A. Wass nursing schools had no plans to offer or expand death education. Time constraints, no need, and limited faculty resources were the main expla nations given(Dickinson, Sumner, Frederick, 1992, Dickinson Mermann, 1996). Serious inadequacies in palliative care education in the United Kingdom have been reported as well. Surveys showed th average medical student received approximately 6 hours of death related instruction, and at best, 20 hours in a 5-year medical curriculum (Doyle, 1991 ). Surveying nursing and medical school faculties in Canada and the United Kingdom, Downe-Wambow Tamlyn(1997)reported results similar to those by Dickinson for the United States. Death educa- tion was included in most programs, mostly integrated into regular cur- ricular offerings or offered as an elective, and only a small minority required a full course. Nursing programs in both countries provided a broader range of topics and allocated a greater number of hours to class and clinical sessions than did programs in medicine which focused marily on pain control/hospice care and ethical/legal issues. In both countries. the theorist most often discussed in death education was Elizabeth Kubler-Ross. Death education content was taught primarily by faculty members of the respective disciplines, except for the United States medical programs in which half the teaching was provided by other disciplines, such as psychiatrists, social workers, and nurses (Dickinson et al., 1992) Content analysis of professional textbooks further indicated the se ous neglect of care for dying patients. An examination of 50 best-selling medical textbooks in multiple specialties in terms of content in 13 end- of-life domains, found that with few exceptions (e.g, family medicine, geriatrics), content in end-of-life care is minimal or absent(Rabow et al., 2000). Nursing textbooks have been found similarly deficient Examination of 50 major textbooks used in nursing schools on 9 essen- tial content areas in end-of-life care showed. overall. less than 2% of he content was devoted to end-of-life care(Ferrel, Virani,& Grant, 1999) Paramedics are among other professionals that routinely work in death-related situations and are often first-line respondents to families in distress and grief. The literature is scant on death education for this group. In a national survey of paramedic programs, Smith and walz (1995) reported that nearly all programs offered some death education that is integrated into their curricula and only a small fraction offered a separate course. The didactic method of instruction was most frequently
nursing schools had no plans to offer or expand death education. Time constraints, no need, and limited faculty resources were the main explanations given (Dickinson, Sumner, & Frederick, 1992; Dickinson & Mermann, 1996). Serious inadequacies in palliative care education in the United Kingdom have been reported as well. Surveys showed the average medical student received approximately 6 hours of deathrelated instruction, and at best, 20 hours in a 5-year medical curriculum (Doyle,1991). Surveying nursing and medical school faculties in Canada and the United Kingdom, Downe-Wambow & Tamlyn (1997) reported results similar to those by Dickinson for the United States. Death education was included in most programs, mostly integrated into regular curricular offerings or offered as an elective, and only a small minority required a full course. Nursing programs in both countries provided a broader range of topics and allocated a greater number of hours to class and clinical sessions than did programs in medicine which focused primarily on pain control/hospice care and ethical/legal issues. In both countries, the theorist most often discussed in death education was Elizabeth Kˇbler-Ross. Death education content was taught primarily by faculty members of the respective disciplines, except for the United States medical programs in which half the teaching was provided by other disciplines, such as psychiatrists, social workers, and nurses (Dickinson et al., 1992). Content analysis of professional textbooks further indicated the serious neglect of care for dying patients. An examination of 50 best-selling medical textbooks in multiple specialties in terms of content in 13 endof-life domains, found that with few exceptions (e.g., family medicine, geriatrics), content in end-of-life care is minimal or absent (Rabow et al., 2000). Nursing textbooks have been found similarly deficient. Examination of 50 major textbooks used in nursing schools on 9 essential content areas in end-of-life care showed, overall, less than 2% of the content was devoted to end-of-life care (Ferrel, Virani, & Grant, 1999). Paramedics are among other professionals that routinely work in death-related situations and are often first-line respondents to families in distress and grief. The literature is scant on death education for this group. In a national survey of paramedic programs, Smith and Walz (1995) reported that nearly all programs offered some death education that is integrated into their curricula and only a small fraction offered a separate course.The didactic method of instruction was most frequently 294 H. Wass
Perspective on Death Education used. Most textbooks practically ignore death and only a minority of respondents use supplemental material so that paramedic graduates may have read less than one page of death-related text. What death edu- cation is available is inadequate. It offers little opportunity for partici- pants to become knowledgeable about death and grief, to deal with their own feelings, or to develop empathy New Developments in End-of-Life Care education Since 1995, medical and associations have made recommen- dations for and developed end-of-life education programs. These programs have been designed to assist physician and nurse educators in self-directed study, to conduct continuing education programs, and to integrate end-of-life information into their basic curricula. For example the American Academy of Hospice and Palliative Medicine in 1996 developed Unipacs, a training program in hospice and palliative care for physicians, consisting of eight modules, with content including assessment and treatment of pain and other symptoms, alleviating psy chological and spiritual pain, ethical and legal decision making, com munication skills, hospice/palliative approach to caring for patients withHivaiDsandforpediatricpatients(www.aahpm.org/) In 1998 the American Medical Association developed the progran EducationforPhysiciansonEnd-of-lifeCare"(epec)(www.epec net/), consisting of 20 modules. In addition, programs were developed to fit into particular programs. For example, the American Academy of mily Physicians prepared guidelines for a curriculum for family prac- tice residents on end-of-life care. This organization added physicians personal attitudes toward death as a component of the program. Similar programs have been developed for nurses. The American Association of Colleges of Nursing recommended competencies and curricular guidelines for end-of-life nursing and in 2000, based on these guidelines, designed the"End of Life Nursing Education Curriculum"(ELNEC (www.aacn.nche.edu/elnec/curriculum.htm Death education for grief Counselors Most counseling models for bereaved people were derived from tradi- tional psychotherapeutic interventions and focused almost exclusively
used. Most textbooks practically ignore death and only a minority of respondents use supplemental material so that paramedic graduates may have read less than one page of death-related text.What death education is available is inadequate. It offers little opportunity for participants to become knowledgeable about death and grief, to deal with their own feelings, or to develop empathy. New Developments in End-of-Life Care Education Since 1995, medical and nursing associations have made recommendations for and developed end-of-life education programs. These programs have been designed to assist physician and nurse educators in self-directed study, to conduct continuing education programs, and to integrate end-of-life information into their basic curricula. For example, the American Academy of Hospice and Palliative Medicine in 1996 developed Unipacs, a training program in hospice and palliative care for physicians, consisting of eight modules, with content including assessment and treatment of pain and other symptoms, alleviating psychological and spiritual pain, ethical and legal decision making, communication skills, hospice/palliative approach to caring for patients with HIV/AIDS and for pediatric patients (www.aahpm.org/). In 1998 the American Medical Association developed the program ‘‘Education for Physicians on End-of-Life Care’’ (EPEC) (www.epec. net/), consisting of 20 modules. In addition, programs were developed to fit into particular programs. For example, the American Academy of Family Physicians prepared guidelines for a curriculum for family practice residents on end-of-life care. This organization added physicians’ personal attitudes toward death as a component of the program. Similar programs have been developed for nurses. The American Association of Colleges of Nursing recommended competencies and curricular guidelines for end-of-life nursing and in 2000, based on these guidelines, designed the ‘‘End of Life Nursing Education Curriculum’’ (ELNEC) (www.aacn.nche.edu/elnec/curriculum.htm). Death Education for Grief Counselors Most counseling models for bereaved people were derived from traditional psychotherapeutic interventions and focused almost exclusively Perspective on Death Education 295