Teaching in Higher Education, Vol. 6, No.

1, 2001

Drama as an Experiential
Technique in Learning How to
Cope with Dying Patients and their
Families
PAT DEENY, ALPHY JOHNSON*, JENNIFER BOORE,
CATHERINE LEYDEN & ELLIS McCAUGHAN
Centre for Nursing Research, University of Ulster, Coleraine, County Londonderry,
BT52 1SA, and *School of Nursing and Midwifery, The Queen’s University of
Belfast, 1–3 College Park East, Belfast, BT7 1LQ, UK

ABSTRACT This paper discusses a teaching experiment in which participation and observation
of a drama helped Ž rst year nursing students to consider ways of dealing with death and dying.
Workshops included dramatised scenarios of critical incidents demonstrating different peoples’
experiences of the death of a Ž ctional patient in hospital. Two nurse teachers performed a
two-part drama about the experiences of a patient just diagnosed with terminal cancer. Live
performances were presented to large groups of students and followed by small group discussions.
Drama as a teaching method was well received, and the combination of drama and group
discussion was considered very effective by students, who requested more similar sessions. Drama
appears highly satisfactory for achieving learning in the affective domain, and can be added to
teaching methods for improving communication skills and coping strategies with nursing
students who will be caring for the dying. However, further research is necessary.

Introduction and Literature Review

Caring for dying patients can be an emotionally painful, distressing, and sometimes
threatening experience for nurses and other health care professionals as the illness is
incurable and death imminent; nurses may feel powerless to help the patient’s
distress and suffering. Often this generates feelings of anger, guilt, fear and loss of
control (Mandel, 1981). Nurses may worry about what to say or do, and feel
ill-equipped to give the sympathy and support which patients and relatives need
(Ferszt, 1984; Hurtig & Stewin, 1990; Servaty et al., 1996; O’Gorman, 1998). They
may feel anxious and this is strongly linked to fear of their own death (Popoff, 1975;
O’Gorman, 1998). Nurses may not have learnt to deal with their own feelings in

Correspondence: Mr P. Deeny, University of Ulster, Cromore Road, Coleraine, Co. Londonderry

BT52 1SA, UK. E-mail: PG.Deeny @ulst.ac.uk

ISSN 1356-2517 (print)/ISSN 1470-1294 (online)/01/010099-14 Ó 2001 Taylor & Francis Ltd
DOI: 10.1080/13562510020029635
100 P. Deeny et al.

relation to death and dying, and may resort to coping strategies such as distancing
themselves emotionally and physically from their dying patients (Ross, 1978). These
problems can be avoided if nurses are helped to face their own personal concerns
with death and dying, and are taught ways to relate to dying patients and their
families. This should begin early in nurse education to promote personal awareness
of death-related fears so that anxieties can be dealt with before caring for these
patients and their families.
Despite possible inner turmoil, nurses assume important roles with dying
patients in providing practical and emotional care (HaisŽ eld-Wolfe, 1996). They are
also expected to provide support for patients’ families, helping to maintain
emotional well-being of all involved. This is only possible if nurses are educationally
prepared, and possess good interpersonal skills and personal coping strategies.
Nurse educators must Ž nd teaching processes that stimulate learning in the affective
domain, that is, facilitating students’ understanding about emotional aspects of the
subject and the feelings and fears of all involved (Hurting & Stewin, 1990; Sawatzky,
1998).
Within the affective domain of learning Bloom (1955) described a hierarchy of
Ž ve levels, in ascending order: receiving or attending, responding, valuing, organis-
ing (or conceptualising) and internalising. It is recognised as an area in which setting
and evaluating achievement of objectives is difŽ cult (Mellish & Brink, 1990). Within
nursing education relatively little work has been undertaken which evaluates meth-
ods of enhancing learning within this domain, and none that assesses the intensity
and long-term stability of affective change in relation to death and dying. However,
experiential learning methods are commonly recommended (Wise, 1974; Parkes,
1985; Lyons, 1988), and are reported as particularly valuable when teaching
interpersonal communication and human skills such as empathy and understanding,
as students are able to explore personal views and reactions (Ferszt, 1984; Burnard,
1985; Quinn, 1997).

