique, and we must be proactive in respecting each of their values, beliefs and preferences.\u201d<\/p>\n

Simulating reality<\/strong><\/span><\/h4>\n

Adding to her belief that nurses cannot practice what they do not know, Lippe said nurses cannot know unless they practice, and that they should practice in a safe and controlled environment.<\/p>\n

Simulated experiences are a valuable component of nursing education, and Lippe has created several simulations inspired by real-life scenarios she experienced. One simulation walks students through several interactions with a family of a seriously ill patient that leads to the withdrawal of life-sustaining measures.<\/p>\n

\u201cI designed the first part to begin with the family not fully understanding what\u2019s going on with their family member,\u201d Lippe said.<\/p>\n

\u201cHow long will he need the tracheostomy? We are going to Paris in one month. Will it be out by then?\u201d asks an actor portraying the patient\u2019s wife during the simulation. The students are tasked to interact with the family, providing information and comfort while their instructor observes.<\/p>\n

The exercise then requires students to assess the patient and communicate with the physician. Students might use the popular SBAR (situation-background-assessment-recommendation) communication framework to identify the problem and, based on pertinent information about the patient and the patient\u2019s condition, consider options and recommend actions.<\/p>\n

\"Heidi
Practice what you teach.<\/strong> The School of Nursing\u2019s Center for Simulation Innovation \u2014 a 7,300-square-foot simulation hospital and 6,500-square-foot skills laboratory \u2014 earned accreditation<\/a> in 2024 by the Society for Simulation in Healthcare. Each spring, the accelerated-track Bachelor of Science in Nursing students complete the palliative care simulation within the center. The simulation is run four times over the course of one month. In this photo, Associate Professor\/Clinical Heidi Worabo, DNP, APRN, FNP-BC, closely observes as her students also use the simulation lab to practice essential clinical skills, such as using a stethoscope.<\/figcaption><\/figure>\n

The final phase of the simulation is Lippe\u2019s favorite.<\/p>\n

\u201cAfter the family meets with the physician, the students further explore treatment options with them. The wife of the patient decides to withdraw life-sustaining measures, specifically the ventilator and medications to sustain blood pressure,\u201d Lippe said.<\/p>\n

\u201cI love that part, to see how their jaws drop because they expect the wife to be in denial or fight for her husband\u2019s life, so they\u2019re like, \u2018Huh?\u2019 This situation teaches them to be prepared for families to surprise them and to quickly adapt to support their decisions, wherever the patient and family are in their journey with a serious illness,\u201d said Lippe.<\/p>\n

A debriefing session follows each part of a simulation to discuss the communication, care and strategies used, as well as how students felt about the experience.<\/p>\n

\u201cI like the idea of putting students in a simulation scenario first. It\u2019s a safe space for them to practice and develop their care and communication strategies and receive feedback,\u201d Lippe said.<\/p>\n

\u201cWhen we think about patients who are actively dying, it is a sacred space. We want students to be as prepared as possible to provide holistic, quality care to patients and families when they enter these sacred spaces.\u201d<\/p>\n

CARES competency<\/strong><\/span><\/h4>\n

Achieving competency is at the heart of the knowing and practicing cycles. Nursing educators across the nation are working to enhance their curricula to teach palliative care content and assess competency, said Lippe. To support them in this endeavor, Lippe leads a national team of nursing faculty and palliative care nursing experts who are developing helpful resources through the End-of-Life Nursing Education Consortium.<\/p>\n

\u201cCARES and G-CARES are very broad but intended to be really helpful for curricular guidance,\u201d Lippe said. \u201cWe also needed a competence assessment regarding specific observable behaviors of students \u2014 some way to verify that students can actually do those behaviors by graduation and demonstrate an ability to provide palliative care.\u201d<\/p>\n

Putting their collective experiences together, the team produced a primary palliative care nurse competence model and assessment tool<\/a>, a student assessment tool that connects clinical behaviors to the CARES competency statements. It also works in conjunction with other supporting documents the team created to map each CARES statement to curricular guidelines in AACN\u2019s Essentials <\/em>framework.<\/p>\n

