Nurses' early experiences with patient death: the results of an on-line survey of Registered Nurses in New Zealand.

BACKGROUND: Death has been identified as a known stressor for nurses and has been extensively researched in nursing populations. However, very little is known about the impact of a specific stressful event; that of the novice nurse's first encounter with patient death. Using a sequential quantitative-qualitative mixed methods design, a study was undertaken to explore the clinical circumstances, impact and challenges and rewards of nurses' early experiences with patient death. This paper reports the findings of the first phase: an exploratory survey of nurses' responses to this stressor. METHOD: A convenience sample of New Zealand Registered Nurses was recruited using email invitations; 174 respondents completed an online questionnaire exploring the clinical circumstances, preparedness, support mechanisms and impact of their earliest memorable patient death. RESULTS: Most nurses reported that their earliest memory of patient death occurred during undergraduate training (61%) or in the first year of qualified practice (23%). Over 80% of these experiences occurred in acute medical, surgical or specialty settings in public hospitals, some involving paediatric or sudden unexpected deaths. Whilst some respondents described a rewarding, 'learning experience', others reported acute helplessness, guilt or marked on-going distress. CONCLUSIONS: Whilst little can be done to control the clinical circumstances of nurses' early death encounters, by understanding more about the reactions to death, it may be possible to minimise negative factors such as unexpected elements, feelings of inadequacy, exclusion and role conflicts whilst facilitating coping, sharing of the experience, personal and professional growth, and other positive outcomes. Nurses' early experiences with patient death appear to have a lasting impact on their professional and personal lives.