The effectiveness of 8A model death education on the reduction of death depression: A preliminary study

Nurses' self-regulation after engaging in end-of-life conversations with advanced cancer patients: a qualitative study

BACKGROUND

Self-regulation is crucial for nurses who engage in in-depth end-of-life conversations with advanced cancer patients, especially in cultural contexts featuring death taboos. An improved understanding of the self-regulation process of nurses can help them address negative emotions and promote self-growth more effectively. Therefore, this study aimed to explore nurses' self-regulation process after end-of-life conversations with advanced cancer patients.

METHODS

This study employed a descriptive, qualitative approach. Seventeen nurses from four hospitals and a hospice unit in mainland China were interviewed between September 2022 and June 2023. Data were collected through face-to-face semistructured interviews. A thematic analysis method was used to analyse the data following the guidance of regulatory focus theory.

RESULTS

Three main themes were developed: self-regulation antecedents include personality, experience, and support; promotion or prevention is a possible self-regulation process for nurses; both self-exhaustion and self-growth may be the outcomes of self-regulation, as did seven subthemes. Personality tendencies, life experience, and perceived support may affect nurses' self-regulation, thereby affecting their self-regulation outcomes.

CONCLUSIONS

Nurses exhibit different self-regulatory tendencies and self-regulation outcomes. The provision of peer support and counselling support to nurses is highly important with regard to achieving good self-regulation outcomes.

Advance Directives in Portugal: A Qualitative Survey

(1) Background: Advance directives (ADs) in Portugal have been legalized since 2012. What has been observed over time, from the few studies carried out, is that despite the positive attitudes in the population, there is a low level of adherence to ADs. To try to understand the reasons for these data, the current study aimed to explore and describe the experiences of the Portuguese population regarding AD. (2) Methods: For this exploratory and descriptive qualitative study, the researchers conducted open (unstructured) interviews with a convenience sample aged over 18 years until data saturation was achieved. (3) Results: A total of fifteen interviews were conducted-eight with women and seven with men. The following four categories emerged from the content analysis of the interviews: (1) AD literacy, (2) AD relevance, (3) AD attitudes, and (4) conditionalities for compiling the ADs. (4) Conclusions: The study pointed out the good receptivity of the participants to the ADs; however, literacy on this subject was low, and identifying the conditionalities in the development of ADs could contribute to improvements in implementation in the population. The data from this study suggest the need to implement measures to increase the literacy of the Portuguese population on ADs and review the legal framework for improving the accessibility of the citizen population. There is also a need to continue researching and obtain more evidence about the ways in which the Portuguese population perceives ADs; thus, in this way, a society can better respond to its citizens' right to freely exercise their prospective autonomy at the end of their lives.

Effects of a death education based on narrative pedagogy in a palliative care course among Chinese nursing students

Background

Death education has been confirmed to be an effective method to enhance nursing students' attitudes and coping abilities toward death. However, integrated Narrative Pedagogy into the death education to explore educational effectiveness is still limited. The study aimed to evaluate the effects of a death education based on Narrative Pedagogy in a palliative care course on the attitude toward death, coping with death, and attitude toward caring for the dying among undergraduate nursing students in China.

Methods

The study was designed as a pre-post intervention study with a quasi-experimental design. All the participants received 6 class hours of death education which was designed in a palliative care course. The death education includes preparation, presentation, discussion, reflection, and practice of the narrative materials. Death Attitude Profile-Revised (DAP-R), Coping with Death Scale (CDS), and Frommelt Attitude Toward Care of the Dying-Form B (FATCOD-Form B) were used to measure outcomes.

Results

Sixty undergraduate nursing students who consented. There were statistically significant increases in the mean score of neutral acceptance and approach acceptance in the DAP-R, CDS, and FATCOD-Form B before and after the intervention.

Conclusion

This death education integrated Narrative Pedagogy which indicated to improve attitude toward death, competence to cope with death, and attitude toward the care of dying patients. The findings assist teachers in understanding the importance and urgency of death education, as well as providing a favorable approach to death education. However, the long-term effectiveness still needs to study in further.

Experiences of Chinese advanced cancer patients after attending a "four-stage" death education programme: A qualitative study

PURPOSE

This study aimed to explore the experiences of cancer patients who participated in and completed a "four-stage" death education programme based on knowledge-attitude-practice theory.

METHODS

This study employed a qualitative descriptive design. Semistructured interviews with an interview guide were used to collect data. Fifteen cancer patients who participated in and completed the "four-stage" death education programme (from November 10, 2021, to December 29, 2021) were recruited via purposive sampling. The "four-stage" death education programme model was developed based on knowledge-attitude-practice theory and included eight death education modules. Each interview was audio-recorded and transcribed verbatim. Generic analysis was used to conduct data analysis by coding, classifying, and extracting themes.

RESULTS

Five themes were identified: the gradual shift of death cognition towards objective reality, a decrease in death anxiety, patients' early thoughts concerning issues related to death and preparation ahead of death, patients' improved ability to respond to death incidents, and patients' increased focus on cherishing the remainder of their lives and living in the moment.

CONCLUSIONS

Cancer patients accept and respond effectively to the implementation of a "four-stage" death education programme based on knowledge-attitude-practice theory. These findings can help cancer patients improve their reasonable perception of death and reduce their doubts and confusion concerning death.

Exploring the needs and barriers for death education in China: Getting answers from heart transplant recipients' inner experience of death

Background

Promoting reflection about death may support better living, and how to carry out death education is an important issue to be addressed across the world. The purpose of the current study was to explore the attitude of heart transplant recipients toward death and their inner real experience to provide information for the development of death education strategies.

Methods

A phenomenological qualitative study was conducted using a snowball method. A total of 11 patients who had undergone heart transplantation more than 1-year ago were recruited for the current study for semi-structured interviews.

Results

A total of five themes were identified: "Not avoid talking about death," "Feeling fear about the pain in the process of death", "Wanting a good death at the end of life," "The richness of feelings during near-death is surprising," and "Being close to death makes people more receptive to death."

Conclusion

Heart transplant recipients have a positive attitude toward death and wish for "good death" at the end of life. These patients' near-death experiences and positive attitudes toward death during the course of their illness provided evidence of the need for death education in China and supported the experiential approach to death education.

Health Education as a Means of Addressing Death in the Elderly

Education for death is an emerging field of study in which health education research and proposals are increasingly being made with the aim of acquiring knowledge and skills to promote positive attitudes towards health and preparation for the end of life. The aim of this study is to find out what experience older people have had with death education and the importance they give to health education. A qualitative methodological design was selected using a semi-structured interview. The survey consisted of interviews with 28 participants from the city of Granada (Spain) aged 61 to 78. This qualitative-descriptive study is based on an analysis of older people's experience of education and preparation for death throughout their lives. The results show that, in most cases, the only information received was in childhood and always from a religious perspective. Death and health are closely related, so working on death education helps to improve the quality of life of elderly people. Health education offers ways of coping with the end of life through the transmission of values and practices that make it possible to anticipate and resolve situations of instability or anxiety. Facing death naturally and as just another part of life will help to make healthy ageing possible, through educational proposals related to the integral health of elderly people.

Death depression in Egyptian clinical and non-clinical groups

Aim

The main aims of this study were to explore the differences between seven Egyptian clinical and non-clinical samples in death depression, as well as to estimate gender-related differences.

Design

A cross-sectional study.

Methods

The Death Depression Scale (DDS) was administered to seven groups (N = 765) of Egyptian normal (non-clinical) patients, anxiety outpatients, schizophrenic inpatients (men and women) and addicts (men only) in individual sessions.

Results

Anxiety outpatients of both sexes obtained significantly and greatly higher death depression scores than did the other five groups, whereas the male schizophrenics, the male addicts, and the male and female non-clinical groups had the lowest death depression scores. Female schizophrenics obtained a significantly higher death depression scores than did male schizophrenics, addicts and non-clinical participants. Female anxiety outpatients and schizophrenics had higher death depression mean scores than did their male counterparts.

Discussion

The present finding is consistent, in general, with previous studies on death anxiety and death obsession. What applied to death anxiety was consistent also with death depression and death obsession. That is, the death distress concept.

Reminiscence in the Face of Death of a Filipino Elderly With Substance Use Disorder: The Case of Burt

Death is an important reality that the elderly face. In preparation for death, old people engage in reminiscence. However, the presence of addiction in the elderly may influence this process. The current study examined the life of Burt, a sixty-five year old man with substance use disorder, his reflections on death, and the different types of reminiscence he uses. Using a case study, six themes were uncovered. Burt's reflections on death revealed his awareness of his death, how he plans to spend his dying days, and his idea of a symbolic death by losing his loved ones. Burt engages in reminiscence patterns that are composed of identity recollections, life milestones, and painful experiences. These themes were examined in order to understand how an elderly person with addiction prepares for his own death. Research limitations, recommendations, and implications in clinical practice and human development research are also discussed.

Social Support Moderates the Relationship Between Death Anxiety and Psychological Distress Among Israeli Nurses

Based on the stress-buffering model, the current study sought to examine the moderating role of perceived social support in the association between death anxiety and psychological distress among nurses. Select variables found in previous studies to correlate with psychological distress served in the current study as covariates to control for their relationship with psychological distress among nurses. These include gender, years of professional experience, self-rated health, self-efficacy, and self-defined burnout. Structured questionnaires were administered to a sample of 795 professionally active nurses in Israel. Psychological distress was assessed by the 6-item Kessler Psychological Distress Scale (K6), death anxiety was assessed by a single item scale designed by Abdel-Khalek, and perceived social support was assessed by the Multidimensional Scale of Perceived Social Support (MSPSS). The research findings show that higher levels of death anxiety were associated with higher levels of psychological distress only among nurses with lower levels of perceived social support. The study indicates that in order to reduce the level of distress experienced by nurses it is important to take action to reduce their death anxiety and enhance their social support mechanisms.

Death distress constructs: A preliminary empirical examination of the Farsi form in nurses: A brief note

Aim

Death distress can increase mental health problems. The aim of the present study was to develop a measure of death distress and evaluate the reliability of this Death Distress Scale-Farsi (DDS-F) among nurses. The hypotheses were that death distress has three components and that the DDS-F would have desirable psychometric properties.

Design

A descriptive cross-sectional study.

Methods

A convenience sample of 106 Iranian nurses from two hospitals at Tehran city, Iran was recruited. They completed the Death Anxiety Scale (DAS), the Death Depression Scale (DDS) and the Death Obsession Scale (DOS).

Results

Cronbach's α for the DDS-F was 0.71. As expected, the DDS-F had three independent components: death obsession, death depression and death anxiety. A principle component analysis with a varimax rotation of the DDS-F items identified three factors accounting for 66.13% of the variance. Factor 1 was labelled "Death Obsession" (31.3% of the variance), Factor 2 was labelled "Death Depression" (21.9% of the variance), and Factor 3 was labelled "Death Anxiety" (12.8% of the variance).

Discussion

Death distress has three components: death obsession, death depression and death anxiety. The DDS-F which measures these has good psychometric properties, and it can be used in hospital settings to assess death distress among Iranian nurses.