"I enjoy being with
freshmen students in Pre-nursing Seminar. The
students in this course are taking the art and science courses that are
prerequisites for nursing courses. Their excitement is contagious!"
Dr. Lynda Shand, R.N.
Associate Professor, B.S.N. Program
School of Nursing
Dr. Shand, what do you teach at
The College of New Rochelle?
I currently teach, or have taught, many different
courses in the School of Nursing. I enjoy being with freshmen students
in Pre-nursing Seminar. The students in this course are taking the arts
and science courses that are prerequisites for nursing courses. Their
excitement is contagious!
I teach Medical-Surgical
Nursing to senior students. This is the last theory and clinical course
before the final practicum. The clinical rotation requires the students
to care for multiple patients and provide expert evidence-based
clinical care and health teaching while functioning as part of the
unit-based interdisciplinary team. Each student also has an opportunity
to spend time with nurses in a home or hospital-based hospice or
palliative care organization. It is the time to refine critical
thinking and clinical skills.
When I teach the Senior
Practicum I have the opportunity to see the synthesis of four years of
scholarship and experience. The students work with a nurse in a
health care facility and assume responsibility for all aspects of
patient care. I am always impressed when I cannot differentiate the
students from regular staff members.
I am most energized when I teach the registered nurses
who are returning to college for their baccalaureate degree. These
students bring many years of professional nursing experience to this
educational endeavor and keep me on my toes.
is your specific interest in teaching and research?
My clinical, educational, and research interests are in
end of life care. Last year I had the opportunity to attend a
specialty course sponsored by Harvard Medical School. Forty health care
professionals from around the world attended the Program in Palliative
Education and Practice for an intensive week-long educational session
and six months of collaborative work on individual and group projects,
followed by an additional week-long session. My professional practice
has been in neonatal nursing when it was an emerging specialty,
pediatric oncology, and care of children who were HIV positive when
treatment options were limited. My nursing career has been in
palliative care. The Harvard PCEP program formalized years of clinical
practice and helped me formulate future professional and educational
is hospice and palliative care?
Hospice care is directed at providing relief to a person
at the end of life through symptom and pain management to provide
comfort and maintain the highest quality of life for as long as life
remains. The focus is not on death but on compassionate
specialized care for the individual and their family. The members
of the hospice team support the person and family through the dying
process and surviving family members through bereavement.
Hospice care can be provided to people wherever they
live-in a private residence, assisted living, a nursing home, or a
Palliative care embraces the hospice philosophy of care
and seeks to bring this approach to a wider group of persons than
currently served by hospice programs. Palliative care is not only
for the imminently dying but also for those wrestling with complex
clinical and personal decisions associated with an eventually fatal
illness. Specialized palliative care services can be offered in
conjunction with curative treatments to both seriously ill people and
those with advanced chronic illness in a broader range of settings,
including intensive care units.
Hospice and palliative care is given by a team of people
knowledgeable in end of life care. The team is made up of many
members including but not limited to: nurses, nursing assistants,
clergy and spiritual counselors, social workers, physicians,
pharmacists and volunteers. Additional team members will be asked
to assist with any special needs that the person and family may
have. The team communicates with the individual and family as
well as each other to assure that individual goals are being met.
The whole person is cared for including physical, emotional, social,
and spiritual needs.
Specialized care giving at the end of life exists for
conditions such as cancer. Hospice and palliative care services
may also support those with varying conditions such as heart, lung or
kidney disease, lupus, or Alzheimer’s disease. Both hospice and
palliative care teams seek to relieve symptoms of an illness but also
help the person and family reach personal goals, reconcile conflicts,
and derive meaning from their experiences at the end of life.
a nation, we have been overwhelmed with the tragic situation of Terri
Schiavo, what suggestions or advice would you give to people who might
be faced with such a family situation?
My suggestions would involve interventions to prevent
another family experiencing the heartache that we are witness to. There
must be intense, and recurrent, discussions on raising awareness and
initiating the process of completing advance directives that specify
how the individual would want their care managed if they were seriously
ill or at the end of their lives.
Do you think there should be a role for the government? It
appears that some in the Congress (on both sides of the issue) believe
that new laws on disability rights need to be written.
The government has already established laws that must be followed.
Changes proposed by individuals and constituencies must preserve the
balance between official standards broad enough to protect basic human
rights for all with individuality to preserve personal choice in
various situations and prevent the prevailing political ideology of the
moment to dictate intimate personal and family decisions.
do you think should have been done years ago with the Terri Schiavo
I have kept up with discussions in the media and
listened as people spoke, usually very passionately, about Terri’s
story. I know what my wishes for myself would be in a similar
situation. I do not feel that I can respond to the question, as posed,
because I do not think any one of us knows the details of a family
crisis that evolved over a decade and a half.
Discussions with students in the School of Nursing have
centered on the role of the nurse as central to helping people they are
caring for to navigate the healthcare environment to prevent a similar
devastating situation. The nurse must serve as the advocate for the
family in maintaining their physical, psychosocial, and spiritual
integrity. The nurse and interdisciplinary members of the health care
team must work with the person and family to enhance and maintain
communication and utilize all available resources to achieve the goals
of the individual in their care.
Students in the School of Nursing have the opportunity
to experience care giving in a hospice or palliative care setting. As
part of that experience, the students add to a journal that chronicles
their thoughts, feelings, and experiences about working with people at
the end of life. A recent entry exemplifies the essence of the current
“In the end, having your wishes met and made a reality
by caring and competent people is the greatest gift that those who love
you can give.”
Do you have any
suggestions where families might go today and find out more information
on such end of life situations?
Some resources available to initiate family discussions
in relation to health care choices are: