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Sriranganathan N, Morris D, Campbell L, Hift R. Palliative care in the emergency department: An observational study of doctors in KwaZulu-Natal. S Afr Fam Pract (2004) 2024; 66:e1-e6. [PMID: 38708747 PMCID: PMC11079381 DOI: 10.4102/safp.v66i1.5860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND The World Health Organization advocates the early, appropriate provision of palliative care (PC) to patients throughout the life course. Patient consultations to the emergency department (ED) have been recognised as opportunities to initiate or optimise their PC needs. This study aimed to assess the knowledge of and attitudes towards PC among doctors at emergency physician staffed EDs in KwaZulu-Natal, South Africa. METHODS A cross-sectional survey was conducted between November 2021 and February 2022 for doctors employed out at emergency physician staffed EDs in KwaZulu-Natal, South Africa, using the validated Palliative Care Attitude and Knowledge questionnaire. The variables assessed were the self-rated and basic knowledge and attitudes towards core domains of PC. Ordinal data were compared using the t-test or ANOVA as appropriate, using MedCalc® Statistical Software version 22.009. RESULTS Of the 39 participants, the scores for the knowledge questions showed that 15.3% participants had good knowledge, 53.8% had fair knowledge and 30.7% had poor knowledge. Participants had either favourable (58.8%) or an uncertain (41.0%) attitude towards PC. No correlation was seen between the knowledge and attitudes scores (Spearman's rho = 0.13, 95% CI -0.19 to 0.43, p = 0.43). CONCLUSION There appears to be a deficit in knowledge of PC among doctors in the ED and a need for in-service training in PC for emergency care physicians.Contribution: This study provides new knowledge around PC practices at EDs in KwaZulu-Natal, South Africa.
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Affiliation(s)
- Nagaleswari Sriranganathan
- Department of Emergency Medicine, Division of Emergency Medicine, School of Clinical Medicine, University of KwaZulu-Natal, Durban.
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Esteban-Burgos AA, Moya-Carramolino J, Vinuesa-Box M, Puente-Fernández D, García-Caro MP, Montoya-Juárez R, López-Morales M. Clinical Simulation in Palliative Care for Undergraduate Nursing Students: A Randomized Clinical Trial and Complementary Qualitative Study. Healthcare (Basel) 2024; 12:421. [PMID: 38391797 PMCID: PMC10888368 DOI: 10.3390/healthcare12040421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND a lack of adequate training in palliative care leads to a greater emotional burden on nurses. PURPOSE to assess the effect of a simulation using standardized patients on self-efficacy in palliative care, ability to cope with death, and emotional intelligence among nursing students. METHODS a randomized clinical trial and qualitative study. A total of 264 nursing students in a palliative care module completed the Bugen, trait meta-mood, and self-efficacy in palliative care scales after active participation in the simulation (n = 51), watching the simulation (n = 113), and the control group (n = 100). An ANOVA with a multi-comparative analysis and McNemar's tests for paired samples were calculated. Active participants were interviewed, and a thematic analysis was conducted. RESULTS there was an improvement after the assessment in all three groups assessed for coping with death (p < 0.01), emotional intelligence (p < 0.01), and self-efficacy (p < 0.01). In addition, the active group improved more than the observer group and the control group in coping with death, attention, and repair. The students in the interviews identified sadness and an emotional lack of control. CONCLUSIONS the simulation improved nursing students' self-efficacy in palliative care. This effect was partially stronger in the active group.
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Affiliation(s)
| | - Jesús Moya-Carramolino
- Gynecological-Obstetrics Nursing Specialist Residence, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | | | - Daniel Puente-Fernández
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - María Paz García-Caro
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Mind, Brain and Behavior Research Institute, University of Granada, 18011 Granada, Spain
| | - Rafael Montoya-Juárez
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Mind, Brain and Behavior Research Institute, University of Granada, 18011 Granada, Spain
| | - Manuel López-Morales
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Primary Care Emergency Service, Andalusian Health System, 18013 Granada, Spain
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Mirhosseini S, Aghayan SS, Basirinezhad MH, Ebrahimi H. Health Care Providers' Attitudes Toward Do-Not-Resuscitate Order in COVID-19 Patients: An Ethical Dilemma in Iran. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:908-918. [PMID: 35042392 PMCID: PMC8792911 DOI: 10.1177/00302228211057992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study aimed to investigate the health care providers' attitudes toward the Do-Not-Resuscitate order (DNR) in COVID-19 patients. This study was conducted on 332 health care providers (HCPs) at the COVID-19 referral hospital in Shahroud, Iran by convenience sampling method. The study tools included a demographic information form and the DNR attitude questionnaire. Significance level was considered 0.05 for all tests. The mean scores of attitudes toward DNR order, the procedure of DNR, some aspects of passive euthanasia, and religious and cultural factors were 25.27 ± 2.78, 40.61 ± 5.99, 11.26 ± 2.51, and 6.12 ± 1.27, respectively. The death of relatives due to COVID-19 and female gender were associated with high and low scores of attitudes toward DNR order, respectively. Extended working hours and more work experience were correlated with high scores of DNR procedure. The history of COVID-19 increased the mean score of attitudes toward some aspects of passive euthanasia. In addition, an increase in following COVID-19 news decreased the score of religious and cultural factors affecting DNR order. Despite the legal ban on implementation of the DNR in Iran, the attitude of Iranian HCPs toward this was positive in COVID-19 patients.
