Student Dietitians’ Experiences of Patient Death Whilst on Placement.

Background: Evidence suggests that health care students experience a degree of trauma after experiencing a patient death [1] and they keep their feelings and concerns about patient death to themselves [2]. Rivers, Perkins and Carson [3] suggest that students may be inadequately prepared to deal with patient death during their placements. The aim of this study was to explore dietetic students’ experiences of patients dying whilst on placement. Methods: A qualitative phenomenological approach was used to explore the experiences of 4th year undergraduate student dietitians. Recruitment was opportunistic and data was collected using semi-structured interviews with topic guide and field notes to capture nonverbal communication. Ethical approval was given by Coventry University’s ethics committee and written consent was obtained from all participants. Interviews were audiotaped and transcribed verbatim using thematic analysis as guided by Braun and Clarke [4]. Peer review of findings was undertaken with the second author. Findings: Three female students were interviewed. The main themes identified were: the reaction to patient death, support, personal experience and personal beliefs. The reaction to patient death included feeling shock and upset, as the patient death was unexpected. Participants reported feeling unprepared for their patient’s death. ‘…he was palliative …I didn't really think… he is going to pass away… that was a really difficult one …’ P3. Support was obtained from debriefing to friends or educators or by formal reflection on their experience, which was aided by presenting the patient as a case study. ‘…writing the case study…helped…it’s kind of like you’re thinking about all your actions...almost reflecting on what I’d done… it’s nice to be reassured that I did everything that I should have done.’ P3. However, the students found it difficult to open up to their educators without being prompted to do so. Patient confidentiality was identified as a barrier to debriefing to friends. Reflection was found to be helpful for participants who found it difficult to approach their educators. Participants felt that preparation could only be achieved through personal experience rather than class room discussion. ‘I don’t think the university can prepare you, it’s more about life experience … it’s something you can’t learn in a class room ...’ P1. Personal beliefs helped some participants cope with the experience. Discussion: Students reported being unprepared for death, which was partly due to a lack of experience and because they felt the death was unexpected. Students anticipated patient’s death by the way the patient looked and acted, rather than using the clinical information which indicated the patients ill health; this was a strong contributing factor to the feeling of shock. Student preference for learning about death was through experience is in line with Rivers, Perkins and Carson [3]. The shock of patient death might be reduced by honest discussion by the educators of how ill patients are. The research is limited by a small sample size due to a low response rate; therefore data saturation is unlikely to have been obtained. Conclusion: Students may require support from clinical educators when faced with a patient death but may find this support difficult to access. Clinical educators have a role in supporting students through debriefing, but students may find it difficult to show their feelings. Inviting the student to talk through their experience and offering reassurance may be helpful.

Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition.

The study was a controlled, comparative clinical effectiveness trial of two supplementary feeding regimens in children at risk of malnutrition from seven centres in rural Malawi. Being at risk of malnutrition was defined as weight-for-height <85%, but >80% of the international standard. A stepped-wedge design with systematic allocation was used for assigning children to receive either ready-to-use therapeutic food (RUTF) (n=331) or micronutrient-fortified corn/soy-blend (n=41) for up to eight weeks. The primary outcomes were recovery, defined as weight-for-height >90%, and the rate of weight gain. Children receiving RUTF were more likely to recover (58% vs 22%; difference 36%; 95% confidence interval [CI] 20-52) and had greater rates of weight gain (3.1 g/kg.d vs 1.4 g/kg x d; difference 1.7; 95% CI 0.8-2.6) than children receiving corn/soy-blend. The results of this preliminary work suggest that supplementary feeding with RUTF promotes better growth in children at risk of malnutrition than the standard fortified cereal/legume-blended food.

En busca de apoyo para programas de salud para el anciano

Este trabajo resume algunas de las actividades realizadas por los sectores publico y privado de los Estados Unidos para promover la implementacion del plan internacional de acción sobre el envejecimiento. Ademas se detallan actividades que han sido planteadas y/o realizadas por entidades gubernamentales como el congreso y privadas como la asociation americana de jubilados, dentro del marco de los lineamentos de la asamblea mundial sobre el envejecimiento