Evaluation of Education Related to Death and Dying

Education about death and dying has been criticised as inadequate (Birch, 1983;
WhitŽ eld, 1983) with nurses being prepared to give physical, but not psychological
or spiritual care (Doyle, 1982). Several authors (Birch, 1983; Hockley, 1989;
Frommelt, 1991) reported students and registered nurses criticism of their teaching
on the subject, and suggested that instruction was inadequate to prepare them for
the real situation. Mackay (1989) reported that death was a common fear of learners
entering nursing, but by their second ward experience initial apprehensions had
diminished, although students still found their early experiences ‘trying’. Where
education was adequate, there was still disparity between theory and practice (Field
& Kitson, 1986; Johnson, 1994).
Stress is common when students anticipate situations concerning death or
suffering of a patient (Kieger, 1993; Rhead, 1995). Dealing with death and dying is
the second most frequently cited stressor among nurses of all levels (Lees & Ellis,
1990). In particular, seeing and handling a corpse, and the idea of losing a much
 Drama as an Experiential Technique 101

cared for patient were considered to be most distressful. Kieger (1994) reported that
at the commencement of training students expressed feelings of dread, uncertainty
and concern about the nature of the dying process, especially how it would affect
them. Much of this concern grew out of their relative inexperience with death and
fear of being unable to cope with emotional care, the pain of seeing suffering, shock
of seeing a dead body and difŽ culty of dealing with bereaved relatives.
This theme of personal inadequacy and fear of mistakes is frequently cited in
literature about stress in nursing students (McKay, 1978; Pagana, 1988; Lindrop,
1991; Sawatzky, 1998) and is not unique in caring for dying patients. Some studies
reported ‘good’ and ‘bad’ experiences with death where students re ected upon and
discussed both satisfying and negative aspects of caring for a dying patient and their
relatives (Johnson, 1994; Kieger, 1994). Regardless of students’ preconceived ideas
about death, the learning through experience of caring for dying patients remained
a particular challenge.
Kieger (1993) stressed the difference between ‘knowing about’ and ‘knowing’.
Inevitably, there will be a disparity between the students’ expectations and their
experience since they cannot really know nursing until they have experienced it.
Despite perceived inadequacies about the care they deliver to the dying person and
family, many will form deep personal and emotional bonds with patients, and gain
satisfaction from providing high quality care (Melia, 1983; Kieger, 1994). How well
they then cope with death of the patient depends on numerous factors, including
personal coping resources (Sawatzky, 1998), previous experiences of death
(O’Gorman, 1998), support by colleagues (Mackay, 1989) and their educational
preparation. Education which develops their emotional resources to deal with this
stressful experience will provide a foundation for continuing enhancement of the
necessary caring skills. Development of interactive abilities and knowledge about
dying must be preceded by dealing with fears and emotional needs about the
subject.

Experiential Learning about Death and Dying

In teaching about death and care of the dying patient, nurse educators must
challenge societal perceptions of death and dying, and facilitate nursing students in
developing a deeper insight into individual responses. Programmes that promote
affective learning, that is interpersonal awareness and empathy with others, are
fundamental (Burnard, 1996). A teaching method that increases students interest
and involvement, and helps them to see connections between abstract ideas and
concrete phenomena is needed.
Students learn from experiencing and participating, and learning is enhanced if
students can process their recent experience by re ecting, describing, talking about
and analysing what they have seen and done (National Society for Experiential
Education, 1997). The experiential learning cycle consists of four stages that actively
engage the participants to stimulate learning: experiencing, re ecting, generalising
and applying. After a practical exercise, a skilled facilitator guides students through
a re ective process which helps them improve their ability to learn and internalise
102 P. Deeny et al.