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Affiliation(s)
- Seyedmohammad Mirhosseini
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Shahrokh Aghayan
- Department of Clinical Sciences, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Hasan Basirinezhad
- Department of Epidemiology and Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Ebrahimi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
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Zhang X, Xu T, Qin Y, Wang M, Li Z, Song J, Tang Q, Wang Z, Xu L, Wu L, Yue P. Exploring the needs and coping strategies of family caregivers taking care of dying patients at home: a field study. BMC Palliat Care 2023; 22:196. [PMID: 38087244 PMCID: PMC10714660 DOI: 10.1186/s12904-023-01315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Most Chinese patients chose to die at home, therefore there is a reliance on the family caregivers to be involved in their palliative care. The needs and coping strategies of family caregivers in home-based palliative care are rooted in culture. Little is known about the needs and coping strategies of family caregivers taking care of dying patients at home. METHODS A field study using semi-structured interview, participant observation, documents and records collection was employed. The study was conducted in two palliative care outpatient departments in tertiary hospitals and four communities in Beijing, China from March 2021 to July 2022. Using purposive sampling, twenty-five family caregivers were recruited. All collected data were analyzed using content analysis approach. RESULTS Five themes emerged, including three care needs and two coping strategies. Family caregivers need to learn care skills and acquire care resources, including (i) decision-making about home-based palliative care, (ii) improving patient's quality of life, and (iii) signs of final hours and funeral procedures. In facing the care burden, family caregivers coped by (iv) balancing the roles of caregivers and individuals: giving priority to patient care while maintaining their own normal life. In facing the death of a loved one, family caregivers responded by (v) making room for coming death by facing death indirectly and "rescuing" patients for consolation while preparing for the coming death. CONCLUSION Family caregivers strive to balance the roles of being caregivers and being themselves. As caregivers, they actively prepare patients for good death with no regrets. As individuals, they preserve themselves from being hurt to maintain normal life. The needs of family caregivers focus on caregiver role and are manifested in care skills and resources. TRIAL REGISTRATION Not registered.
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Affiliation(s)
- Xiaotian Zhang
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Tianmeng Xu
- Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China
| | - Yuan Qin
- Hospice & Palliative Care Department Ward of Beijing Haidian Hospital, Beijing, 100080, China
| | - Minghui Wang
- Puhuangyu community health center, Fengtai District, Beijing, 100079, China
| | - Zhaoyu Li
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Jingyu Song
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Qianqian Tang
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Zidan Wang
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Lijie Xu
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Lingling Wu
- Puhuangyu community health center, Fengtai District, Beijing, 100079, China
| | - Peng Yue
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China.
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Quintiens B, Smets T, Chambaere K, Van den Block L, Deliens L, Sallnow L, Cohen J. Discomfort With Suffering and Dying, a Cross-Sectional Survey of the General Public. J Pain Symptom Manage 2023; 66:529-540.e6. [PMID: 37437645 DOI: 10.1016/j.jpainsymman.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Abstract
CONTEXT Death and the process of dying have become increasingly medicalized and professionalized. The associated cultural estrangement from death may affect how comfortable we feel about death and dying. This study examines the general public's discomfort with another person's suffering and dying, and whether these feelings are associated with specific personal characteristics or experiences. OBJECTIVES Cross-sectional survey in a random sample of people aged 16 or older in four municipalities in Flanders, Belgium (N=4400). We used the self-developed construct Discomfort with someone's suffering and dying. A directed acyclic graph guided the development of a multivariable regression model which explored the effect of different variables on the main outcome measure. RESULTS A total of 2008 completed questionnaires were returned (response rate: 45.6%). Average discomfort with someone's suffering and dying was 3.74 (SD = 0.89). Being female or currently mourning a loss were associated with more discomfort. Not being religious, having better knowledge about palliative care, having worked in healthcare, having been with someone else at the time of their death and having been culturally exposed to death and dying were associated with less discomfort. CONCLUSION A considerable level of discomfort is present within the general public about the suffering and dying of others and this may increase social stigma and a tendency to avoid seriously ill people and their social surroundings. Our findings suggest that interventions may help shift this societal discomfort if they incorporate a focus on cultural and experiential exposure and increasing knowledge about palliative care.
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Affiliation(s)
- Bert Quintiens
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium.
| | - Tinne Smets
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Kenneth Chambaere
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium
| | - Libby Sallnow
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; St Christopher's Hospice (L.S.), London, UK; Marie Curie Palliative Care Research Department (L.S.), Division of Psychiatry, University College London, London, UK
| | - Joachim Cohen
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium
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Hou X, Li X, Guo R, Wang Y, He S, Yang H, Bai D, Lu Y. Knowledge and Practice Behaviors Toward the Care of the Dying Among Chinese Oncology Nurses: A Cross-Sectional Survey. J Hosp Palliat Nurs 2023; 25:E94-E101. [PMID: 37525347 DOI: 10.1097/njh.0000000000000967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
The quality of care provided to patients with cancer at the end of their lives remains unsatisfactory, especially during their last days and hours of life. This study aimed to investigate knowledge and practice behaviors of oncology nurses in relation to the care of the dying and to analyze the influencing factors. A convenience sample of 222 oncology nurses was recruited from 14 hospitals in Beijing, China, in January 2022. These nurses completed an online survey that included a demographic and work characteristics questionnaire and knowledge and practice behavior questionnaires regarding the care needs of dying cancer patients. The self-perceived knowledge and practice behavior of oncology nurses toward the care of the dying were found to be moderate. However, their understanding of airway management, restlessness, and delirium management was insufficient. In addition, their ability to effectively communicate recommendations for discontinuing unnecessary procedures, medications, treatments, and monitoring was inadequate. Nurses' previous end-of-life care education and experience of caring for dying patients influenced their knowledge. Nurses' practice settings, experience of caring for dying patients, and their knowledge were key factors in shaping their behaviors. Providing targeted continuing education for nurses in hospital settings and exploring the nursing pathway may be important ways to bridge their knowledge gap and enhance their practice behaviors toward caring for dying patients.
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Chiu AF, Huang CH, Chiu CF, Hsieh CM. Attitudes toward End-of-Life Resuscitation: A Psychometric Evaluation of a Novel Attitude Scale. Healthcare (Basel) 2023; 11:2618. [PMID: 37830655 PMCID: PMC10572246 DOI: 10.3390/healthcare11192618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
AIM With the advent of an aging society and the development of end-of-life care, there is an increasing need to understand the older generation's attitude toward end-of-life resuscitation. The study aimed to develop and validate a novel attitude scale toward end-of-life resuscitation in older inpatients. METHOD Instrumental development and a psychometric evaluation were used. First, a new attitude scale toward end-of-life resuscitation was formulated from literature views, expert content validity, and face validity. Next, the new scale was evaluated using a principal component analysis and internal consistency reliability in a sample from 106 medical-surgical inpatients in a southern Taiwan hospital 1 enrolled through convenience sampling. Serving as an indicator of concurrent validity, a logistic regression analysis was performed to analyze the association between scores on the scale and intention to discuss end-of-life CPR issues. RESULTS After being validated by the expert content validity and face validity, a draft of a 20-item scale was created. Throughout the exploratory factor analysis, two items with low factor loadings were removed from the draft scale and an 18-item scale of attitude was generated. This 18-item scale had a three-factor structure that accounted for 64.1% of the total variance; the three components were named 'stress, avoidance, and ignorance', 'a peaceful death', and 'self-determination and ambivalence'. The Cronbach's alpha of the total scale and three components were 0.845, 0.885, 0.879, and 0.857, respectively, which indicated a favorable reliability. Scores on the scale were significantly associated with the intention to discuss end-of-life CPR issues, which also indicated a favorable concurrent validity. CONCLUSIONS A 18-item attitude scale with three factors is a valid scale to measure the attitude toward end-of-life resuscitation. The result provides preliminary evidence of the psychometric properties of the scale. Further research with larger samples or other populations is required.
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Affiliation(s)
- Aih-Fung Chiu
- Department of Nursing, Meiho University, Pingtung 91202, Taiwan; (A.-F.C.); (C.-H.H.)
| | - Chin-Hua Huang
- Department of Nursing, Meiho University, Pingtung 91202, Taiwan; (A.-F.C.); (C.-H.H.)
| | - Chun-Fung Chiu
- Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
| | - Chun-Man Hsieh
- Department of Nursing, Tajen University, Pingtung 907101, Taiwan
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Rezaei Z, Nematollahi M, Asadi N. The relationship between moral distress, ethical climate, and attitudes towards care of a dying neonate among NICU nurses. BMC Nurs 2023; 22:303. [PMID: 37670308 PMCID: PMC10478422 DOI: 10.1186/s12912-023-01459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Nurses working in neonatal intensive care units play a crucial role in providing care to critically ill or premature neonates. However, is not without its challenges, particularly when it comes to making difficult ethical decisions about end-of-life care. In some cases, neonates do not survive despite the best efforts of medical professionals. The present study aimed to investigate the relationship between moral distress, ethical climate, and attitudes towards end-of-life care among nurses working in neonatal intensive care units. METHODS This is a descriptive-analytical cross-sectional study (May 21, 2021).The research population included 126 nurses working in neonatal intensive care units in Kerman province (Kerman, Jiroft, Bam, and Rafsanjan). Data collection tools included four questionnaires: demographic information, the Frommelt Attitudes towards Care of the Dying (FATCOD), the Hospital Ethical Climate Survey, and the Moral Distress Scale. SPSS22 was used to analyze the data. RESULTS The results revealed that the mean frequency and intensity of moral distress were 44.42 ± 17.67 and 49.45 ± 17.11, respectively. The mean ethical climate was 92.21 ± 17.52 and the FATCOD was 89.75 ± 9.08, indicating NICU nurses' positive perceptions of ethical climate and their favorable attitudes towards EOL care, respectively. The results showed a direct and significant relationship between ethical climate and the FATCOD (P = 0.003, r = 0.26). DISCUSSION We suggest policymakers and managers design strategies for better ethical climate in hospitals and reduction of moral distress among nurses.
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Affiliation(s)
- Zeinab Rezaei
- Department of Pediatric and Neonatal Intensive Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Neda Asadi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
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Li X, Kongsuwan W, Yodchai K. Attitude toward care of the dying and practice of peaceful end-of-life care in community hospitals in China. Int Nurs Rev 2023; 70:345-354. [PMID: 36580069 DOI: 10.1111/inr.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 11/08/2022] [Indexed: 12/30/2022]
Abstract
AIM To evaluate nurses' attitude toward caring for dying patients, their practice of peaceful end-of-life care in community hospitals, and the association between these two variables. BACKGROUND Community hospitals play an important role in the peaceful end-of-life care. For nurses, one of the key points of offering high-level care is to improve attitude. However, there are very few studies exploring how the attitude of nurses toward caring for dying patients relates to the practice of peaceful end-of-life care in community hospitals across China. METHODS A total of 363 questionnaires were included in this study. Simple random sampling was used to recruit participants from six community hospitals in China. A new instrument, Nurses' Practice of Peaceful End-of-Life Care Instrument (NP-PECI), was developed according to the Theory of Peaceful End of Life to assess the practice of nurses. Besides, Frommelt Attitudes toward Care of the Dying (FATCOD) was adopted to assess nurses for their attitude toward caring for dying patients. RESULTS The nurses' attitude toward caring for dying patients showed a significant positive correlation with their practice of peaceful end-of-life care statistically (r = 0.175, p < 0.01). CONCLUSION For community nurses, it is necessary to improve the attitude of nurses toward the practice of caring for dying patients, thus enhancing the outcome of peaceful end-of-life care. IMPLICATIONS FOR NURSING PRACTICE The Theory of Peaceful End of Life provides a theoretical framework and guideline on the practice of clinical nursing for quality control of peaceful end-of-life care, which is significant for improving the palliative care system. In the future, it is worth developing programs based on the Theory of Peaceful End of Life. IMPLICATIONS FOR NURSING POLICY For healthcare policy makers, this study can be helpful to refine the existing palliative care support policies and strategies targeted at community hospitals and their nurses.
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Affiliation(s)
- Xia Li
- Master of Nursing Science Student in Adult and Gerontological Nursing (International Program), Faculty of Nursing, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Waraporn Kongsuwan
- Associate Professor, Faculty of Nursing, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Kantaporn Yodchai
- Associate Professor, Faculty of Nursing, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
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Haroen H, Mirwanti R, Agustina HR, Pahria T, Harun H, Akuoko CP, Nadirawati N. A Qualitative Study of Perception and Experience Toward End-of-Life Care Among Nursing Students Who Witnessed Dying People in Their Family. J Multidiscip Healthc 2023; 16:2261-2270. [PMID: 37588170 PMCID: PMC10426403 DOI: 10.2147/jmdh.s423198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction This study aims to explore nursing students' perception and experience of end-of-life care (EoLC) in Indonesia, particularly in the family environment. Methods This study used a qualitative research design to explore the experiences and perceptions of nursing students who have witnessed the dying of their family members. The study recruited 15 nursing students using a purposive sampling method, who were then invited to reflect and write their experiences in witnessing death of their families, and perceptions towards EoLC. The written reflections were analyzed using thematic analysis. Results Thematic analysis showed that the experience of witnessing dying of a family member shaped nursing students' perceptions and attitudes towards EoLC. Some themes that emerged in this study included the importance of effective communication with patients and their families, symptom management, spiritual, emotional, and social support, as well as the need to improve nursing education and training. Conclusion This present study shows that the experience of witnessing the death of a family member shapes nursing students' perceptions of EoLC in Indonesia. This present study provides recommendations that the students must be prepared emotionally and psychologically in caring EoL or dying patients. How attitude and readiness to care EoL patients are shaped by the experience in witnessing the dying family or loved one. As such, palliative and EoL curriculum should be included methods that allow desensitization and naturalization of dying for the students in order to make them ready to provide better EoLC for patients and their families. The results of this study can contribute to improving the quality of EoLC in Indonesia.
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Affiliation(s)
- Hartiah Haroen
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Ristina Mirwanti
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Hana Rizmadewi Agustina
- Department of Fundamental Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Tuti Pahria
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Hasniatisari Harun
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Cynthia Pomaa Akuoko
- Department of Nursing and Midwifery, Faculty of Health and Applied Science, Christian Service University College, Kumasi, Ghana
| | - Nadirawati Nadirawati
- Nursing Sciences Program, Faculty of Health Science and Technology, Universitas Jenderal Ahmad Yani, Cimahi, Indonesia
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Maric D, Maric G, Jovanovic A, Maricic J, Ivanovic K, Pekmezovic T. Psychometric Properties of the Serbian Version of the Death Attitudes Profile- Revised (DAP-R) Instrument. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231181256. [PMID: 37269118 DOI: 10.1177/00302228231181256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Death Attitude Profile-Revised (DAP-R), one of the most widely used scales for assessing death attitudes is a multidimensional questionnaire capable of measuring a wide range of attitudes towards death. The aim of our study was to assess the reliability and validity of the Serbian version of the DAP-R. The study was conducted in October 2022 and included a total of 547 students of the Faculty of Medicine University of Belgrade (FMUB). Based on Cronbach's alpha coefficient values, our data show good reliability of the DAP-RSp (Serbian version). In our study, the confirmatory factor analysis showed a good fit of the data to the original factor structure with minor discrepancy; compared to the original version (five factors), our analysis yielded one more factor (six factors in total), however, almost all items had factor loading >0.3 on the appropriate scale.
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Affiliation(s)
- Dragana Maric
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gorica Maric
- Institute of Epidemiology, University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Aleksa Jovanovic
- Institute of Epidemiology, University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Jovana Maricic
- Institute of Epidemiology, University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Katarina Ivanovic
- Institute of Epidemiology, University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, University of Belgrade Faculty of Medicine, Belgrade, Serbia
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12
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Che SL, Li X, Zhu M, Ng WI. The Death Literacy Index: translation, cultural adaptation, and validation of the Chinese version. Front Public Health 2023; 11:1140475. [PMID: 37250081 PMCID: PMC10213892 DOI: 10.3389/fpubh.2023.1140475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Applying public health approaches to address palliative care allows for a broader perspective. The Death Literacy Index (DLI) is a novel instrument designed to assess the knowledge and skills required to access, comprehend, and make informed decisions regarding end-of-life care. Translation of the DLI could strengthen the capacity to build desirable services and policies regarding dying and death. It could also help to identify the barriers to services and future advocacy efforts. Methods The DLI was forward translated into Chinese and backward translated through two panels. Two rounds of cognitive interviews and a pilot test were conducted before the survey. A sample of 3,221 participants was recruited via an online survey in five cities in southern China (Guangzhou, Zhuhai, Jiangmen, Hong Kong and Macao) to evaluate the factor structure, validity and reliability of the translated DLI. Additionally, multi-group confirmatory factor analyses (MGCFA) were performed to examine measurement invariance across genders and the experiences of parental death. Results Exploratory factor analysis showed a six-factor structure for the translated DLI, and confirmatory factor analysis confirmed the structure. The overall scale and subscales had high internal consistency and satisfactory validity. The results from MGCFA showed that death literacy was adequately invariant for different genders and experiences of parental death. Conclusion The Chinese DLI is a reliable and valid instrument for measuring death literacy among people in southern China, and therefore can be used for both research and community practice.
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Affiliation(s)
- Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Xiang Li
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Wai I Ng
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
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Guo Z, Wu K, Shan H, Kim Y, He Q. Experience of chinese counter-marching nurses with COVID-19 patients' death in Wuhan: a qualitative study. BMC Nurs 2023; 22:141. [PMID: 37106366 PMCID: PMC10133906 DOI: 10.1186/s12912-023-01270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/26/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic was occurring worldwide with over a 6.5 million deaths. It's important to explore the instructions for the global nursing community by identifying the personal coping methods of Chinese nurses in Wuhan to deal with patient deaths. METHODOLOGY The study used a qualitative conventional content analysis with 14 Chinese Counter-marching nurses. Purposive sampling, snowball sampling, and semi-structured interviews were used for participants and data collection. To assess the quality of the findings, Guba and Lincoln's criteria for confidence were fulfilled. RESULTS The data analysis results in 4 main categories:(1) psychological shocks related to COVID-19 patient's death; (2) personal psychological adjustment and demands; (3) insights on life and values; (4) Needs for relevant knowledge and skills. CONCLUSIONS During the outbreak of the epidemic or pandemic, adequate psychological care resources need to be provided to nurses when facing the death of infectious patients, to reduce the negative emotions brought by death. Effective coping strategies should also be formulated to enhance their resilience and promote their professional competence.
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Affiliation(s)
- Zhifang Guo
- College of Nursing, Dali University, Dali, China
| | - Kunli Wu
- Department of Infection Disease, Kunming Third People's Hospital, Kunming, China
| | - Huibin Shan
- People's Hospital of Dali Bai Autonomous Prefecture, Dali, China
| | - Younglee Kim
- Department of Nursing, College of Natural Science, California State University, San Bernardino, CA, 92407, USA
| | - Qilian He
- College of Nursing, Dali University, Dali, China.
