A Higher Level of Care

When Penny Alt-Gehrman's father was in the hospital with terminal cancer, she made a point to not tell his caregivers that she was a nurse. Yet she found herself switching into “nurse mode” to help her family better understand what was happening and what to expect. This important information wasn't coming from her father's caregivers.

“I wanted to be the daughter, not the nurse,” says Alt-Gehrman, assistant professor and simulation coordinator in Alverno's JoAnn McGrath School of Nursing and Health Professions. “They took great care of my dad, but they didn't ask my sisters or me if we needed anything.”

Having worked in intensive care and emergency settings, Alt-Gehrman had contemplated how to best help families with end-of-life issues, always asking herself, “What would I want?”

Years of teaching had also shown her that too many nursing students were uncomfortable with a key aspect of clinical or simulation experiences with terminal patients: “Students would tell me they didn't know what to say to the family,” she says.

Embarking on her nursing doctorate at Marquette University in 2014, Alt-Gehrman had a dissertation idea in mind. She wanted to assess undergraduate nursing students' knowledge and confidence before and after a simulation with a terminal patient's quarreling family members.

She changed course upon discovering a gaping hole in the research literature: Despite plenty of information about how nurses felt and what families wanted, there was nothing on nursing students' perceptions about caring for families of dying patients.

In interviews, Alverno undergraduate nursing students shared that they felt comfortable taking care of terminal patients but felt unprepared for and apprehensive about family interactions. Encountering rude or aggressive relatives, dealing with disagreements among family members, and managing their own emotions in the face of a loved one's grief were all areas of concern.

The interviews also revealed students' desire to practice working with families before graduating from nursing school. Alt-Gehrman, who earned her PhD in December, is working to incorporate this kind of training into the Alverno curriculum. She says the school's sim lab is an ideal setting, where students can not only practice the technical aspects of patient care but also take part in scenarios that put the patient and caregiver relationship in a larger context.

Ultimately, nurses should learn how to be a compassionate and skilled resource for family members, which Alt-Gehrman and her sisters found missing in their father's care.

“No one wants to talk about death,” she says. “As nurses, however, we need to broach difficult subjects. What are the loved one's wishes? What about power of attorney? How will we care for them for the rest of their time in the hospital? We have to encourage these dialogues.”

This article appears in the spring/summer 2019 issue of Alverno Magazine.