The relationship between death anxiety and attitudes toward the care of dying patient in nursing students

Spiritual Care and Death in Intensive Care from the Perspective of Nursing Students in Turkey: An Exploratory Mixed Study

This mixed methods research study aimed to determine spiritual care competencies and death anxiety levels of nursing students practicing in intensive care. The quantitative part of this study included 33 students while the qualitative part included 17 students. Nursing students' spiritual care competence was detected to be above medium and their death anxiety was high. Two themes emerged from the qualitative data collected through in-depth interviews with 17 nursing students: (a) Views on spiritual care competencies and (b) Views on death. These findings are significant to reduce nursing students' death anxiety, increase spiritual care competencies and the quality of patients' end-of-life care.

Examining nurses' death anxiety and attitudes toward caring for dying patients: a cross-sectional study in Turkey

Death anxiety may reduce the interaction between nurses and patients, causing nurses to focus more on the physical care needs of patients and ignore their psychosocial and spiritual needs. This study was conducted to examine nurses' death anxiety and attitudes toward caring for dying patients. The data were collected using an information form, the Thorson-Powell Death Anxiety Scale (TPDAS), and the Frommelt Attitudes Toward the Care of the Dying Scale (FATCOD). The mean TPDAS and FATCOD scores were 46.71 (14.48) and 104.97 (13.55), respectively, and it was determined that they had moderate death anxiety and positive attitudes towards the care of dying patients. Those working in intensive care and internal medicine clinics had more positive attitudes toward caring for dying patients compared with those working in surgical clinics. Those who reported having a strong faith had lower death anxiety.

The Death Café: Effectiveness of a hospice care educational program for nursing undergraduates based on LIFE experience-A qualitative study

BACKGROUND

Nursing students' knowledge of hospice care is limited to textbooks due to the inadequate education and training system in China and student's willingness to participate in hospice care.

OBJECTIVES

To deepen nursing students' understandings toward life and death, to improve their knowledge about hospice care, and to promote their willingness for hospice care practice.

DESIGN

This study used a qualitative descriptive study design.

SETTINGS

The study was conducted at a medical university in Sichuan province, China.

PARTICIPANTS

71 nursing sophomores participated in this study.

METHODS

The Death Café teaching program was implemented which requires students to recall their memories about death and to imagine how they felt about dying, as if they were having a conversation in a death-themed café. During the implementation phase, a small-group interactive teaching approach was utilized. During the reflection phase, the students were asked to finish an essay answering four questions without standard right answers. The essays that students finished were used for evaluating the effectiveness of the Death Café program. The answers of the first two questions were presented as a word cloud. Graneheim and Lundman's qualitative content analysis method was used to analyze answers of the third and fourth questions.

RESULTS

Word cloud analysis indicated that at the beginning of the program participants showed more negative emotions (i.e., fearful). Students' attitudes toward death changed from negative to positive through imagining death when role-playing the different stages of life. The program enhanced students' understanding of life and taught the students effective ways to cope with death. Students clarified the objectives and necessary preparation for providing hospice care and gained new understandings for improving their hospice skills.

CONCLUSIONS

The Death Café program can address students' negative emotions and perceptions of death. Students gained personal benefits and professional benefits of coping with life and death from the program.

Exploring the variations in death anxiety among oncology nurses in China: a latent class analysis

BACKGROUND

Various factors have been found to be associated with high levels of death anxiety experienced by oncology nurses. The aim of this study was to use a person-oriented approach to examine the death anxiety patterns of Chinese oncology nurses and to analyze the differences in anxiety characteristics and their associated influencing factors.

METHODS

A cross-sectional survey regarding palliative care among registered oncology nurses was conducted in Jiangsu Province, China.Latent class analyses was applied to identify their patterns of death anxiety. The score of PCQN-C (The Chinese version of the Palliative Care Quiz for Nursing) and FATCOD-B-C (The Chinese version of the Frommelt Attitude Toward Care of the Dying scale), the demographic and working characteristics were further analyzed through covariance analysis (ANCOVA) and multivariate (or logistic) regression across the subgroups.

RESULTS

A two-potential-category model was selected based on the fit index. The results showed that 79% of oncology nurses belonged to the high pressure and pain group and 21% belonged to the low death anxiety group. The high pressure and pain group had significantly higher scores in the dimensions of emotion, stress and pain, time awareness, and cognition compared to the low death anxiety group. Factors influencing the high pressure and pain group included shorter working years, non-national or provincial oncology nursing specialists, non-national palliative care specialists, never discussing the topic of death with patients or family members, no palliative care related training, and PCQN and FATCOD scores.

CONCLUSIONS

Our study suggests that oncology nurses' death anxiety can be divided into two categories: low death anxiety and high stress pain, and certain factors, such as being female, having a short work experience, and lacking palliative care-related training, increase the likelihood of death anxiety.

Longitudinal Follow-Up of Death Anxiety and Psychophysical-Symptom Experience of Participants in the Silent Mentor Program

This study assessed death anxiety (Death Anxiety Questionnaire, DAQ) and psychophysical- (psychological and physical) symptom experience following cadaveric dissection among the Silent Mentor Program (SMP) participants before thawing (T1), after the suturing, dressing and coffining session (T2), and one month post-program (T3). There was a significant decline in the total DAQ score comparing T1 and T2 (t = 7.69, p < 0.001) and T2 and T3 (t = 5.00, p < 0.001) and T1 and T3 (t = 10.80, p < 0.001). There was a significant reduction in total psychological-symptom score comparing T1 and T2 (t = 4.92, p < 0.001) and between T1 and T3 (t = 4.85, p < 0.001). However, for the physical-symptom experience, a significant increase in the physical-symptom score between T1 and T2 (t = -3.25, p = 0.001) was reported but the scores reduced significantly one month after the program (T2-T3; t = 4.12, p < 0.001). The mentoring concept of the SMP program has beneficial effects on improving attitude towards death and psychophysical-symptom experience associated with cadaver dissection.

The Relationship Between the Levels of Thanatophobia and the Attitudes Towards the Care of Dying Patients Among Student Nurses

This study aims to examine the relationship between the levels of thanatophobia and the attitudes towards the care of dying patients among student nurses. It is descriptive, cross-sectional, and correlational. 140 student nurses studying at the faculty of health sciences of one foundation university participated in it. We collected research data using 'Defining Features of a Student Nurse Form', 'Frommelt Attitude Toward the Care of the Dying Scale', and 'Thanatophobia Scale'. 17.1% of student nurses were deeply affected by death in the last year and 38.6% stated that a patient they cared for died during their internship. The thanatophobia scale scores of student nurses who chose their profession willingly were higher on a statistically meaningful level than those participants who did not choose their profession willingly. We found a statistically significant (p < .05) difference between the FATCOD scale scores of interns and their gender, family type, having been affected by death, and willingness to care for dying patients. We suggest that nursing students should more often provide care to dying patients before graduation.