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Alkhamees N, Zaidi U, Ibrahim ZM, Bakry H, Suaigar S, Alosaimi B. Attitudes of Female Health Science Students and Recent Graduates toward the Care of the Dying in Saudi Arabia. Am J Hosp Palliat Care 2023; 40:256-263. [PMID: 35570800 DOI: 10.1177/10499091221102546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Positive and professional attitude of health professionals toward the palliative care issues of patients is crucial and challenging for fresh graduates. This study aimed to explore the perspectives of health science graduates about providing care for dying patients and their families. METHODS In this cross-sectional study, graduates of the College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Saudi Arabia (n = 113) have participated. The FATCOD -B scale was used to measure the attitude of health science graduates toward the care of patients and their families on a 5-point Likert scale. Data was collected through survey research forms. RESULTS Significant associations of graduates' attitude toward care of the dying patient with age, department, religious beliefs, education and experience (p = .05) were found. On the scale of caring for the dying patients' families, religious beliefs and education (p = .05) were significant. Furthermore, multiple linear regression confirmed the predictive relationship of religious beliefs, education, and experience (R2 = .342, F = 11.021, p = .000) with graduates' attitudes toward patient care. In comparison, education (R2 = .068, F = 1.541, p = .183) was the predictor of participants' attitudes towards care of the patients' families. CONCLUSION There is a dire need to focus on palliative care in the formal curriculum for all the health sciences disciplines. It is highly recommended to utilize case scenarios and simulation practice skills during the academic year to prepare students before the internship year. On-job counselling sessions can be helpful to increase the positive attitude of young Health graduates while working with dying patients and their families.
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Affiliation(s)
- Nouf Alkhamees
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, 112893Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Uzma Zaidi
- Department of Health Sciences, College of Health and Rehabilitation Sciences, 112893Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - ZiZi M Ibrahim
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, 112893Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Huny Bakry
- Department of Health Sciences, College of Health and Rehabilitation Sciences, 112893Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Shahad Suaigar
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, 112893Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Bashaier Alosaimi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Lv T, Li L, Wang H, Zhao H, Chen F, He X, Zhang H. Relationship between Death Coping and Death Cognition and Meaning in Life among Nurses: A Cross-Sectional Study. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231158911. [PMID: 36803151 DOI: 10.1177/00302228231158911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
To explore nurses' ability to cope with death and its relationship with death cognition and meaning in life in the context of Chinese traditional culture. 1146 nurses from six tertiary hospitals were recruited. Participants completed the Coping with Death Scale, the Meaning in Life Questionnaire, and the self-made Death Cognition Questionnaire. Multiple regression analysis revealed that the search for meaning, the understanding of "good death", receiving education related to life-and-death, cultural aspect, the presence of meaning, and the number of patient deaths experienced in career explained 20.3% of the variance in the ability to cope with death. Lacking a correct understanding of death, nurses are not sufficiently prepared to deal with death and their ability to cope with death is influenced by the unique cognition of death and the sense of the meaning in life in the context of Chinese traditional culture.
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Affiliation(s)
- Tingting Lv
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Lezhi Li
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Huiping Wang
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hong Zhao
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Fengzhi Chen
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiachan He
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Huilin Zhang
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
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Turnbull M, Yu C, Wu XI. Practitioner accounts of end-of-life communication in Hong Kong, Mainland China and Taiwan: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 106:31-41. [PMID: 36273978 DOI: 10.1016/j.pec.2022.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Communication at the end-of-life (EOL) is complex and multidimensional. Although culture is acknowledged as a key influence, there remains a gap in knowledge about intracultural aspects of EOL communication in the Chinese context. This review presents a synthesis of practitioners' accounts of communication at the EOL in Hong Kong, Mainland China and Taiwan. METHODS This review was registered prospectively on PROSPERO (CRD42021297052). Five databases were systematically searched using the terms 'communication', 'End-of-Life', 'Hong Kong', 'China' and 'Taiwan'. Empirical research published between 2015 and 2021 was downloaded and appraised. Fifteen articles were included in the review. RESULTS Findings highlight the influence of Chinese culture and philosophy, inadequate communication skills training and psychological support for practitioners and legislative and organisational factors. CONCLUSION Education and training for practitioners and public education about the EOL needs strengthening. Enhanced understanding of how culture influences EOL communication will strengthen service delivery and enhance awareness in multicultural communities. PRACTICE IMPLICATIONS EOL workers need practical and workplace-based support to engage in meaningful communication practices. The influence of culture and the readiness of patients and families to engage in communication are also important considerations.
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Affiliation(s)
- Margo Turnbull
- Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Carol Yu
- Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | - Xiaoyan Ivy Wu
- Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
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Ghazanfari MJ, Karkhah S, Shahroudi P, Mollaei A, Niksolat M, Foolady Azarnaminy A, Emami Zeydi A. A Systematic Review and Meta-analysis of Attitudes of Iranian Nurses and Related Factors Towards End-Of-Life Care. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221133496. [PMID: 36254820 DOI: 10.1177/00302228221133496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This meta-analysis aimed to summarize the evidence regarding attitudes of Iranian nurses and related factors towards end-of-life (EOL) care. PubMed, Web of Science, Scopus, Magiran, Iranmedex, Scientific Information Database, and Google Scholar search engine were searched using Persian and English appropriate keywords from the earliest records up to September 11, 2020. A total of 849 nurses were included in six studies. After a meta-analysis of the mean score of nurses' attitudes, the pooled mean was 80.07 out of 120 (Q(5)=4.32, I-squared=0.00%; 95%CI: 73.53-86.60; p < 0.001). Marital status, ward type, education level, a history of participating in EOL care workshops, personal study of EOL care, experience of caring for a dying family member or close people, natural and approach acceptance, fear of death, and professional autonomy had a significant positive relationship with nurses' attitudes towards EOL care. Therefore, further large-scale studies considering potential confounding variables are needed to confirm our findings.
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Affiliation(s)
- Mohammad Javad Ghazanfari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Samad Karkhah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Parinaz Shahroudi
- Department of Surgical Technology, Guilan University of Medical Sciences, Rasht, Iran
| | - Aghil Mollaei
- Student Research Committee, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Niksolat
- Firoozabadi Clinical and Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Foolady Azarnaminy
- Department of Anesthesiology and Ccritical Care Medicine, Social Security Organization Hospital, Ardabil, Iran
| | - Amir Emami Zeydi
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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Cao W, Li C, Zhang Q, Tong H. Perceptions on the current content and pedagogical approaches used in end-of-life care education among undergraduate nursing students: a qualitative, descriptive study. BMC MEDICAL EDUCATION 2022; 22:553. [PMID: 35842629 PMCID: PMC9288025 DOI: 10.1186/s12909-022-03625-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND With the aging of the population, high rates of cancer and comorbidity complexity, the end-of-life care for patients will be ever more important. Nurses have always played an essential role in end-of-life care. Insufficient education and training in end-of-life care has been regarded as a major reason of inadequate symptom recognition, symptom management, and communication which results in mental trauma for both the patient's family and attending health care providers. Undergraduate nurses do end-of-life care as part of their clinical learning. However, undergraduate nurses' perceptions of the education they received about end-of-life care are not documented. OBJECTIVE This study aimed to critically explore the current state of education regarding end-of-life care from the perspectives of undergraduate nurses. METHODS We used a descriptive qualitative design. Face-to-face semi-structured interviews were conducted from May to August 2020, with a purposive sample of 15 fourth-year undergraduate nurses who finished the internship. Data were transcribed verbatim and analyzed using content analysis. FINDINGS Three main themes relating to undergraduate nurses' experiences of end-of-life care education emerged from the thematic analysis: 1) Universities provide foundational knowledge about end-of-life care, but it still needs improvement; 2) Clinical practice consolidates and drives undergraduate nurses' knowledge, skills and confidence about end-of-life care; and 3) cultural attitudes of patients' family toward disease and death sometimes impedes learning and knowledge translation about end-of-life care. CONCLUSION Undergraduate nursing students benefit from not only theoretical content delivered in the university setting but also practice happened on clinical placement. The current undergraduate curriculum, related to end-of-life care, is disjointed. Meanwhile, undergraduate nurses' learning and knowledge translation of end-of-life care are impeded by cultural attitudes toward disease and death.
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Affiliation(s)
- Wenjing Cao
- Nursing School, Xiangnan University, Chenzhou, Hunan, China
| | - Chunyan Li
- Nursing School, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Qianqian Zhang
- Nursing School, Xiangnan University, Chenzhou, Hunan, China
| | - Huiru Tong
- Foreign Language Department, Guangxi University of Chinese Medicine, Nanning, Guangxi, China.
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Perception of Medical Students on the Need for End-of-Life Care: A Q-Methodology Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137901. [PMID: 35805560 PMCID: PMC9265334 DOI: 10.3390/ijerph19137901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 12/04/2022]
Abstract
End-of-life care and the limitation of therapeutic effort are among the most controversial aspects of medical practice. Many subjective factors can influence decision-making regarding these issues. The Q methodology provides a scientific basis for the systematic study of subjectivity by identifying different thought patterns. This methodology was performed to find student profiles in 143 students at Cantabria University (Spain), who will soon deal with difficult situations related to this topic. A chi-square test was used to compare proportions. We obtained three profiles: the first seeks to ensure quality of life and attaches great importance to the patient’s wishes; the second prioritizes life extension above anything else; the third incorporates the economic perspective into medical decision-making. Those who had religious beliefs were mostly included in profile 2 (48.8% vs. 7.3% in profile 1 and 43.9% in profile 3), and those who considered that their beliefs did not influence their ethical principles, were mainly included in profile 3 (48.5% vs. 24.7% in profile 1 and 26.8% in profile 2). The different profiles on end-of-life care amongst medical students are influenced by personal factors. Increasing the clinical experience of students with terminally ill patients would contribute to the development of knowledge-based opinion profiles and would avoid reliance on personal experiences.
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Abu-Odah H, Molassiotis A, Liu JYW. Assessment of the Educational and Health Care System-Related Issues From Physicians' and Nurses' Perspectives Before Developing a Palliative Care Program Within the Palestinian Health Care System: A Cross-sectional Study. J Hosp Palliat Nurs 2022; 24:E59-E75. [PMID: 35085161 DOI: 10.1097/njh.0000000000000840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A scarcity in research assessing the palliative care (PC) educational and health care system-related issues has been reported in the Middle East region; the region comprises a wide range of economically diverse countries. Discrepancies across countries have created difficulties in adopting other countries' experiences. This study aimed to assess PC knowledge, attitude, educational needs, and health care system-related issues from physicians' and nurses' perspectives before developing PC services within the Palestinian health care system. One hundred sixty-nine professionals participated in this cross-sectional survey. Data were collected by validated instruments. Professionals had insufficient knowledge about PC, but they had positive attitudes toward end-of-life care and care of the dying. Patients'/families' avoidance of talking about issues around dying and lack of training for staff related to PC were the most 2 significant barriers to providing PC. Educational level and previous training were found to be associated significantly with knowledge and attitudes toward PC. Study conclusions support the recommendation for integration of education about PC within the health curricula and in-service training and should cover the basic and advanced principles of PC and symptom management.
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Chen L, Li XH, Pan X, Pan QN, Huang HQ, Tao PY, Li GY, Ma JH, Huang JC. Nurses' knowledge, attitudes, and willingness to practice hospice care: An analysis of influencing factors. PLoS One 2022; 17:e0259647. [PMID: 35202415 PMCID: PMC8870562 DOI: 10.1371/journal.pone.0259647] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hospice care is a multidisciplinary approach that focused on patients’ quality of life, and nurses allocate more of their time with patients and patients’ families than those nurses working in other disciplines. Nurses’ knowledge of and attitudes toward hospice care can affect the quality of hospice care. At present, China’s hospice care institutions are suffering from an obvious shortage of nursing staff. Since clinical nurses are the main force behind the future provision of hospice care, their knowledge of, attitudes and willingness to practice can greatly promoted the growth of hospice care, however, available data on clinical nurses’ willingness to practice hospice care are limited. Methods A cross-sectional descriptive study design was employed to collect data from 1833 nurses working in tertiary or secondary general hospitals in Guangxi, China. We examined nurses’ demographic characteristics and scores on the Chinese version of the hospice care knowledge scale, the Chinese version of the Bradley Attitude Assessment Questionnaire, and a brief quiz concerning their willingness to practice hospice care in the future. Descriptive, single factor, multiple regression analyses and logistic regression analyses were used for data analysis. Results Nurses displayed moderate mean scores for both knowledge of and attitudes, and only 505 (27.5%) nurses expressed their willingness to practice hospice care, 1329 (72.5%) of nurses sampled expressed their unwillingness or uncertainty. Multivariate regression analyses showed that education, professional qualification, monthly income, whether they had been trained in hospice care, and willingness to practice hospice care were the main influencing factors of knowledge; education, whether they lived with someone aged >60 years, and whether they had been trained in hospice care were main factors influencing attitudes. Additionally, logistic regression analyses showed that hospice care knowledge, whether they had been trained in hospice care, and whether they had clinical experience affected the nurses’ willingness to practice hospice care. Conclusion This study highlighted a knowledge gap and moderate attitudes toward hospice care among nurses, and most nurses did not prefer to practice hospice care. Having been trained in hospice care was the main common factor of nurses’ knowledge of, attitudes toward, and willingness to practice hospice care in the future, indicating the necessity to provide nurses with more targeted hospice care training.
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Affiliation(s)
- Lin Chen
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao-Hong Li
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Pan
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qi-Ni Pan
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hui-Qiao Huang
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- * E-mail: (HQH); (PYT)
| | - Pin-Yue Tao
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- * E-mail: (HQH); (PYT)
| | - Gao-Ye Li
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guxngxi, China
| | - Jin-Hui Ma
- Department of Nursing, The Fifth People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jing-Can Huang
- Department of Nursing, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
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Zahran Z, Hamdan KM, Hamdan-Mansour AM, Allari RS, Alzayyat AA, Shaheen AM. Nursing students' attitudes towards death and caring for dying patients. Nurs Open 2021; 9:614-623. [PMID: 34729934 PMCID: PMC8685863 DOI: 10.1002/nop2.1107] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/12/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Aim To examine the attitudes of undergraduate Jordanian nursing students towards death and caring for dying patients. Design A cross‐sectional correlational design. Methods The Frommelt Attitude Toward Care of the Dying and Death Attitude Profile‐Revised scales were used in this study with a convenience sample of 555 students from nursing schools in Jordan. Results Nursing students had positive attitudes towards death (M = 153.7, SD = 21.5) and a positive attitude towards caring for dying patients (M = 98.1, SD = 9.2). Fear of death, escape acceptance and death avoidance were significant negative predictors, while neutral acceptance, higher academic level and female gender were significant positive predictors of caring for dying patients (F = 4.5). Conclusion Nursing students had positive attitudes towards caring for dying patients that was influenced by university type, academic level and gender. Nursing education must further focus on death, dying and end‐of‐life care across the core courses of nursing curricula, theory and practicum.
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Affiliation(s)
- Zainab Zahran
- Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
| | | | | | - Rabia S Allari
- Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
| | | | - Abeer M Shaheen
- Community Health Nursing Department, School of Nursing, University of Jordan, Amman, Jordan
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Liu Q, Zheng Z, Chen J, Tsang W, Jin S, Zhang Y, Akinwunmi B, Zhang CJ, Ming WK. Health Communication About Hospice Care in Chinese Media: Digital Topic Modeling Study. JMIR Public Health Surveill 2021; 7:e29375. [PMID: 34673530 PMCID: PMC8569548 DOI: 10.2196/29375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospice care, a type of end-of-life care provided for dying patients and their families, has been rooted in China since the 1980s. It can improve receivers' quality of life as well as ease their economic burden. The Chinese mass media have continued to actively dispel misconceptions surrounding hospice care and deliver the latest information to citizens. OBJECTIVE This study aims to retrieve and analyze news reports on hospice care in order to gain insight into whether any differences existed in heath information delivered over time and to evaluate the role of mass media in health communication in recent years. METHODS We searched the Huike (WiseSearch) news database for relevant news reports from Chinese mass media released between 2014 and 2019. We defined two time periods for this study: (1) January 1, 2014, to December 31, 2016, and (2) January 1, 2017, to December 31, 2019. The data cleaning process was completed using Python. We determined appropriate topic numbers for these two periods based on the coherence score and applied latent Dirichlet allocation topic modeling. Keywords for each topic and corresponding topics' names were then generated. The topics were plotted into different circles, and their distances on the 2D plane was represented by multidimensional scaling. RESULTS After removing duplicated and irrelevant news articles, we obtained a total of 2227 articles. We chose 8 as the suitable topic number for both study periods and generated topic names and associated keywords. The top 3 most reported topics in the first period were patient treatment, hospice care stories, and development of health care services and health insurance, accounting for 18.68% (178/953), 16.58% (158/953), and 14.17% (135/953) of the collected reports, respectively. The top 3 most reported topics in the second period were hospice care stories, patient treatment, and development of health care services, accounting for 15.62% (199/953), 15.38% (15.38/953), and 14.27% (182/953), respectively. CONCLUSIONS Topic modeling of news reports gives us a better understanding of the patterns of health communication about hospice care by mass media. Chinese mass media frequently reported on hospice care in April of every year on account of a traditional Chinese festival. Moreover, an increase in coverage was observed in the second period. The two periods shared 6 similar topics, of which patient treatment outstrips hospice care stories was the most reported topic in the second period, implying the humanistic spirit behind the reports. Based on the findings of this study, we suggest stakeholders cooperate with the mass media when planning to update policies.
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Affiliation(s)
- Qian Liu
- School of Journalism and Communication, National Media Experimental Teaching Demonstration Center, Jinan University, Guangzhou, China.,Department of Communication, University of Albany, State University of New York, New York, NY, United States
| | - Zequan Zheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jingsen Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Winghei Tsang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Shan Jin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, China
| | - Yimin Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Babatunde Akinwunmi
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States.,Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Casper Jp Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
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Tang ML, Goh HS, Zhang H, Lee CN. An Exploratory Study on Death Anxiety and Its Impact on Community Palliative Nurses in Singapore. J Hosp Palliat Nurs 2021; 23:469-477. [PMID: 34183589 DOI: 10.1097/njh.0000000000000782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurses working in palliative care settings encounter death and dying regularly and face a greater risk of developing death anxiety and negative attitudes than their counterparts. Such distress and apprehension can cause care fatigue and affect patients' quality of life. Death anxiety remains an underresearched area in Asia, where death and dying are still considered taboo. This study explored death anxiety and its impact on community palliative nurses in Singapore and was conducted at a community hospital in Singapore from January to June 2018. Purposive sampling was used to recruit 16 nurses of different job grades for the face-to-face interviews, which were transcribed verbatim and analyzed using the data analytical approach of Miles et al. Four overarching themes were generated: (1) intrinsic factors influencing death anxiety, (2) extrinsic factors influencing death anxiety, (3) emotional struggles and coping, and (4) need for death education and psychological support. Gaps in palliative care education and death education need to be contextualized to increase the community palliative nurses' awareness and acceptance of death and enhance their death literacy in a multicultural setting.
