Nursing Students' Experiences Caring for Dying

Patients

Since the 1960s nurse educators have been searching for the most effective approach to
prepare nursing students for care of the dying. Studies investigating the effectiveness of
death education programs for nursing students have reported inconsistent findings. A
phenomenological study was conducted to explore the meaning of 26
undergraduate nursing students' experiences in caring for dying patients.
The nursing students' written descriptions of their experiences were analyzed using
Colaizzi's (1978) phenomenological method. Six themes emerged from this analysis. While
caring for dying patients, nursing students experienced a gamut of emotions such as fear,
sadness, frustration, and anxiety. Contemplation of the patient's life and death occurred as
the students cared for their patients. In addition to providing physical, emotional, and
spiritual support for dying patients, an integral part of nursing students' care involved
supporting the patients' families. Helplessness was experienced by the students regarding
their role as patient advocates. While caring for dying patients, nursing students' learning
flourished. Educational strategies for preparingnursing students to care for the dying are
addressed based on the findings of this qualitative study.

Nurse educators have been searching for the most effective approach to
prepare nursing students for care of the dying since the 1960s (Drummond & Blumberg,
1962; Wagner, 1964). Death education interventions have focused on
decreasing nursing students' death anxiety and increasing their positive attitudes toward
care of the dying. Results of studies have varied depending on, for example, whether
didactic, experiential, or both approaches were used or whether or not students had
previous experiences with the dying.

Using a quasiexperimental design, Degner and Gow (1988) evaluated the effectiveness of
two different approaches on nursingstudents' death anxiety and attitudes toward caring for
the dying. One approach involved an eight-credit-hour course on care of the dying, while the
second included an integrated approach to death education throughout the undergraduate
program. A non-nursingstudent control group was also included. Death anxiety was
measured using the Collett-Lester Scale (Collett & Lester, 1969). This Likert scale consists of
36 items capturing four aspects of death anxiety: fear of death itself, fear of death of others,
fear of dying of oneself, and fear of dying of other people. The Winget Questionnaire, a
50item Likert scale, measured nursing students' attitudes toward care of the dying (Ward &
Lindeman, 1978). Data were collected before students entered their junior year, at the end
of their junior year, and 1 year after graduation. At both posttest times, the death anxiety of
the two groups of nursing students was not significantly different. The nursing students who
had taken the specific death and dying course, however, did have significantly better
attitudes toward caring for the dying.

Lockard (1989) reported significant short- and longterm reductions in death anxiety levels
of nursing students who attended a 7-hour death education instructional unit, compared to
those students in a control group unit. The Death Anxiety Scale (Templar, 1970), consisting
of 15 true- false statements, was used for data collection at three separate occasions:
immediately at the end of the instructional unit, 4 weeks after, and again at 1 year after.
Seventy-four students completed the study through the 4 weeks after the posttest, and 50
students completed the 1year follow up.

Using the State Form of the State-Trait Anxiety Inventory (Spielberger, Gorsuch, & Lushene,
1970), Johansson and Lally (1990) studied the effectiveness of a death education program in
decreasing death anxiety experienced by 22 junior and 32 senior
baccalaureatenursing students. An experimental pretest-posttest design was used.
Senior nursing students' death anxiety scores decreased significantly following the death
education program. Junior nursing students, however, after attending the death education
program, had a significantly higher mean death anxiety score.

The effect of death education and experience on nursing students' attitudes toward death
was investigated by Hurtig and Stewin (1990). One hundred six diploma nursing students
were randomly assigned to one of three groups: experiential, didactic, and control. In the
didactic group, lectures, films, and group discussions were used to present information on
death and dying. A personal focus was taken in the experiential group. Death awareness
exercises, music, art, and dyadic encounters between students were employed. The
Confrontation Integration of Death Scale (Klug, 1976) measured nursing students' death
confrontation and death integration. Data analysis revealed that the death attitudes of
inexperienced students who were in the experiential group were more positive than
similarnursing students who were in the didactic and control groups. Experienced students,
however, were affected negatively by the experiential approach.

