Passages
Nurse finds her niche in teaching, helping those bringing a new life into the world and those left behind when someone leaves it

By Phil McPeck
April 17, 2003

Karen Nilsen, RN, often draws on nursing in substantive ways, but never more emotionally than when she was able to tell an 11-year-old: "Honey, I'm a nurse. I work in a hospital and I can promise you that your cold, the germs from your cold, did not cause your grandpa's death. He was very, very sick and weak before he even went to the hospital."

The boy, who had been allowed to visit his dying grandfather in an intensive care unit, was participating in Nilsen's STAR class, a 30-minute session that prepares children to attend a funeral. STAR stands for Special Time to Always Remember.

Using her teaching experience as an obstetrics nurse, Nilsen developed the STAR program over several years at the family's Morris Nilsen Funeral Chapel in Richfield, Minn., and she now markets it to funeral homes around the country. Her company, What's a Funeral Anyway?, has about 40 clients.

Like many women of her generation, Nilsen, 52, said she felt she had two career choices: teacher or nurse. As it turned out, though, she was able to have her cake and eat it, too. "I chose to go into nursing and discovered I was a teacher," she said. "Most of my day in OB was spent teaching."

Among other things, Nilsen wrote a curriculum for breast-feeding for Abbott Northwestern Hospital in Minneapolis, which is known partly for its high-risk pregnancy cases. She said she remembers telling new mothers, "I have confidence in you that you have every skill you need to take care of this little baby," pointing out that the women had been bathing, dressing and feeding themselves since before they can remember.

And then came her favorite "trick": a tray containing perhaps 30 items: breast pumps, salves, etc. "I asked them to look at the tray and tell me which two things are necessary for successful breast-feeding," she said. After the mothers debated the possibilities, sometimes aloud, and choosing specific items, she'd let them in on the answer: The only things necessary for successful breast-feeding is the mother, the baby and a desire. "It really doesn't work too well if you're doing it because someone else wants you to," Nilsen said.

It was another OB class, though, that carried her to today's work.

"I taught new brother/new sister classes, which probably is what prepared me best for what I'm doing now, which is to sit on the floor with little ones and explain things," Nilsen said.

She is quick to point out that STAR classes are not grief therapy or counseling. Instead, they prepare children from preschool to early adolescence for the funeral of a loved one.

"With people living longer now, we sometimes skip a generation without a death in the family," Nilsen said. "Younger parents just simply don't know what to say to their kids. We expect them to just come in and behave. 'Sit still and be quiet' is what we hear a lot of parents saying, and kids have no clue what's going on," she said.

The theory behind STAR classes is the same as it is for pre-surgery patients. At some hospitals, children facing a procedure are allowed to come in beforehand, dress in doctor clothes, role play and prepare for what otherwise could be a frightening and difficult experience. That's the children's version of nurses and medical staff educating adults about what to expect before, during and after surgery.

With younger children, Nilsen explains that death means a body doesn't function anymore; it can't move, eat or feel. Her nursing education helps older children understand things they may have heard in connection with the deceased: Alzheimer's disease, cancer or terms such as aneurism or myocardial infarction.

STAR class participants create a frame for a picture of the deceased and, just before proceeding as a group to the funeral or visitation, the children write a message on a yellow, star-shaped paper that's often placed at the back of the casket for the service, Nilsen said.

"If they're allowed to express feelings, it usually comes straight from the heart," she said, using a wee voice to share one child's thoughts: " 'Dear Grandpa. I wish you didn't die.' "

Like nursing and teaching, "It's just as simple and honest as you can get," Nilsen said.