\u201cTo go back to our [simulation] example, the role of a nurse is to adjust care to a patient\u2019s rapidly changing needs physically, psychologically, socially and spiritually when a patient is dying,\u201d Lippe said. \u201cIs a student able to adjust through the care process based on a patient\u2019s condition or not? If a student is in a simulation or at the bedside, I can actually watch them do this and evaluate it.\u201d<\/p>\n

Rethinking palliative care<\/strong><\/span><\/h4>\n

For Andrya R. Rivera-Burciaga, DNP, APRN, FNP-BC, ACHPN, a student in the School of Nursing\u2019s PhD in Nursing Science program, having a faculty member on staff who is an expert in this area and who is creating tools on behalf of the profession is beneficial.<\/p>\n

\u201cAs an advanced practice nurse, I feel there is still a perception in the profession that palliative care isn\u2019t as important as other spheres of care, but the updates to nursing education and tools such as these will bring an awareness that palliative care is valuable,\u201d she said.<\/p>\n

Lippe believes it is important for educators to see that their students are already at the bedside of so many patients who would benefit from palliative care.<\/p>\n

\u201cAs educators, we need to re-envision and expand the who, what, where, when, why and how of palliative care education to ensure we prepare future nurses and health care professionals who will care for these patients and their families,\u201d Lippe said.<\/p>\n

\u201cIn taking a step back to realize where nurses are taking care of patients with serious illnesses, we find it is everywhere. Palliative care is needed throughout our community because that\u2019s where our patients who have a serious illness live,\u201d said Lippe.<\/p>\n

\u201cOur goal is to empower the workforce to improve the quality of life of patients and families living with serious illness across the disease trajectory and at the end of life.\u201d<\/p>\n

 <\/p>\n

\n

The future of palliative care<\/strong><\/span><\/h2>\n

Because of her multifaceted expertise and dedication to advancing nursing education and palliative care, Megan Lippe, PhD, MSN, RN, ANEF, FPCN, FAAN<\/a>, has been awarded fellowship into three esteemed organizations: the American Academy of Nursing, National League for Nursing\u2019s Academy of Nursing Education and Palliative Care Nursing.<\/p>\n

\u201cDr. Lippe is an exceptional leader, and she is contributing much to the advancement of care for the seriously ill by preparing our nurses,\u201d said Betty Ferrell, PhD, FAAN, FPCN, CHPN, the principal investigator of the End-of-Life Nursing Education Consortium. \u201cHer years of work in creating curricula, innovative teaching strategies and evaluation methods has reached over 1,100 undergraduate and 375 graduate programs.\u201d<\/p>\n

ELNEC is a national program dedicated to improving palliative care by equipping nurses with training in skills such as pain management and communication.<\/p>\n

As a member and regional chair of the consortium, Lippe is working with other nursing faculty to shape the future of palliative care education. She is the lead author of the End-of-Life Nursing Education Consortium curricula, as well as the American Association of Colleges of Nursing-endorsed national palliative care competence statement revisions for both undergraduate and graduate education.<\/p>\n

Lippe\u2019s collaborative research efforts have likewise produced new quantitative measures to assess primary palliative care curricula and competence for advance practice and entry-to-practice nurses.<\/p>\n

 <\/p>\n

\n

Four spheres of care<\/strong><\/span><\/h2>\n
    \n
  • Wellness, disease prevention. <\/strong>Promotes health and prevents illness through education, lifestyle modification and early-detection strategies<\/li>\n
  • Chronic disease management. <\/strong>Manages long-term conditions to optimize quality of life and minimize disease progression through ongoing care and support<\/li>\n
  • Regenerative\/restorative care. <\/strong>Restores patient health and functional abilities following acute illness or injury through rehabilitation and recovery-focused interventions<\/li>\n
  • Hospice\/palliative care. <\/strong>Provides compassionate care to relieve symptoms and improve the quality of life for patients with serious, life-limiting illnesses, including end-of-life care<\/li>\n<\/ul>\n

    Source: The Essentials: Core Competencies for Professional Nursing Education<\/em>, American Association of Colleges of Nursing, 2021 (fig. 2, pg. 19).<\/p>\n

     <\/p>\n

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