knowledge. Re ection used wisely in group or one-to-one discussions, can enliven
and sharpen the learning experience for students (Greenaway, 1999). Ideas, experi-
ences and feelings are discussed, and linked to abstract concepts so that theoretical
knowledge can be integrated with practical experience. Thoughts and insights are
transformed into generalisations, and then applied to real life situations in the
clinical area. The cycle begins again as students re ect upon how well these
generalisations test in reality.
A range of methods can be used for experiential learning to help students get in
touch with their own feelings and fears about the subject, and provide opportunities
for discussion about death and reactions to it (Hurtig & Stewin, 1990). Lessons
learned can facilitate the transition to practical application in the clinical setting
(Wise, 1974). Role play can improve communication skills, and promote interaction
with patients and their families (Parkes, 1985), while role play, drama and small
group exercises can promote skill-building and self-learning (Lyons, 1988; Kalisch,
1974). Wise (1974) and Lewis (1977) described positive results from simulation and
drama techniques.

Use of Drama as a Method for Teaching Death and Dying

Drama facilitates affective learning about death and dying because it provides
opportunities for self-exploration and personal re ection (Ferszt, 1984), and enables
practice and development of effective interactional skills (Parathian & Taylor,
1993). Participation in drama, as an actor or viewer, can foster empathy: as actors
express characters’ innermost thoughts and feelings, so viewers gain a deeper
appreciation of how the patient and family may feel. This fosters creative thinking
in the following discussion, as students learn new ways of interacting with patients
and relatives (Kalisch, 1974). Drama can put students in touch with their feelings
about death (Lewis, 1977), promote interpersonal learning (Ferszt, 1984), increase
self-awareness, and assist in personal growth and development (Weil & McGill,
1989).
Fundamental to the value of this experience is the process of re ection. This
can take place: within the drama; in class discussion following the drama; in written
work arising out of the drama; in compiling statements of insights achieved during
the drama to be shared with others; or in further reading and thinking (O’Neill et al.,
1976). Through re ection, individuals can arrive at personal understanding of
themselves or the world around them, and may be able to transfer learning to similar
situations or propose alternative actions.
Drama in education is a mode of experiential learning which involves students
in active participation through identiŽ cation with imagined roles and situations
(O’Neill & Lambert, 1984). It builds upon the knowledge, skills and experiences
that students bring to the learning situation in order to enrich their knowledge of a
subject. The teacher engages in creating and sharing the process of learning with
students (O’Neill et al., 1976). It raises awareness of facts and issues surrounding
the care of a dying patient. It is particularly beneŽ cial for dealing with emotive issues
such as death in a non-threatening way in which students Ž rst experience this
 Drama as an Experiential Technique 103

emotive topic in relation to the lives of Ž ctional characters. Advocates suggest that
drama facilitates the education of the emotions by allowing students to develop
empathy with characters, mood, situation and content (O’Hara, 1984). The result-
ing learning helps students to order and control their emotions (Allen, 1975),
assisting them towards appropriate and creative forms of expression with patients
and relatives.
Because drama in education is designed to help students connect with sensitive
and sometimes complicated human issues, and can expose students to new,
emotional, intensive, confusing or complex experiences, not all students will be
comfortable with this situation. Therefore, drama workshops need to be handled
with sensitivity and care, with experienced staff present to lead discussions and
debrieŽ ng sessions. Students may be anxious about ‘feeling safe’, especially in
relation to self-disclosure of emotions and feelings and the threat of ridicule from
other students (Burnard, 1996). When facilitating re ective discussion, educators
must channel re ection towards establishing facts and exploring, examining and
expressing feelings in a safe environment for students (Greenaway, 1999). While
expression of opinions is to be encouraged, ground rules must clearly state that
language used must be non-threatening and non-offensive to others. Staff need to be
alert for volatile areas especially when dealing with ethnic, racial and ethical issues
(Bontempo, 1995)

Research Problem
Research into the effectiveness of drama in learning has been undertaken in the
context of general education (Brossell, 1975) and the use of drama in nursing
education has been described (Hurst, 1993). However, there is little evidence of
attempts to evaluate the effectiveness of drama as a teaching method in nursing
education.
This study arose from evaluations by previous student groups who received
traditional lecture-and seminar-based teaching about death and dying. As in the
literature previously discussed, they reported difŽ culty in coping with situations in
the ward and stated ‘we need more’. Thus, this study aimed to enhance student
understanding of this subject area, while also beginning to address the deŽ cit in
evaluation of drama as a teaching method in nursing education.

Research Methodology
Research Method
The aim of the dramatic intervention was to highlight the types and range of
emotional responses experienced by patients, families and professionals associated
with dying. Two acts of approximately 10 minutes each were presented (see Boxes
1 and 2). Both acts presented scenarios dealing with issues and feelings related to
open/closed awareness, power, ownership of information, patient–professional rela-
tionships, touch and spirituality. Stage props were used to create atmosphere and
104 P. Deeny et al.

Box 1. Act one

This act emphasises how nursing students may feel isolated within the ward team and bereft
of information, even though most of their day is spent giving direct patient care. Personal and
professional con icts in this situation are explored. Beginning with the patient being told not
that he has cancer, but a ‘suspicious growth’, act one shows the nursing student is in the middle
of a communication nightmare. The patient knows he has cancer, he also knows that the nurses
know he has cancer, the student knows, but no-one except the student is talking with the
patient. The student cannot disclose what he knows because of fear of being rebuked by the
Ward Sister. The student wants to support the patient, but is very clumsy in interaction, being
more evasive than helpful. Both student and patient are left feeling uncomfortable. In
particular, the patient was confused, bewildered and ultimately neglected. The nursing student
is Ž lled with self-blame and guilt. The Ž rst act points up the con ict within the team. Failure
to recognise the learning needs of the student and the conspiracy of silence around cancer
diagnosis are presented. The ‘handmaiden role’ of the nurse in relation to not giving
information unless instructed by the doctor or merely rephrasing the words of the doctor is
also explored.

Box 2. Act Two

The second act progresses to a stage when the nursing student has become a staff nurse. One
year after the diagnosis of cancer the patient returns to the ward to die. At the beginning of
Act Two, a powerful soliloquy by the patient reminds the audience of what it is like to have
a fatal diagnosis. The patient reminds us of the denial, despair, anger, depression and aggressive
outbursts with the family. The nurse has established a close emotional bond with the patient
and nurse and patient relate to each other’s needs within a meaningful human relationship.
The intimacy that develops is emphasised. The family, in particular the wife, is unable to deal
with the death of her husband, refuses to visit and keeps the two children at home. The nurse
acts as intermediary conversing with the wife and the children by telephone. As the patient
draws near death the nurse lights a candle and prays. The patient dies. After a short silence
the nurse re ects on the loss. The nurse then begins the bereavement process in a melancholic
way whilst listening some music which was a favourite of the patient. In an angry manner the
nurse then appeals to the audience (as nurses) to attend more closely to the needs of dying
people and those who care for them.

help the audience focus on elements with signiŽ cant meaning within the drama. A
short piece of music, a bed, bedside cabinet, a family photograph, a scented lighted
candle, a cruciŽ x and a bible were used to create the atmosphere around the
death-bed.
After the drama, students were divided into small groups, and asked to share
feelings and discuss issues raised. Teachers were available afterwards for one-to-one
discussion if needed. The effectiveness of this as an educational method to illumi-
nate the topic of death and dying was evaluated by using a questionnaire to obtain
student views, attitudes and opinions. Students were asked to complete the ques-
tionnaire 1 week later, having had time to assimilate learning and share feelings with
peers.
 Drama as an Experiential Technique 105

Sample
The research sample was drawn from the total population of Ž rst year nursing
students within Northern Ireland undertaking the Common Foundation Pro-
gramme of a Project 2000 Diploma or Degree. An important issue for consideration
was the religious mix of the sample as the scenarios presented included some
religious symbolism which could have different implications for those from Catholic
or Protestant backgrounds. Thus, it was decided to ensure that the ample ade-
quately represented students from both communities.
A cluster sampling technique was used: from a total of six nurse education
establishments within Northern Ireland, three were selected. Group A (n 5 35) was
based within a predominantly Catholic and the other (Group B, n 5 75) within a
mainly Protestant catchment area. These groups were used for the main study. The
third group (n 5 25), which was used for the pilot study, had substantial numbers of
students from both communities. The ages of participants ranged from 19 to 30
(mean 21) and most of the sample were female (91%).

The Questionnaire
The questionnaire (Table I) was developed from issues identiŽ ed in the literature.
It consisted of 21 questions, comprising two items related to biographical details, 18
items which explored students’ opinions and feelings about the scripted drama, and
one open-ended question which allowed respondents to comment on the drama.
Students’ were asked to rate their response to each of the 18 questions along a Visual
Analogue Scale, indicating their response by placing a mark through the point of the
line which best re ected their perception (see Table I).
The Visual Analogue Scale provides interval-level data with Ž ne discrimination
of values (Burns & Grove, 1987), and is particularly useful for scaling attitudes and
feelings (stimuli) as it discourages the respondent from always choosing the extremes
of a scale (Lodge, 1981). The scale is a line exactly 100 mm in length, with the
extremes of the response placed at each end of the line. Respondents are asked to
place a mark through the line to indicate the intensity of the stimulus. A ruler is then
used to measure the distance between the left end of the line and the mark placed
by the respondent, for example, if the mark is at 67 mm then this response is given
a score of 6.7.
The scripted drama and the questionnaire were piloted with a group of 25
nursing students not used in the main study. This enabled the actors to practice the
drama and identiŽ ed errors in the questionnaire such as presentation, typographical
errors, overlapping response sets and ambiguity (Litwin, 1995). A few amendments
were made to clarify ambiguities.
Content and face validity were established through scrutiny by a panel of nurse
educators and practitioners (Litwin, 1995). The questionnaire provided consistent
and accurate data, and tests of internal consistency were undertaken with the main
data set to determine the questionnaire’s reliability. Analysis demonstrated a high
internal consistency (Cronbach’s a coefŽ cient 5 0.835).
106 P. Deeny et al.

TABLE I. Questionnaire for evaluation of Drama for teaching about death and dying

For each question respondents were asked to insert a mark on that position on the line which re ected
their response (as indicated).
Not at all
u A great deal

1. I enjoyed the drama as a method for teaching me about death and dying
2. The drama encouraged me to read the handout about death and dying
3. The drama helped me understand my own feelings about death and dying
4. The drama helped me understand how a patient might feel about death and dying
5. The drama helped me understand how a member of the family may feel
6. The drama helped me to understand how nurses might feel about caring for a dying patient
7. During the drama I felt emotional
8. I think the drama will help me prepare for the real situation
9. The drama dealt with death and dying in a sensitive way
10. The use of props and aids helped me to attend to the drama
11. I found the drama helped learning
12. The drama helped me identify the need for emotional support for nurses
13. I thought about the drama afterwards
14. The drama will help me to use touch to express feelings towards dying patients
15. The drama will help me talk with patients who are dying
16. The drama made me think about my own attitudes to death and dying
17. The drama raised more questions than provided answers
18. The drama showed me the need for peer support from fellow nursing students
19. Please comment on the drama

Results
Overall, results from this study demonstrate very positive feedback from students
regarding drama as a method of teaching students about death and dying (see
Figure 1) with scores ranging from 5 (i.e. half-way along the continuum from not at
all to a great deal) to 9 (90% of the way along that continuum). Results from Group
A (n 5 35) (predominantly Catholic) and Group B (n 5 75) (mainly Protestant)
were compared using t-tests and no signiŽ cant differences were noted in any of the
items. There were no age or gender differences in responses.
Eighty-four per cent of the students in Group A and 80% of those in group B
perceived that the drama helped them to learn about death and dying, and gain
insight into the patients’ perspective. Qualitative comments supported this:
The drama presented a life-like situation and it made me think about how
I would cope with someone who is dying and how I would communicate
with them.
It made me understand more as it was the actual patient who was talking
about his feelings and the family.
made me realise how a dying patient feels as they approach death. Since
they are in a strange hospital environment it makes it all the more
frightening and lonely. It is the nurse who must provide company.
 Drama as an Experiential Technique 107

FIG . 1. Results from questionnaire on drama about death and dying.

