Caring for the dying can be a nurse’s biggest challenge. Binghamton course helps students overcome it

When Alma Rood was growing up in Puerto Rico, there were no nursing homes. Families cared for elderly relatives at home until they died.

“We fed them, bathed them, gave them their medications. We turned them in bed and made them more comfortable. It was natural,” said the clinical assistant professor of nursing at Binghamton University’s Decker College of Nursing and Health Sciences, who knew from an early age she wanted to become a nurse and care for geriatric patients.

“I wanted to learn how to honor somebody’s life at death.”

Rood has devoted her 30-year nursing career to providing long-term, gerontological, palliative and hospice care:

• Palliative care focuses on symptom management and is available to anyone, at any age. Those receiving palliative care still seek curative treatments (for example, dialysis or chemotherapy) and will still go to the hospital when needed.
• Hospice care focuses on individuals with a life expectancy of six months or less who no longer seek curative treatments and do not wish to go to the hospital. Individuals under hospice care wish to be kept comfortable until their death. Pain management is a significant element of hospice care.

In addition to teaching, Rood is a home health case manager for Guthrie Lourdes Hospice. She joined the nursing faculty at Decker College in 2015 and has always shared her expertise with future generations, but it wasn’t until 2023 that she had the opportunity to develop an elective course on palliative care. Decker College previously offered a course on the subject, but it was discontinued years ago.

After gaining approval from Ann Fronczek, MS/FNP cert ’99, Decker’s director of undergraduate and PhD nursing programs, Rood updated and rebuilt the course.

NURS 392: Palliative Care has been offered as a spring-semester elective for undergraduate students since 2023. So far, about 50 students have completed it. Each semester, enrollment increases, and students from other majors across the University may take the course with advisor approval.

Rood, who also teaches Decker courses in geriatrics and the fundamentals of nursing, said the palliative care course fills a content gap.

“During their clinical experiences, Decker students encounter patients who need end-of-life care or are dying, and they don’t know how to treat them or even how to talk to them,” she said. “They’re not prepared clinically or emotionally to help these patients or their family members.”

Rood added that these encounters are not limited to clinicals in long-term care facilities, but can happen in any care setting.

“Caring for the dying will happen for almost every nurse in their career at expected and unexpected times,” added Fronczek.

There is also a significant need for palliative and hospice care nurses and other providers. According to the World Health Organization, approximately 56.8 million people globally need palliative care; yet, only about 14% receive it.

With NURS 392, Decker aims to change that by helping students learn the skills and interventions specific to palliative and hospice care, including how to talk to dying patients and their families. The course also explores all facets of the dying experience — physical, emotional, existential and spiritual — to ensure high-quality, end-of-life care is provided.

Along with modules about the history of palliative and hospice care, the curriculum covers topics such as nursing care at end of life; culture and traditions; communication; special issues in pediatric palliative care; achieving quality care at end of life; pain and symptom management; ethical and legal issues; preparation and care for the time of death; grief, loss and bereavement; holistic aspects of palliative care; and self-care for palliative nurses.

“This elective allows the students to know many aspects of caring for palliative and hospice patients, including navigating difficult conversations about how to approach the end of life, symptom management, psychosocial and spiritual support, as well as how to process the loss of a patient or loved one,” Fronczek said. “A course like this also introduces students to approaching issues of moral and ethical obligations to their patients and families. It is also a course that can benefit the nursing student in supporting their own families.”

NURS 392 is an online asynchronous course, but Rood regularly communicates with students via email, text and phone. And, that doesn’t mean she hasn’t been face-to-face with them.

Each student has the opportunity to shadow Rood as a hospice nurse for a day. This is a voluntary experience; no credit is granted for participating. Students accompany Rood on a home visit and may perform certain skills, such as a head-to-toe patient assessment. After the visit, once they have left the home, Rood and the student discuss the patient assessment, care plan, the student’s perspective on how the visit went, how the student feels and their plan for self-care.

“I’ve had students who love it and tell me the experience was incredible,” Rood said, “and others cry and tell me how rough it was.”

At the end of the semester, students complete a survey. Rood reviews each one for feedback to help improve the course.

“I get a lot of feedback from students that this is a transformative course,” she said. “Students say that after the course, they are more comfortable with patients who are dying. They feel more at ease having end-of-life conversations with them. They feel more astute in their assessments, and that they are more in tune with their own wellness — how they’re feeling emotionally and physically and when it is time to do self-care.”

Dani Kesys, who graduated from Decker’s nursing program in January 2025 and is now a med/surg nurse at Strong Memorial Hospital in Rochester, New York, enrolled in NURS 392 because she thought it would be more meaningful than other electives. She soon learned she didn’t understand what palliative care involved and how much the course would affect her.

“This course helped shape the kind of nurse I want to be. It strengthened my ability to advocate for patients in moments that are emotional, complicated and deeply human,” she said. “I learned how important it is when people receive honest education and compassionate support. Even during heartbreaking experiences, care can be aligned with what truly matters to the patient, including their values, wishes and needs. That is the kind of nursing care I hope to provide.”

Rood said her wish list for the elective course includes offering an in-person session, “because the conversations we have are incredible.”

Additionally, she’d like the course to be a permanent, required part of the nursing curriculum rather than an elective. “There is no doubt in my mind that all students are going to face dealing with patient death, no matter what unit they work on.”

Decker is examining its undergraduate nursing curriculum to address palliative and hospice care for patients across the lifespan, with a goal to expand opportunities for students to experience palliative and end-of-life simulation scenarios and to engage with community partners for additional clinical experiences. Additionally, faculty and students are engaging in End-of-Life Nursing Education Consortium (ELNEC) activities as part of the current coursework.

Finally, Rood, who is working toward her Certified Hospice and Palliative Nurse (CHPN) certification and has completed a Train-the-Trainer course through ELNEC, would love to see Decker College offer an advanced graduate certificate in palliative and hospice care.