Nursing requires hands-on training. But research has found that university curriculum often goes light on one of life's universal experiences — dying.
There's a sound near the end — the death rattle. We stop swallowing. Our lungs fill up. There can be involuntary moaning.
"So you get all that noise. And that's really distressing for family members," says Belmont University professor Sara Camp, between gurgling and coughing into a microphone, mimicking the death rattle herself.
Camp and other nursing instructors at Belmont wear headsets and watch video monitors in a dark closet. The sounds they make emerge from realistic robots lying in hospital beds on the other side of the wall. The instructors also control the stats for the robots' breathing, pulse and blood pressure.
Other than administering morphine, there's no exact prescription for students to follow. A review of nursing textbooks found many make no mention of this standard part of the job. And studies of professional nurses find many feel unprepared.
"They're really comfortable in their skills, like putting in IVs and giving medications," Camps says. "In this one, they have to focus on communication, when there's not that much to do. It challenges them."
There are family dynamics to navigate, like explaining to grown children how their mom signed a do-not-resuscitate order. They have to balance caring for the dying patient and attending to the family.
In response to surveys showing anxiety about death among young nurses, Belmont started hiring actors to make these end-of-life interactions as realistic as possible.
"That old cancer ... didn't want it to come back," says Vickie Bailey, who has embraced her role as a grieving daughter.
The student, senior Sara Lindsay, sits on the bedside and puts a hand on Bailey and warns the end is near.
"Now would be a good time if you have prayers or anything you want to say," she tells Bailey.
"I've been praying all morning," Bailey responds in character.
The monitors stop beeping. Everyone sits in silence.
Once the simulation ends, Lindsay marvels at how real the moment felt.
Half a dozen beds are going at the same time in this simulation lab. And all the students gather to debrief afterward. Senior Zacnite Vargas volunteers that she second-guessed herself.
"Should I say she's dying? She's dead? She's passed?" she asks. "I don't know how to be straight-forward with it."
Camp tells the class to be cautious, especially about predicting when a patient will die, but also show compassion.
"They may not remember what you say, but they'll remember how they feel when you were there, because you were there."
It's such important work, Camp says, that more students should get the chance to rehearse.