Four hundred twenty-four nursing students completed the Attitude Questionnaire and the
Experience Questionnaire in a study concerned with the contribution of different death-
related experiences to nursing students' attitudes toward caring for dying patients (Brent,
Speece, Gates, Mood, & Kaul, 1991). All the nursing students had some personal,
professional, and educational death-related experiences. The Attitude Questionnaire was a
Likert-type scale consisting of 22 items classified as either attractive or aversive aspects of
caring for dying patients. The Experience Questionnaire examined four types of deathrelated
experiences: personal, professional, educational, and general life experiences. The findings
indicated that while nursing students felt strong aversion to some aspects of caring for dying
patients, they also found many aspects attractive. For instance, nursing students often felt
uncomfortable and at a loss discussing dying with their terminally ill patients and their
families. On the other hand, nursing students strongly agreed that they learned much from
dying patients that they did not learn from other patients. Nursing students reported that
caring for dying patients was professionally challenging and resulted in feelings of
professional competence and personal satisfaction. Findings also indicated
that nursing students' aversiveness to some aspects decreased, the attractiveness of some
aspects increased, and their overall attitude became more positive as the number, degree,
and specificity of students' death-related experiences increased.

Brent, Speece, Gates, and Kaul (1993) also investigated the contributions of death-related
experiences to attitudes toward dying patients of 104 nursing students with no previous
experience in caring for dying patients. A selfadministered questionnaire containing a
demographic section, an experience section, and an attitudes section was completed by
the nursing students. Results indicated that the number of hours of death and dying
coursework, age, and general life experience exerted a significant influence on attitudes
toward talking to dying patients about death and dying, but not on touching dying patients
to provide care, nor on feelings of personal competence.

In the studies that were reviewed, only quantitative instruments were used to
assess nursing students' attitudes and anxiety related to death and dying and to measure
the effectiveness of the educational strategies. Perhaps a step backwards needs to be taken
before death education courses are implemented and evaluated so that these courses are
designed based on nursing students' own experiences caring for dying patients. If
educational strategies are targeted for specific issues identified by nursing students,
perhaps more consistent findings will be reported, and nursing students will be better
prepared for death and dying. The purpose of this qualitative study was to describe the
meaning of nursing students' experiences caring for dying patients.

METHODOLOGY

Research Design

Phenomenology was the qualitative research design chosen to provide an understanding of

the essential structure of nursingstudents' experiences providing care to dying patients.
Phenomenology is an inductive, descriptive research method that studies essences
(MerleauPonty, 1962). Phenomenology asks what is the nature or meaning of something. It
is the study of lived experience as it is experienced prereflectively rather than as it is
conceptualized, categorized, or reflected on (Husserl, 1970).

To study the essence of a lived experience, the researcher engages in bracketing, which is
the act of suspending one's presuppositions about the phenomenon under study (Merleau-
Ponty, 1956). Through bracketing, the researcher's layers of interpretation and
presuppositions are peeled away so that the phenomenon under study can be seen as it is
and not as it is reflected through preconceptions.

Sample

Participants in this study were enrolled in a northeastern university in the United States. This
medium-size state university enrolls approximately 15,000 students. In the College
of Nursing, there are about 425 students enrolled in the undergraduate program, of which 54
are freshmen, 195 are sophomores, 98 are juniors, and 78 are seniors. The College
of Nursing also has master's and doctoral programs. During an
undergraduate nursing research course, time was allotted for the nursing students to
respond in writing to the following statement:

Please describe an experience you have had providing nursing care to a dying patient. Share
all your thoughts, perceptions, and feelings you can remember until you have no more to
write about the experience.

Forty-nine sophomore- and junior-level undergraduate nursing students were enrolled in this
research course. Because of this mix ofnursing students, not all of the students at that time
had cared for a dying patient. An elective on death and dying is offered in the College
of Nursing, but the students had not taken this course yet. Twenty-six of the 49 students
described experiences they had caring for a dying patient. Their participation was strictly
voluntary and anonymous. Before participation in the study, informed consent was obtained
from the 26 nursing students. The students were given as much time as they needed to
write their descriptions. However, no more than 30 minutes was needed to complete the
assignment. The average length of their descriptions was two handwritten pages.

Since participation was anonymous, no identifying information was asked of these 26

students, such as their age or gender. To provide some general background, a description of
the 49 students in the research class as a whole is given. The age range was 18 to 55 years.
There were 8 males and 41 females. Seven students were married, and 42 were single.

Data Analysis

Colaizzi's (1978) phenomenological methodology was used to analyze the nursing students'
written descriptions of their experiences caring for dying patients. First, each of the 26
written descriptions were read and reread to become familiar with the data. Next, significant
statements that directly pertained to nursing students' experiences caring for dying patients
were extracted from the participants' written protocols. For each significant statement,
meanings were formulated. These formulated meanings were then organized into clusters of
themes. Next, the researcher integrated these theme clusters into an exhaustive description
of the phenomenon under study. The researcher then returned to the nursing students with
this exhaustive description for validation.

Qualitative Rigor

To establish the trustworthiness of the findings of this qualitative study, Lincoln and Guba's
(1985) factors of credibility, auditability, and fittingness were addressed. Credibility refers to
the confidence one can have in the truth of the findings. Peer debriefings and member
checks were used to establish the credibility of this study. Peer debriefing was accomplished
by sharing the data and analysis with a research assistant experienced in phenomenological
research. Member checks were achieved by having the nursing students who had
participated in the study review and validate the data analysis. Bracketing of the
researcher's preconceptions and presuppositions regarding the phenomenon under study
was performed prior to data collection and analysis to further ensure credibility.

Auditability is the ability of another investigator to follow the decision or audit trail. The
decision trail consists of all the decisions made by a researcher at each step of the data
analysis. In this study, the research assistant followed the decision trail the researcher used
for data analysis. Intersubjective agreement between the researcher and the research
assistant was achieved at each step of Colaizzi's (1978) phenomenological analysis.
According to Lincoln and Guba (1985), fittingness measures how well the results fit into a
context other than the one from which they were generated. The typicality of
the nursing students who participated in the study was established. Elite bias did not occur
in this sample. Also, the data were not made to appear more similar or congruent than they
really were.

RESULTS

One hundred five significant statements regarding nursing students' experiences caring for
dying patients were extracted from the 26 written protocols. Table 1 lists examples of these
significant statements. Once formulated meanings were derived from the significant
statements, six clusters of themes were identified. Examples of two of them along with their
subsumed formulated meanings are presented in Table 2.

Theme 1: Nursing Students Experienced A Gamut Of Emotions While Caring For Dying
Patients

Initially, nursing students were afraid to provide nursing care to their dying patients. As one
student said, "He couldn't speak and laid in bed motionless. At first I was afraid of him. It is
scary to be in a room with someone dying." As the clinical day progressed, nursingstudents
became more comfortable caring for their terminally ill patients. As nursing students
watched their patients' physical conditions worsen, sadness enveloped the students.
Students remarked how difficult it was to watch their patients become weaker and weaker.
One nursing student expressed, "It scared me when I thought about the whole experience
because it was like I saw the life drain out of her. It was very sad to walk in the hospital and
see her bed empty."

Some nursing students shared that they felt like withdrawing themselves from the situation
because it was so emotionally difficult. The following quote illustrates this: "I began to
emotionally distance myself from the family and their needs. I pretended I could not feel
their sorrow; however, every time I saw my patient I cried inside."

Because of their inexperience in caring for dying patients, nursing students became anxious,
frustrated, and angry at themselves. A passage from a nursing student's written description
illustrates these emotions:

He drifted in and out of alertness and fsicTwas very difficult to understand him. I was scared
to hurt him and had no idea what to say to him. I would get so upset with myself when he
would try to communicate with me and, for the life of me, had no idea what he wanted. I
hated myself for that. I was in a state of anxiety the whole time.

At many times during the clinical day, the nursing students became anxious because they
were unsure of what they should do in regard to their dying patients. In their minds, they
kept questioning what they should do. For example, one student had a dilemma of whether
or not to disturb her dying patient to take vital signs.

There was no position that made her comfortable. When it came to taking her vital signs, I
almost didn't want to. How could I ask her to move so I could listen to her lung sounds. It all
seemed so insignificant at the time.

For other students, their dilemma centered on whether to leave their patients alone or to
encourage them to fight. As one nursingstudent expressed:

My heart went out to this old lady She had already lost 16Ve pounds and everything was a
struggle for her. She couldn't even talk. She had lost the will to live. She was not motivated
to do anything and told me that she would rather be in pain than take her medicine. I wasn't
sure if she should be left alone or encouraged to fight.

Nursing students also expressed that they became frustrated and angry at themselves
because they often lacked the right words. As one student shared, "the pain he was feeling
wasn't anything that could be managed by an analgesic. He needed the right words. I'm still
trying to figure out just what they are." Because of their inexperience in caring for dying
patients, students did not feel comfortable discussing death and dying with their patients or
their families. One student said:
I found it very hard to communicate. We would talk a lot about 'other' things. I felt that by
diverging, we were running away from reality. I was helping him in a way that was only
hurting him more.

Anger was directed not only at themselves because of their inexperience, but also at
the nursing and medical staff. Nursing students at times felt angry at the nurses and
physicians for not doing more for their dying patients. Anger surfaced as nursing students
questioned why their patients had to be in so much pain. Why weren't the physicians
increasing the pain medication to make their patients' last days as comfortable as possible?
One nursing student expressed another reason for becoming angry:

At times I felt angry, and other times I just wanted to sit and cry with her. I was angry
because she was so young and the doctors were being so vague with her about her
condition.

Anger was also vented toward the nursing staff. The following quote provides an example of
this: "The nurses treated her as if she were already dead, for example, not ensuring her
privacy."

Another said:

I became so angry. The nursing staff seemed to give up on her easily. 'She's so old,' 'she had
a good life.' They also avoided her as she was stubborn and thus she developed pressure
sores and beginning of contractures.

Theme 2: Contemplating The Patient's Life And Death Occurred As Nursing Students Cared
For Their Patients

As a bond began to develop between nursing students and their dying patients, the students
realized that there wasn't just a dying body in the bed. The students wondered what kind of
persons these patients had been and what kind of lives they had lived. The following
passage illustrates this:

He wasn't just a 96-year-old man who couldn't communicate very well. He waved at me and
the nurses. The one thing I remember about him was his warm, caring blue eyes. He was on
a pureed diet and didn't care for his meal except for orange sherbet. I was feeding him the
sherbet and after a few spoonfuls he wanted to rest a little so I left the room. When I came
back in a few minutes, he was feeding himself and he had drops of sherbet on his lap, chest,
and face. He really enjoyed the sherbet and seemed proud of himself because he did a good
job eating it by himself. Caring for this man gave me a lump in my throat because it made
me think that there isn't just a dying body in the bed. It made me think of the Ufe he led and
his likes and dislikes and what kind of person he was.
Nursing students also contemplated their patients' imminent deaths. Would their patients
die alone? Would someone be with them? How much longer would they live?

Theme 3: Supporting The Dying Patient's Family Became An Integral Part

Of Nursing Students' Care

Nursing students became acutely aware that their dying patient was not their only
responsibility; the grieving family needed them as well. At times the nursing students
needed to set priorities regarding who would receive more of their time and attention- the
dying patient or the grieving family. The following passage illustrates this theme:

I then realized my goals that afternoon would be to make the patient comfortable and then
give my support to the parents. I felt I had to decide who needed me more. The patient who
needed pain control or his parents who were literally walking around with no guidance, hope,
or direction. The hopelessness and frustration of his older parents were overwhelming. I
realized I had three patients: a whole family that was dying of AIDS. I felt torn, my heart was
going out to these elderly parents who were watching their son die of a disease they were
not equipped to intellectually handle. They felt like failures.

Theme 4: Helplessness Was Experienced By Nursing Students Regarding Their Role As

Patient Advocates

Because of their role as nursing students, at times they felt trapped and useless when their
dying patients were unaware of their prognosis. For example, one nursing student described
the following distressing situation:

I approached the primary caregiver and again asked, 'Is this woman ever going to know she
is terminally ill so she can get her affairs in order and possibly start coping?' The nurse
replied, 'as soon as the MD sets up the meeting.' I was so upset over the situation. I felt I
was trapped and couldn't be an advocate for my patient because I was only
a nursing student.

Nursing students also felt helpless and useless because they believed they did not have
enough clout to have their dying patients' pain medication increased so they could die a
more peaceful death. As one nursing student described:

I did what I could as a nursing student to make her more comfortable but the bottom line
was she needed a more effective pain medication. Because this was 'not an emergency" and
the doctor was gone for the day, nothing could be done. I felt helpless. What if she died
within the next 24 hours and her last day would be filled with pain. I don't think that's right.
Another aspect of nursing care where students experienced feelings of helplessness and
uselessness was in carrying out their dying patients' last wishes. The following passage
illustrates these distressing emotions for a nursing student:

Around 10:30 a.m. I decided to do my final vitals and assessment of my patient because
the nursing home crew would be arriving soon. All of a sudden, he completely stopped
breathing. My heart began to pound completely out of my chest. The primary nurse began to
shake and call the patient. After several attempts, the patient began a more normal
breathing pattern. The nursing home crew came and my patient began to get very agitated.
I tried to communicate with him to identify what the problem was. My patient did not want to
go to the nursing home. He was very upset. When phoned, the physician insisted that he go
even with the change in condition. My patient was taken to the nursing home struggling all
the way. I was extremely shaken. Here we had a man who was mentally intact whose only
wish was to die. He was forcefully Tarought back' only to be taken to a place that was
unfamiliar to him to die. I was upset with the nursing staff and physician. I had walked in
feeling we were going to guide this patient to his final rest and walked out feeling that a
great injustice had been done. I felt so helpless.

Theme 5. Nursing Care for Dying Patients Entailed Providing Comfort Physically, Mentally,
and Spiritually

Measures to relieve pain and increase the dying patient's comfort were integrated
throughout the nursing students' care. At times,nursing students discovered that just sitting
quietly in the patient's room was an effective nursing intervention. Holding a patient's hand
or praying with the patient were measures used by nursing students to convey to their
patients that they were not alone in their dying. A quote from a nursing student illustrates
this caring:

Even experiencing the most excruciating pain and not being able to breathe, my patient
would still thank me for wiping her mouth or blessing [sic] me when I sneezed. I spent all my
time holding her hand and talking to her even when she didn't respond so she wouldn't feel
alone.

Another student said:

I prayed with him. I listened to him. I comforted him. I fed him. I was there for him if he
needed someone to be with him. I did not want him to be alone in a strange place when he
took his last breath.

Allowing dying patients to discuss their imminent death was difficult for
the nursing students, but they realized it was an essential component of their nursing care.
One nursing student shared this experience she had discussing her patient's death and
dying:

Though she had no hair and a very weak body, she smiled and took my hand. Throughout
the 2 weeks I spent with her, many times I would sit in her room with her and talk to her
about how she was feeling. Sometimes she was very scared and other times she was not.

Theme 6. While Caring For Dying Patients, Nursing Students' Learning Flourished

Providing nursing care to dying patients taught nursing students something about
themselves. As one nursing student said, "With each death, you share yourself with
someone and they teach you something about yourself, a strength that you did not know
was there before the experience." Dying patients also taught nursing students about caring
unconditionally and nonjudgmentally. Nursingstudents learned that nurses not only help
people to get well, they also help people die.

Another type of beneficial learning transpired that helped to counteract nursing students'
feelings of inadequacy and fortify them with more confidence for the next time they were
assigned to a dying patient. Just when nursing students believed they had been of no help to
their patients because of their inexperience with the dying, their patients proved them
wrong. They learned the power of caring. The following illustrates this: "When I left, he
kissed me goodbye and held my hand tight. Thank you,' he said. All the time I thought I was
of no help. He really felt how much I cared!"

DISCUSSION

Research on evaluating the effectiveness of death education programs on nursing students'

attitudes and anxiety towards death have yielded contradictory findings. The most effective
approach to providing such education to nursing students remains to be determined. The six
theme clusters that emerged from this phenomenological study have implications for nurse
educators in preparingnursing students for care of the dying.

Some death education programs for nursing students have focused primarily on decreasing
the students' death anxiety in facing their own death (Lockard, 1989). These programs are
based on the assumption that nursing students must face their own mortality every time
they care for dying patients and that this constant identification is the major reason for their
increased anxiety. This anxiety about their own deaths did not emerge from
the nursing students' descriptions of their experiences caring for the dying. This
phenomenological study revealed that the nursing students' death anxiety instead stemmed
from their feelings of personal inadequacy and limited clinical experience caring for dying
patients. Perhaps nurse educators should first help students deal with their anxiety
regarding their inadequacy to care for the dying. Once nursing students feel more prepared
and confident in their ability to comfort and support their dying patients, they may then be
able to move on to recognize and confront their own reactions to death.

The helplessness experienced by nursing students in their role as patient advocates also
needs to be addressed by nurse educators. Lacking the full status of registered
nurses, nursing students felt impotent in exercising any power to advocate for their dying
patients' rights, such as informing patients of their prognosis or adequately medicating them
for pain. Nursing curricula on death and dying should address strategies for
empowering nursing students in their care for dying patients.