Death Anxiety and Associated Factors Among Oncology Nurses and Physicians

Background: Providing care for dying patients is a stress-inducing, complicated, as well as essential responsibility for health care providers. Furthermore, end-of-life care is associated with intense personal emotions such as grief, anxiety, depression, frustration, and guilt. Moreover, caring for terminally ill patients is a challenging task that confronts physicians and nurses with the psychological concerns of dealing with death, which is accompanied by a high level of physical and psychological discomfort.Objective: This study was aimed to measure the level of death anxiety among oncology nurses and physicians and to determine the associated factors that influence their level of death anxiety.Method: A cross-sectional descriptive design was used to guide this study, a non-probability convenience sampling method was used to recruit 200 oncology nurses and physicians from one specialized cancer center in Jordan. Data were collected using an electronic self-reported questionnaire include demographic data sheet and Collett-Lester fear of death scale, as well as all participants were invited via email for voluntary participation in this study.Result: The results revealed that the oncology nurses and physicians exhibited a moderate levels of death anxiety (CLDFODS = 91.07), furthermore, the result showed that female nurses and physicians exhibited a higher level of anxiety than male. Further, there were statistically significant differences in nurses' and physicians' level of death anxiety according to years of experience, receiving previous education on death and dying, and religious beliefs. On the other hand, there is no statistically significant differences in nurses' and physicians' level of death anxiety based on present or previous experience with loss of someone close to them.Conclusion: Jordanian oncology Nurses and physicians exhibited a moderate levels of death anxiety and fear of death, therefore, they have to address the inevitability of mortality since they are caring for dying patients frequently. They have to understand and acknowledge their thoughts regarding death and dying, as well as their death anxiety level before interacting with dying patients.

An Investigation of the Relationship Between Attitudes Towards Caring for Dying Patients and Compassion

The study aims to investigate the relationship between nurses' attitudes towards caring for dying patients and compassion levels. This cross-sectional study was conducted with the volunteer participation of 130 nurses working in various clinics in a hospital located in eastern Turkey between March and June 2019. Data were collected through the Socio-demographic Form, the Frommelt Attitude toward Care of Dying Scale (FATCOD), and the Self-Compassion Scale (SCS). A statistically significant difference was found between nurses' education level and compassion level (p < 0.01). A significant difference was found between the units where they were working and attitude towards caring for dying patients (p < 0.01). A positive, statistically significant relationship was found between the FATCOD total score and SCS total score (p < 0.01). A significant relationship between the compassion level and attitude toward caring for dying patients is an important finding for nurses, who encounter death frequently.

"Do Not Protect Us, Train Us."-Swiss Healthcare Students' Attitudes Toward Caring for Terminally Ill Patients

Positive attitudes and a sense of competence toward end-of-life care are the key to adequately support terminally ill patients. This qualitative study aims to explore healthcare students' attitudes toward caring for terminally ill patients. Eleven students from the University of Applied Health Sciences in Switzerland participated in focus groups. Attitudes were overall positive. Most participants felt that supporting dying patients was a way to achieve professional fulfillment. However, most students felt not competent in palliative care and lacking experience. They wanted to receive better training, more specifically in good practices and appropriate behaviors. Our study fills a knowledge gap regarding the opinions and pedagogical needs of healthcare students, and highlights the importance of experiencing end-of-life care during the educational process. We recommend early exposure to terminally ill patients and appropriate attitudes toward death and dying as part of the bachelor's curriculum, accompanied by benevolent guidance from teachers and health professionals.

A meta-analysis of nursing students' knowledge and attitudes about end-of-life care

OBJECTIVES

To synthesize nursing students' knowledge and attitudes about end-of-life care and to identify strategic directions for optimizing end-of-life care education.

DESIGN

A meta-analysis of observational studies.

DATA SOURCES

PubMed, Web of Science, EMBASE, CINAHL, PsycINFO, MEDLINE, CNKI, and WANFANG 8 electronic databases in English and Chinese were systematically searched from inception until 10 April 2022.

REVIEW METHODS

Two reviewers independently screened literature and extracted data using structured tables. The Agency for Healthcare Research and Quality (AHRQ) was used to appraise the methodological quality of included studies. The study outcomes were synthesized using a meta-analysis.

RESULTS

26 cross-sectional studies of medium or high quality from 13 countries met the eligibility criteria, involving 9749 nursing students. In our review, nursing students demonstrated insufficient knowledge about end-of-life care, with a pooled mean score of 7.50 (95 % CI: 6.55-8.45); of these, knowledge about philosophy and principles, psychosocial and spiritual care, and pain and symptom management were all deficient, with pooled mean scores of 1.49 (95 % CI: 0.78-2.21), 1.00 (95 % CI: 0.35-1.65), and 3.44 (95 % CI: 2.25-4.63), respectively. Conversely, nursing students showed positive attitudes toward end-of-life care, with a pooled mean score of 102.97 (95 % CI: 99.43-106.51). The subgroup analysis revealed that male nursing students had lower pooled mean scores for end-of-life care knowledge and attitudes.

