[Recognizing and defining dying. Analysis of end-of-life coverage in German nursing textbooks]

Abstract

Text books play an important role in basic education in nursing. This study aimed at capturing the extent and content of end-of-life issues in nursing text books in German language. For that reason, a quantitative and a qualitative analysis of relevant content in a comprehensive sample of nursing text books available (n = 65) were conducted. Whereas 29.2 % of the books do not cover the issue at all, 44.5 % dedicate a separate chapter to the issue of dying, which accounts for 1.34 % of all pages on average. Of all specialties, both surgery and internal medicine feature the lowest, and paediatrics and oncology the highest share of coverage. 41.53 % of all text books studied contain a definition of the term dying which is based on a great variety of approaches. 23 books list criteria that define the recognition of dying, 21 of which draw attention to symptoms of impending death. 84 % of the books refer to the work of Elisabeth Kübler-Ross. Overall, the amount of coverage of the issue of dying in nursing text books can be considered marginal by international comparison. What is problematic is the conceptual reduction to physiological signs of impending death and the lack of references to existing theoretical work. Integration of knowledge from the area of palliative care in all specialties is strongly needed. Additionally, there is a need for a stronger conceptual debate in order to avoid problems in communication about death and dying in nursing education and practice.