One component of the meaning of nursing students' experience in caring for the dying was
their encounters with ethical dilemmas. One example of this dilemma is the man who
wanted to die in the hospital surrounded by the nursing and medical staff he had come to
know, but was transferred to an unfamiliar nursing home. Pederson, Duckett, and Maruyama
(1990) described an educational strategy, structured controversy, for
helping nursing students learn content and skills required for dealing with difficult ethical
situations. In structured controversy, a dilemma is presented in a way that
allows nursing students in small groups to argue both for and against a specific position
regarding a disputed issue, then to reach a consensus. This educational strategy can be
used to help prepare nursing students to deal with ethical dilemmas they will be confronted
with in caring for dying patients.

Truth telling and confidentiality are additional ethical dilemmas with which
the nursing student may be faced (High, 1989). One of the theme clusters in this
phenomenological study revealed the frustration and anger nursing students experienced
when they found themselves caught in the middle between their patients and the
physicians. Nursing students questioned to what extent they could encourage their dying
patients to raise questions about their prognosis. Not knowing what and how much the
physician had told their dying patients created yet another dilemma. Time needs to be
designated in nursing curricula to allow students the opportunity to grapple with these
difficult issues before they encounter them on the clinical unit. High (1989) emphasized the
importance of truth telling and confidentiality because these issues can affect the moral
relationship between the nurse and the dying patient.

Within another theme that emerged from nursing students' descriptions was the sadness
they experienced as they watched their patients become weaker and
weaker. Nursing students expressed that they felt there was not much they could do to
improve their patients' quality of life. Ways to provide dying patients realistic hope can be
addressed by nursing faculty. Taylor and Gideon (1982) purport that terminally ill patients
continue to have hope- their own kind of hope. The nurse's job is to help the patient
translate this hope into a realistic possibility and to help that patient make that possibility a
reality. Realistic hope fits the patient's actual circumstances. This could be hope of
celebrating the patient's next birthday, which was a hope of one of the nursing students'
patients in this study whose birthday was 2 weeks away. Nursing students can be taught
strategies to assist dying patients define their hope, and in return, the students may begin
to identify ways they can improve the lives of the terminally ill.

Benner's (1984) model of skill acquisition can be used as a basis for some additional
suggestions for nursing educators in relation to the themes that emerged in this study.
Novice practitioners, the first level of Benner's nursing proficiency, have little or no
experience with the situations in which they are expected to perform. Novices rely on rules
to guide their actions. One of the preferred methods of learning, according to Benner, is by
observing and emulating role models. Expert nurses are the role models who act as mentors
or instructors to the less experienced nurse or nursing student. Perhaps
when nursing students begin caring for dying patients they can be linked up with expert
nurses on the unit where the novice students are assigned. When students are assigned to
care for a dying patient for the first time, their role could be more of an observation role of
the expert nurse, who acts as the student's mentor. Once the primary responsibility for
providing care to the dying patient is removed from the novice students, their anxiety level
decreases and allows the students to observe and study the performance of their mentors
before they are required to care for a patient on their own.

Benner (1984) also includes descriptions of excellence from expert nurses as offering new
clinical possibilities for less proficient nurses. On the clinical units, nurse educators can enlist
expert clinicians to attend pre- or postconferences and share specific experiences in caring
for dying patients and describe their interventions that made a difference. Knowledge that is
embedded in their expert practice can become visible for the nursing students as the expert
clinicians share these exemplars.

When nursing faculty address death and dying in their curricula, emphasis also needs to be
placed on the positive and rewarding aspects of caring for terminally ill patients. As one of
the themes that surfaced in this phenomenological study highlighted, nursingstudents'
learning flourished while caring for dying patients. Nursing students should be encouraged
to share with each other their stories regarding the rewarding aspects of caring for the
dying. For, as Norton (1985) expressed:

When we listen to a dying patient, and stay near- to share, touch, care, and not be afraid- we
discover that the challenge of helping a patient die comfortably is as rewarding as helping a
patient recover (p. 1099).

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AuthorAffiliation
Cheryl Tatano Beck, DNSc, CNM, FAAN

AuthorAffiliation
Dr. Beck is Professor, School of Nursing, University of Connecticut, Storrs, CT.

Address reprint requests to Cheryl Tatano Beck, DNSc, CNM, FAAN, Professor, School
of Nursing, University of Connecticut, 231 Glenbrook Road, U-26, Storrs, CT 06269-2026