I thought the drama was a very easy-to-follow and simple way to under-
stand death and bereavement.
Students also indicated that the drama helped to raise their awareness of the
emotional aspects of caring for dying patients, especially how patients, families and
nurses feel. Most of the qualitative comments referred to how they could identify
with patients and families much more after the drama.
I found it very useful because it got me into contact with my emotions/
feelings. It brought back memories of loved ones on their deathbed.
It provoked a lot of emotion and was very effective in raising issues
concerning death and terminal illness.

Very good, very emotional where a video or other approach would not get
across the same feelings.
Findings also indicate a heightened awareness of the need for support for nurses
(Group A 89%, Group B 90%). Qualitative comments such as:
I thought the drama was very powerful. It brought across how the nurse
feels in this situation. It prepared me for what is to come and gave me an
idea on how I might cope.
I found the drama very interesting, and it proved how difŽ cult it can be for
student nurses to discuss death with senior nurses and other members of
the team.
The drama clearly demonstrated the difference between the role of the
student and the staff nurse. It hit me how the student wasn’t able to answer
the questions. This is how I feel sometimes.
108 P. Deeny et al.

However some of the qualitative comments highlighted dissatisfaction with the

drama:
I felt that it was not realistic, it was a bit fake I thought.
It was good but afterwards I felt very unsure, I would still be insecure in
dealing with this situation.

I thought that the drama was good but I found it difŽ cult to hear the
patient at times. I would have liked more emphasis on the family, perhaps
some actors doing the family would have helped.

I felt that the drama was too short in duration. The death was too quick.
A few students had difŽ culty with the symbolic meaning behind various props used
in the drama. For example:
I thought that this was very Catholic, the cruciŽ x and all. They should have
been less provocative.

We do not have candles at the death. I think that this was too Roman
Catholic.
These last two comments came from the predominantly Protestant students (group
B). Interestingly, issues related to the religious symbolism did not arise as a problem
within the pilot study with the mixed religious group.

Discussion
Learning about Dying
The Ž ndings in this study support the use of drama as an experiential method in
teaching nursing students about death and dying. As intended, the drama caused an
emotional response in students and enabled them to re ect on how they might feel
and cope in the real situation, similar to the Ž ndings of Hurtig & Stewin (1990).
Drama taking place in a group setting results in participants sharing their experi-
ences with others, and discovering that they all feel and respond in similar ways.
This engenders feelings of support and afŽ rmation from colleagues identiŽ ed by
Mackay (1989) as one of the factors which in uence the ability to cope with the
death of a patient.
The evidence from the questionnaires suggest that the drama and discussion
resulted in affective learning as the students perceived it as being beneŽ cial in
understanding how others feel. However, whether it will enable students to respond
in a more empathetic manner to dying patients in their clinical placements can only
be evaluated by undertaking a follow-up study with the same students. Some
informal feedback from these students at a later date has indicated that it did help
them in practice through enhancing their understanding of how the patient, family
and nurses might feel.
Educational preparation to care for dying patients and their families needs to be
 Drama as an Experiential Technique 109

combined with supportive clinical experiences. Johnson (1994) highlighted that

students considered that only some aspects of death and dying can be taught in
college. Other aspects, such as how they will feel when faced with the situation of
caring for dying patients and development of coping strategies, can only be devel-
oped fully within a supportive clinical environment and this was reinforced by
student feedback. However, the approach discussed in this paper may help to bridge
the gap between academic and clinical settings, particularly when followed by
experience with effective clinical role models, and the opportunity to re ect on
practice with nursing colleagues and/or academic tutors.
The affective domain within Bloom’s Taxonomy (1956) is a difŽ cult area in
which to evaluate the effectiveness of learning opportunities provided. Within this
example, it was clear from the students’ responses to the questionnaire that learning
at the Ž rst two levels (receiving or attending, and responding) was achieved. The fact
that over 80% of students responded positively to the statement that ‘the drama made
me think about my own attitudes to death and dying’ indicates that it is likely that many
also achieved the third level (valuing). The discussion following the drama was
intended to facilitate them in reaching towards the fourth level in which they would
be able to conceptualise their knowledge and experiences. However, at this stage in
their programme, this penultimate stage and the Ž nal level, in which they will
internalise their new understanding, are unlikely to have been achieved. It is
predicted that relevant experience in practice with appropriate support, as described
by Mackay (1989), will build on this initial introduction to enable achievement at all
levels in this hierarchy.

Limitations and DifŽ culties of Educational Method

There are some issues related to the method and the rigour of the research that merit
discussion. This study used a relatively weak experimental design with an interven-
tion or independent variable (the drama and discussion) followed by measurement
of the dependent variable (students’ attitudes and opinions) 1 week later. It would
have been improved by some measurement of these before the intervention. Simi-
larly, the study would have been enhanced by including a comparison group who
received a more conventional educational input on death and dying. This would
have eliminated the possible in uence of the Hawthorne effect in increasing the
positive results obtained. Nevertheless, the students’ own evaluation of their learning
through this activity cannot be discounted.
Students in this study were asked to complete the questionnaire 1 week after the
drama. The rationale for this approach was that they required time to assimilate the
knowledge and emotional experience and discuss the experience with their peers. It
also means, however, that there is a possibility of diffusion of ideas and positive
perceptions of the drama that may bias the evaluation, and (with the Hawthorne
effect) explain the overly positive response. The two groups in the study had no
contact with each other and the similarity in responses reinforces the reliability of the
Ž ndings. To elucidate students views, attitudes and opinions a self-report question-
110 P. Deeny et al.

naire was the only feasible method, but does not assess the in uence on their
professional practice of the learning they have achieved.
Respondents’ comments that props used during the drama, such as a cruciŽ x
and lighted candle, were ‘too Roman Catholic’ were made within Northern Ireland,
a divided society with many having strong afŽ liations to either the Protestant or the
Catholic community. These comments, not surprisingly, were mainly from the
predominantly Protestant group. Nurse educators’ responses to these type of state-
ments need to be carefully considered. On one hand, it is easy to be critical of some
individuals’ unwillingness to appreciate cultures other than their own. Conversely,
it also highlights the need for educators to avoid ethnocentrism and offence
(Bontempo, 1995).
However, symbols and rituals of death and mourning are an important part of
the process of grieving for families (O’Gorman, 1998). Presentation of such symbols
to students in the context of teaching about death and dying is crucial if they are to
re ect on how they might deal with these in a respectful manner within the patient
care situation. The issue that this study raised is how do nurse educators, knowing
that such prejudicial perceptions may exist in groups of nursing students, incorpor-
ate these into their teaching without causing offence. In this situation the issue was
not foreseen, but in the future when such symbols are introduced in any form of
teaching they should re ect the diversity within the particular society and should not
cause offence to any. When using drama, educators need to carefully consider
students’ ethnic and cultural backgrounds, and endeavour to integrate a diversity of
traditions and there should be open discussion on the topic. Indeed, the introduc-
tion of such symbols could act as a catalyst for re ective discussion on prejudicial
perceptions and attitudes.

Potential Value of Drama in Professional Education

The use of drama as a teaching method was well received, and the combination of
drama and group discussion was considered very effective by the students. Drama
was found a highly satisfactory method for enabling nursing students to re ect on
their understanding of the emotional aspects of death and dying in hospital. This
method has considerably wider application than nursing education. Many health
professionals have to confront similar situations and this method of introducing the
topic and enabling students to begin to consider possible coping strategies could be
used with all such groups. If undertaken within multi-professional groups, it would
have the additional advantage of enhancing inter-professional understanding and
thus enhancing patient care.
In addition to the topic of death and dying, there are many other difŽ cult
situations which health and social care professionals encounter. Drama is a viable
method of enabling students to begin to think about and come to terms with such
issues, and could be used much more widely to provide opportunities for students
to practice the affective skills needed.
While this study was carried out in Northern Ireland, considerations similar to
those discussed above would apply in other situations where different cultures meet,
 Drama as an Experiential Technique 111

including many other parts of the United Kingdom. Use of this teaching method
would enhance students’ abilities in working empathetically with patients from
cultures other than their own.

Acknowledgements
The authors gratefully acknowledge the National Board For Nursing, Midwifery and
Health Visiting for Northern Ireland for second-line research funding related to this
project.

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