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Spirituality is a critical component of patient and family care at the end of life, yet some health care providers do not feel prepared to deliver spiritual care. To prepare nursing and medical students taking care of dying patients and their families, the Catalyzing Relationships at the End of Life (CAREol) program includes addressing perceptions of one’s own death through journal reflection.
The CAREol program includes cognitive and experiential components and provides interdisciplinary education to nursing and medical students about facilitating final conversations to improve family relationships among patients and families at the end of life.
The reflective journaling exercise included structured prompts to encourage reflection on one’s own death, reactions, and communication themes presented in the CAREol program. The structured reflective journaling prompts included:
- What is most important to you (if you were dying)? Also, what would be most important to your family?
- What will be hardest for you to give up as the dying person as you near death? What about your family?
- What do you want your family to know about your (love, forgiveness, identity, faith, hopes and dreams, about how you want to die)? What do you think they would want you to know about?
A total of 156 nursing and medical students from two non-religious universities in Ohio completed reflections about their own death through online journaling. Journal entries were coded using a descriptive qualitative approach and four themes were revealed including: meaning, beliefs, connections, and good death:
- Meaning: How one makes sense of their illness or situation and finds purpose in one’s life.
- Beliefs: Personal understanding of the universe that may or may not include traditional religious dogma.
- Connections: Personal growth encompassing relationships with self, others, a higher power, and the environment that can lead to personal growth. Connections occur through intrapersonal (interaction with self through reflection), interpersonal (interactions with others), and transpersonal (interaction with a higher power) and involve questions, worries, or doubts about spirituality.
- Good death: Includes self-transcendence, which involves how one moves closer to God or a higher power, expectations of treatment by others, and an interpersonal experience of having faith in humankind to do what is right by an individual. Examples include honoring preferences for the dying process, emotional well-being, life closure, and quality of life.
The authors concluded that these themes relating to spirituality reflected an understanding of death and dying. Journal reflections about one’s own death increased student awareness of the spiritual nature of death, the importance of connections, and the need for relationships.
Source: Hansen, D. M., Stephenson, P., Lalani, N., & Shanholtzer, J. (2023). Reflective Journaling as Preparation for Spiritual Care of Patients. Journal of Hospice & Palliative Nursing, 25(1), 45-50.