CONCLUSION

There is a mismatch between nursing students' knowledge and attitudes about end-of-life care, they have a positive attitude but lack the necessary knowledge. Male nursing students seem to have a greater deficit of knowledge and a relatively conservative attitude toward end-of-life care. These findings may provide a significant reference for nursing educators to adjust educational strategies promptly.

Investigation of The Relationship Between Nursing Students' Fear of Death and Their Perceptions of Patient Care

Amaç: Bu araştırma hemşirelik öğrencilerinin yaşadıkları ölüm korkusu ile hasta bakım algıları arasındaki ilişkinin incelenmesi amacıyla gerçekleştirilmiştir. Yöntem: Araştırma kesitsel, tanımlayıcı ve ilişki arayıcı tipte olup araştırmanın örneklemini, Ekim-Kasım 2021 tarihleri arasında bir üniversitenin hemşirelik bölümünde öğrenim gören 326 öğrenci oluşturmuştur. Verilerin toplanmasında, ‘Kişisel bilgi formu’, ‘Ölüm korkusu Ölçeği’ ve ‘Bakım Davranışları ölçeği-24’ kullanılmıştır. Veriler yüz yüze toplanmış olup form ve ölçeklerin doldurulması ortalama 15 dakika sürmüştür. Bulgular: Çalışmaya katılanların çoğunun 280’inin (%85,9) kadın olduğu, 179’unun (%54,9) ölmekte olan hasta bakımı ile ilgili bilgi kaynaklarını okuduğunu, 245 öğrencinin (%75,2) çevresinde ölüm olgusuyla karşılaştığı, 306’sının (%93,9) yaşam sonu dönemde olan hastaya bakım verme deneyiminin olmadığı ve 175’inin (%53,7) ölümden korktuğu belirlenmiştir. Cinsiyete bağlı olarak kadınların hem ölüm korkusunun hem de yaşam sonu hasta bakımı hemşirelik algılarının, BDÖ-24 Ölçeği alt boyutlarından bağlılık ve saygılı olma alanlarında daha yüksek puan aldıkları belirlenmiştir. Yaşam sonu dönemde bir hastaya bakım verme deneyimi olmayan hemşirelik öğrencilerinin, ölüm korkusu ve bakım davranışları arasında anlamlı bir fark olmadığı belirlenmiştir (p&gt;0,05). Sonuç: Hemşirelik öğrencilerinin hemşirelik bakım algıları yüksektir. Kadın öğrencilerin hem ölüm korkuları hem de hemşirelik bakımı algıları erkeklerden yüksek olarak bulunmuştur. Yaşam sonu dönemde olan hastaya bakım verme deneyimi olmayan hemşirelik öğrencilerinin daha fazla güvence verme algısına sahip oldukları belirlenmiştir. Öğrencilerin yaşam sonu dönemde olan hastaya güvence verme algılarının yüksek olması açık bir şekilde yaşam sonu hemşirelik bakımı konusunda yetersiz bilgiye sahip olduklarını göstermektedir. Bu nedenle lisans eğitimi boyunca yaşam sonu dönem hasta bakımı ve ölüm korkusu konularında müfredatta daha fazla başlığın ve eğitim metodlarının yer almasının gerekli olduğu düşünülmektedir.

