For immediate release: Aug. 29, 2007

GALVESTON, Texas - Nursing students spend most of their time learning how to help people get well. They learn the ABCs of nursing but somewhere along the way the curriculum typically doesn't get around to D. D, after all, is what health care workers work to avoid. They want their patients to get healthy but death sometimes is inevitable, even in pediatric units.

Because the death of infants and young children is rare - in 2004 in Galveston County 25 children, from birth to 24 months, died - nursing students get virtually no exposure to pediatric death. This is one reason Julie Lindsay, a clinical instructor in the School of Nursing at the University of Texas Medical Branch at Galveston, developed the "Pediatric Critical Care - End-of-Life Lecture." The lecture incorporates a realistic simulation that exposes students to the heart-breaking impact of a child's death. For many of the students who have attended the lecture, it's their first personal encounter with the prospect that children in hospitals don't always get well.

"I'm doing a manuscript now for a journal and when I started planning this (lecture) I just remembered my first death as a new nurse when I was 20 and I said, ‘Nobody told me I was going to have all these different feelings,' " Lindsay said.

Lindsay introduced the simulation during the spring semester to 46 students. An additional 16 students attended the lecture during the summer session. Now she's preparing to deliver the lecture this fall.

Her lecture on pediatric death involved role-playing by students who staged a scene during which last ditch efforts to save an infant fail. It didn't matter to the students that the "infant" was a manikin or that everyone, from the students posing as the infant's family to the students observing the scene unfold, knew everything was made up.

"I didn't expect it to be what it was," said nursing student Jessica Bateman. "Even when we were practicing and simulating it I was bawling like I couldn't stop. It really hit me in a way that I didn't expect it to hit me."

Another student, Lindsey Waldrep, also was emotionally moved by the lecture. "I didn't get to actually take part in it, but I watched. It still had an effect," Waldrep said. "You wouldn't believe how many people (in the audience) were just crying. You're just sitting in your seat and you're like ‘I want to cry. Is everyone else crying?' I'm like, I can't believe I'm crying about a manikin."

A recording of the half-hour lecture/simulation showed Lindsay talking to students about the equipment and procedures that they would observe, followed by the simulation. The medical team, portrayed by Priscilla Brooks, Lisa Lawrence, Ogechukwu Okereke, Roxanna Sanchez, Jade Truong and Larissa Ferguson, worked feverishly to keep the infant alive. The intense silence was interrupted only by the subdued whirring and beeping of equipment. Every few minutes Janis Goulder, portraying a physician, visited with the students posing as family members - Jozef Gajdusek, Mkunde Makundi and Brianna Flach - to give them increasingly grim updates on the baby's condition. After the child died, the medical equipment is turned off and an uncomfortable silence filled the room. To finish the simulation, the parents held their child and were asked about donating the infant's organs.

Participants in the simulation rehearsed their roles but didn't work from a script.

"We practiced," Lindsay said. "We met a couple of times to practice. This is all stuff that they did extra. I didn't give them a script but I gave them basic ideas. It's like in that situation you shoot more from your heart. I said, ‘If you're all reading a script you're not going to be concentrating.'"

The emotional tension of the simulation eventually resulted in a barrage of questions from the students. "It was awesome," Lindsay said. "They asked ‘what was it like being a pediatric nurse having to take care of a child who died and having to go home and being with your own kids.' They wanted to know if they could go to the funeral."

Perhaps the most significant lesson that came from the lecture had nothing to do with the medical aspects of nursing.

"They said, ‘how do you know what to say?' I said, ‘Well, sometimes you don't say anything. You just hold their hand and if you have tears in your eyes, that's OK.' "
The University of Texas Medical Branch at Galveston
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Galveston, Texas 77555-0144
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