Journal of Nursing Education

Syllabus Selection: Innovative Learning Activity Free

Teaching Facilitation of Patient Choice at the End of Life

Ellen M. D'Errico, PhD, RN, NEA-BC

Teaching Strategy: “A Room, a Hat, and Panic Button”

The American Association of Colleges of Nursing’s baccalaureate essentials VIII and IX (2008) recommend that undergraduate nursing programs address ethical and moral patient issues related to end-of-life decision making and patient-centered, evidence-based care of the dying. Faculty completing the End-of-Life Nursing Education Consortium training are encouraged to use consortium materials to promote end-of-life education with students (American Association of Colleges of Nursing, 2010). The teaching strategy described in this article is a thought-provoking way to satisfy the intent of these requirements.

The exercise, “A room, a hat, and panic button,” involves reflective learning using the Neuman model’s five variables (physiological, psychological, sociocultural, developmental, and spiritual) relating to intrapersonal and interpersonal stressors common to dying patients. The goal of this exercise is to raise awareness regarding end-of-life issues, thus instilling an appreciation for and advocacy of patient choice. It can be used in courses that address care of the dying patient, such as undergraduate nursing fundamentals or medical–surgical nursing.

Description of Activity

Students complete the following pre-class homework assignment:

  • Draw a picture of a room where, if given a choice, you would like to spend your final moments of life.
  • Draw the hats that represent the people you would like to have around you.
  • Think about what would make you “push the panic button” if you knew the end of your life was very near, and draw a picture of it (Lo, 1996).

Students bring their drawings to class and split into groups of up to five members. If comfortable, they share their drawings and reflections with classmates. The groups have 8 to 10 minutes to discuss the exercise while a faculty member circulates through the classroom. When class is called to order, students clarify major findings and concerns. Discussion continues with the faculty member stating:

You all have varied and interesting preferences about what you want and what concerns you would have at the end of your life. Our patients have preferences and concerns, too. What advocacy role do nurses play at this important time of a patient’s life? What if the patient wants to be at home, but the family wants the patient in the hospital? How does culture affect patient autonomy regarding end-of-life preferences? What steps must the nurse take to insure good symptom control and emotional support when a patient is ‘pushing the panic button?’

Student Outcomes

Nurturing students’ spirit of empathy and advocacy for the needs of dying patients requires a heightened self-awareness and realization that, as part of the human family, our desires and fears about death and dying are not very different from the patients we serve. When students put themselves in the patient’s place by identifying their own personal end-of-life preferences (Table), they are more likely to remember such human commonalities when opportunities for end-of-life care encounters occur. If students can identify closely with patients, they may engage in more persistent advocacy actions. The exercise has generated many lively class discussions on end-of-life care issues and the crucial role nurses play in helping patients achieve a “good death.”

Major Themes of Student Preferences After End-of-Life Exercisea

Table: Major Themes of Student Preferences After End-of-Life Exercise

Ellen M. D’Errico, PhD, RN, NEA-BC
Loma Linda University


  • American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: Author.
  • American Association of Colleges of Nursing. (2010). Use of End-of-Life Nursing Education Consortium materials. Washington, DC: Author. Retrieved from
  • Lo, K. (1996). Care at the time of death. Largo, FL: The Hospice of the Florida Suncoast.

Major Themes of Student Preferences After End-of-Life Exercisea

Room (Where I want to be)My home, the ocean/beach, the mountains, a quiet and peaceful place in nature, a hospital, a hotel (e.g., the VIP room in Las Vegas)
Hat (Who I want with me)Family, friends, a nurse, clergy, pets, doctors, chef, God/angels, helpers (e.g., maid, comedian, masseuse, home aide, lawyer)
Panic Button (Why I would push it)Uncontrolled pain, respiratory distress, being alone, loss of control, unfinished business, watching my body shut down, not saying goodbye, leaving loved ones behind, seeing my loved ones sad, fear and anxiety


Sign up to receive

Journal E-contents