Perception of Death in Intensive Care Nurses

Amaç: Bu araştırma yoğun bakım ünitelerinde ölümü yaklaşan hastalara bakmanın stresli deneyimini yaşayan hemşirelerin, ölüm ile ilgili görüşlerinin neler olduğunu, bu hastalara bakmanın ölüm algılarını nasıl etkilediğini, benzetmeler ve çizimler aracılığıyla nitel olarak incelenmesini amaçlamaktadır. Gereç ve Yöntem: Araştırmaya toplam 40 yoğun bakım hemşiresi dahil edilmiştir. Araştırma verileri nitel veri toplama yöntemlerinden görüşme yöntemi kullanılarak toplanmış ve görüşmelerden elde edilen verilerin analizinde içerik analizi yöntemi kullanılmıştır. Bulgular: Araştırmada hastaların ölümü karşısında yoğun bakım hemşirelerinin algıları; bedensel, duygusal, ruhsal, bilişsel ve davranışsal; ölümü yaklaşan hastaya verilen bakımın amacı, fiziksel, psikolojik ve manevi; hemşirelerin kendi ölümlerini algılamaları ise kabullenme, kaçış ve korku temaları altında sunulmuştur. Sonuç: Çalışmada hemşirelerin ölüm ve ölümü yaklaşan birey ile karşılaştıklarında ölüm karşısında üzüntü ve korku hissettikleri, bakım esnasında ise en çok yetersizlik ve çaresizlik yaşadıkları saptanmıştır. Tüm bu bulgular sonucunda ölüm ile sık karşılaşan yoğun bakım hemşirelerinin kendi duygularını fark ederek uygun bireysel baş etme mekanizmaları geliştirebilmesi ve ölüme ilişkin olumlu tutum sergilenmesi için hizmet içi eğitimler planlanması önerilebilir.

The Relationship Between the Attitudes of Nursing Students Towards Providing Care for a Dying Patient and Their Empathic Tendencies

This study was planned to determine the relationship between the attitudes of nursing students towards death and dying patients and their empathic tendencies. This study was conducted with a descriptive and correlational design. The research was completed with 176 students. Positive significant relationship found between between the FATCOD and ETS scores. It was observed that a 1-point increase in the Empathic Tendency Scale score caused an increase of 0.502 points in the FATCOD score. İt is recommended providing training sessions with simulation applications for nursing students to prepare them for end-of-life care experiences.

A Death and Dying Class Benefits Life and Living: Evidence From a Nonrandomized Controlled Study

Humanistic theorists have long emphasized the importance and benefits of death awareness (Yalom, 1980) yet the literature on death education has focused on fear and anxiety. In the present study, 150 undergraduate students taking either a class on death and dying or a comparison class completed a pre and post-questionnaire on attitudes (negative and positive), values (intrinsic and extrinsic) and eudaimonic wellbeing (meaning in life and vitality). Results revealed that compared to their peers in another class, students studying death and dying significantly increased in death acceptance, intrinsic values, meaning in life, and vitality. Furthermore, increases in intrinsic values mediated the relationship between participation in death and dying education and meaning in life. Results are discussed in light of experiential learning, posttraumatic growth, and terror management.

'Who would even want to talk about death?' A qualitative study on nursing students' experiences of talking about death with terminally ill patients with cancer

OBJECTIVES

This study aimed to describe nursing students' experiences of talking about death with terminally ill patients with cancer.

METHODS

The study adopted a qualitative design, and participants (n = 28) were final-year undergraduate nursing students. Data were collected by conducting in-depth semi-structured face-to-face interviews using a pilot-tested interview guide. The researchers followed a systematic data analysis procedure which is an appropriate method of analysis when aiming to create knowledge based on experiences and meanings from cross-case analysis.

RESULTS

The responses of the nursing students were subsumed under the following three themes: (1) 'balance on the rope', (2) 'who would even want to talk about death' and (3) 'need to talk but …'. The findings suggest that many nursing students do not believe that they are competent enough to talk about death with terminally ill patients with cancer, even though they believe it is essential to end-of-life care.

