Death is a universal phenomenon. Of all health professionals, the nurse is the most likely one to be present at the time of death. Although nursing curricula provide mandatory clinical experiences in labor and delivery, pediatrics, psychiatry and adult medical surgical areas, there is no mandatory requirement for a clinical experience with death. In fact, before 1999, there was not even a requirement to teach about death and dying in undergraduate nursing curricula. As a result, students (who later become nurses), feel unprepared to take care of dying patients. Because death has meanings beyond just the cessation of vital signs, students develop attitudes about death that come from their culture, religion or previous experience. Discomfort with end-of-life (EOL) comes from these attitudes as well as feeling unprepared to care for the dying patient. In order to provide competent EOL care, students need factual knowledge but they also need the opportunity to explore and evaluate attitudes that may help or hinder their nursing practice. Transformational Learning Theory (TLT) provides a framework for teaching EOL care. TLT is an adult learning theory that focuses on attitudes as an important part of the learning process. By participating in learning environments that challenge attitudes as well as teach skills, students have the opportunity to identify, reflect on and discuss their attitude with others and hear others' perspectives. This process may change their attitude and ultimately modify their behavior the next time they encounter a similar situation. In order to provide competent EOL care, students need opportunities to explore their attitudes about death and dying.

Date of publication

Spring 4-2011

Document Type




Persistent identifier


Included in

Nursing Commons