Death and dying patients : experiences and coping mechanisms of undergraduate diagnostic radiography students during workplace learning

Abstract

Death and dying is an often neglected area in the radiography theoretical and workplace learning curriculum. Yet, it is estimated that approximately 50% of all deaths are encountered in healthcare establishments. Literature highlights that the phenomenon of death and dying is experienced differently by different people. How healthcare professionals experience and cope with death and dying patient encounters in the workplace have been studied for more than a decade. However, no evidence could be found of a similar study done in the South African diagnostic radiography context. This and classroom interactions with my students spurred me to conduct a study in this area with a specific focus on undergraduate diagnostic radiography students. The aim of this study was to investigate the experiences and coping mechanisms, and the nature of this relationship, of undergraduate diagnostic radiography students pertaining to death and dying patients in the workplace, and to identify support strategies to assist students to cope better with death and dying patients. To achieve this aim, a qualitative, exploratory-descriptive, contextual research design was used. Sixteen undergraduate diagnostic radiography students (n=16) were purposively sampled at one higher education institution in South Africa. Reflective journaling and individual, face-to-face, semi-structured interviews using an adapted format of the Mmogo-technique™ were utilised as data gathering methods. The data was analysed using an inductive, thematic analysis. Five themes and 13 sub-themes were identified. Strategies were employed to ensure trustworthiness and ethical integrity during the research process. Theme one relates to the participants’ sense-making, meaning construction and elicited affective responses during their experiences with death and dying patient encounters. Participants appraised these experiences to make sense thereof. They also created meaning using the quest hero narrative metaphor. Their appraisal of the experience elicited an array of positive and negative affective responses. Theme two relays participant- and workplace-related factors that contributed to how the participants would appraise their experiences with death and dying patients during workplace learning (WPL). These factors were categorised as being inconsequential, mitigating or aggravating the negative connotations attached to such experiences. While theme three conveys the emotion-focused, problem-focused and appraisalfocused coping mechanisms that the participants used to cope with their experiences with death and dying patients during workplace learning. Theme four provides a description and discussion of the relationship that was identified between the participants’ experiences and coping. Theme five presents recommendations that the participants put forth that they believe will facilitate their effective coping with death and dying patient encounters during workplace learning. A literature control and the theoretical framework underpinning the study (i.e., the transactional model of Lazarus and Folkman) was used to locate the findings of this study in relation to the available and accessible body of knowledge. The findings, literature and theoretical framework underpinning the study were used to inform the development of support strategies to facilitate the effective coping of undergraduate diagnostic radiography students in relation to death and dying patient experiences they may encounter during workplace learning. The conceptual framework of Dickoff, James and Wiedenbach was used as a theoretical premise to develop the education and empowerment for coping (EEC) support strategies. The strategies comprise two main support strategies with five and four functional strategies, respectively. The first main strategy covers educational strategies that can be developed and implemented to facilitate undergraduate diagnostic radiography students’ understanding of death, dying, grief and effective coping as well as patient care and management. The second main strategy encompasses empowerment strategies that facilitate the development of a support culture for undergraduate diagnostic radiography students to facilitate their coping with death and dying patients. To enhance the credibility of these strategies, a review was conducted by a panel of five reviewers using evaluation criteria proposed by Chinn and Kramer. I reflected on six germane lessons I learnt during my doctoral journey. A summary of the findings in relation to each of the four objectives underpinning the study, the limitations of the study, recommendations for future research and implications for practice are provided in the final chapter of this thesis. In conclusion, novel findings were presented in this thesis. These findings provide the first insights, from a South African perspective, about undergraduate diagnostic radiography students’ experiences and coping with death and dying patients whilst they are in the clinical setting for WPL. Furthermore, the relationship between their experiences and identified coping, can potentially inform the creation of a diagnostic radiography specific theory in this regard. The proposed education and empowerment for coping (EEC) support strategies can form the basis for implementing changes at higher education institutions and clinical training sites to facilitate effective coping of undergraduate diagnostic radiography students in respect of death and dying patient incidents that they may face during WPL.