CONCLUSION

The findings underscore the importance of examining students' perspectives on death, which not only shapes their experiences of caring for terminally ill patients but also influences the quality of care. Further, students feel unprepared for talking to terminally ill patients with cancer and require support to avoid ignoring calls to speak about death.

Italian nursing students' attitudes towards care of the dying patient: A multi-center descriptive study

BACKGROUND

International literature reports that nursing students feel unprepared when facing patients and families within dying care. They consider their curricula inadequate in teaching end-of-life care and promoting the attitudes required to care for dying patients. Findings of recent studies exploring nursing students' attitudes towards care of the dying patient are often contradictory.

OBJECTIVES

To explore Italian nursing students' attitudes towards caring for dying patients.

DESIGN

A multicenter cross-sectional study was conducted.

SETTINGS

The Bachelor's Degree in Nursing courses of four Universities of the Lazio Region.

PARTICIPANTS

The sample included 1193 students.

METHODS

Data were collected between September 2017 and March 2018 using the Italian version of FATCOD-B-I. The differences between the mean scores were compared through t-test or ANOVA. Associations between scores and participant characteristics were evaluated through generalized linear regression.

RESULTS

The mean score of FATCOD-B-I was 115.3 (SD = 9.1). Higher scores were significantly associated with training in palliative care (p < 0.0001) and experience with terminally ill patients (p < 0.0001). Students manifested more negative attitudes when they perceived patients losing hope of recovering, and patient's family members interfering with health professionals' work. Uncertainties emerged around knowledge of opioid drugs, decision-making, concepts of death and dying, management of mourning, and relational aspects of patient care.

CONCLUSIONS

Italian nursing students seem to have more positive attitudes towards care of dying patients than most other countries. They believe that caring for a terminal patient is a formative, useful experience but they do not feel adequately prepared in practice. Deeper palliative care education, integrated with practical training, would prepare students better, enabling them to discover their own human and professional capacity to relieve suffering.

Factors affecting attitudes towards caring for terminally ill patients among nursing students in Switzerland: a cross-sectional study

OBJECTIVES

Positive attitudes towards end-of-life care are essential among nursing students to adequately support terminally ill patients and enable students to feel confident about providing end-of-life care. This study aimed to determine nursing students' attitudes towards caring for terminally ill patients, as well as the associations between these attitudes and year of study, exposure to terminally ill people, self-perceived nursing skills and subjective impact of instruction.

DESIGN

Cross-sectional study.

SETTING

A health sciences school in Switzerland.

PARTICIPANTS

All preparatory students, first-year nursing students and third-year nursing students were invited to participate; 178 agreed to participate.

PRIMARY OUTCOME MEASURE

Attitudes towards terminally ill patients were assessed using the Frommelt Attitudes Toward Care of the Dying Scale, Form B (FATCOD, Form B), as the primary outcome. Secondary measures were gender, age, year of study, number of terminally ill persons encountered, self-perceived palliative care nursing skills and subjective impact of instruction.

RESULTS

Mean FATCOD, Form B score was 117.7 (SD: 9.8, median: 118.0). Better attitudes towards terminally ill patients were significantly associated with being aged 24-26 years (β=6.97, 95% CI 2.00 to 11.95, p=0.006), year of study (β=3.47, 95% CI 1.69 to 5.25, p<0.001), professional encounters with terminally ill patients (β=3.59, 95% CI 2.23 to 4.95, p<0.001) and self-perceived palliative care nursing competence (β=1.23, 95% CI 0.41 to 2.04; p=0.003). In the multivariate analysis, professionally encountering terminally ill patients remained significant (β=3.00; 95% CI 1.43 to 4.57; p<0.001).

CONCLUSIONS

Nursing students' attitudes towards caring for terminally ill patients were positive and improved as their year of study progressed. Professional exposure to terminally ill patients was the strongest factor, followed by private encounters, self-perceived palliative care nursing skills, year of study and age.