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Chang T, Darshani S, Manikavasagam P, Arambepola C. Knowledge and attitudes about end-of-life decisions, good death and principles of medical ethics among doctors in tertiary care hospitals in Sri Lanka: a cross-sectional study. BMC Med Ethics 2021; 22:66. [PMID: 34039321 PMCID: PMC8152188 DOI: 10.1186/s12910-021-00631-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Competent end-of-life care is an essential component of total health care provision, but evidence suggests that it is often deficient. This study aimed to evaluate the knowledge and attitudes about key end-of-life issues and principles of good death among doctors in clinical settings. METHODS A cross-sectional study was conducted among allopathic medical doctors working in in-ward clinical settings of tertiary care hospitals in Sri Lanka using a self-administered questionnaire with open- and close-ended questions as well as hypothetical clinical scenarios. Univariate and logistic regression analysis were used to identify the independent factors associated with knowledge and attitudes. RESULTS Of the responders who had not been a caregiver for a terminally ill relative (n = 390), 57.9% were men with a mean age of 36.5 years (SD = 8.2). Compared to undergraduate (65.6%; n = 256), only 27.4% (n = 107) had received end-of-life care training at postgraduate level. Only 65.9% of doctors favoured disclosing terminal prognosis to patients; 27.7% of doctors were aware of advance directives; 14.6% were aware of the correct time of death when certifying brain death; 70.3% felt more comfortable in withholding than withdrawing life-sustaining treatment; 61.3% were aware of do-not-attempt cardiopulmonary resuscitation (DNACPR) decisions while 26.7% felt reluctant to administer it; 15.1% thought that all life-sustaining therapy should be withdrawn with a DNACPR decision; and only17.9% were able to name the four principles of medical ethics while 57.9% could not name a single. Participants scored a mean of 9.2 (SD = 3.9) of a maximum 14 points when tested on principles of a 'good death'. Doctors who had pursued postgraduate studies were more likely to be aware of breaking bad news (adjusted-Odds-Ratio:1.99; 95%CI = 1.19-3.32), advance directives (adjusted-OR: 4.15; 95%CI = 2.49-6.94), aware of certifying the correct time of death (adjusted-OR:2.37; 95%CI = 1.33-4.2) and less reluctant to make DNACPR decisions (adjusted-OR:1.74; 95%CI = 1.13-2.68). Doctors who had worked in ICU were more comfortable withholding than withdrawing treatment (adjusted-OR:1.99; 95%CI = 1.2-3.31). CONCLUSIONS Knowledge and attitudes about end-of-life care, good death and principles of medical ethics among doctors in Sri Lanka were suboptimal. Structured training of end-of-life care needs to be integrated within curricula and in-service training.
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Affiliation(s)
- Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka.
| | - Saumya Darshani
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka
| | - Pavithra Manikavasagam
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Hidalgo-Andrade P, Mascialino G, Miño D, Mendoza M, Marcillo AB. Knowledge of Palliative Care in Ecuador. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094840. [PMID: 33946620 PMCID: PMC8124347 DOI: 10.3390/ijerph18094840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 01/29/2023]
Abstract
Palliative care is a holistic approach to care for people with chronic, advanced, and life-threatening illnesses. It improves the quality of life of patients and their caregivers. However, there is still limited access to palliative care in many countries. Knowledge about palliative care is key to increase its availability. Thus, this article aimed to explore the knowledge of the general population about palliative care in Ecuador. The study had a descriptive cross-sectional design. Through snowball sampling, between September 2019 and January 2020, 257 people completed an anonymous online questionnaire about general and specific aspects of palliative care. Descriptive and ANOVA analyses indicate that people have many misconceptions about palliative care and how it should be provided. Gender, education, training, occupation, and experience as caregivers were related to the total level of knowledge about palliative care. Regression analyses show other variables as predictors of knowledge. This study highlights the lack of knowledge about specific issues within palliative care in the general population in Ecuador. It also shows the need to develop and implement education measures to fill these gaps and enhance access to palliative care in health systems.
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Zhang X, Clarke CL, Ding R. The experience of bereavement on family caregivers of people with dementia in China. DEMENTIA 2021; 20:2235-2247. [PMID: 33666539 DOI: 10.1177/1471301220988237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite many studies on 'life after care' for family caregivers with dementia in Western societies, little is known about the bereavement experiences of family caregivers in China. The aim of this study was to explore the experience of bereavement on family members of people with dementia in China. It also hopes to inform end-of-life care within communities, providing a theoretical basis for improving the quality of life of bereaved family caregivers. METHODS Interpretative phenomenological analysis approach was adapted for this study. Purposive sampling was used to recruit former family caregivers of people with dementia. Semi-structured in-depth interviews with 12 bereaved family caregivers were collected. Thematic analysis was used for data analysis. FINDINGS Five themes were identified: recalling the past life, lack of support, uncertainty of the future, social withdrawal and acceptance and release. CONCLUSION The experiences of bereavement on family members of people with dementia in China are socially and culturally complex. This article recommends that bereavement should be supported throughout the palliative process of community services and healthcare services. Providing all-round support and education on death and dying can help the family caregivers to pass through grief and help them to maintain their normal life.
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Affiliation(s)
- Xiubin Zhang
- School of Nursing, 12426Lanzhou University, Lanzhou, China
| | | | - Rong Ding
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Zheng ZH, Luo ZC, Zhang Y, Chan WCH, Li JQ, Pang J, Jia YL, Tang J. Hospice care self-efficacy among clinical medical staff working in the coronavirus disease 2019 (COVID-19) isolation wards of designated hospitals: a cross-sectional study. BMC Palliat Care 2020; 19:188. [PMID: 33302944 PMCID: PMC7726609 DOI: 10.1186/s12904-020-00692-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused more than 462,417 deaths worldwide. A large number of patients with severe COVID-19 face death in hospital. Hospice care is truly a philosophy of care that delivers patient-centred care to the terminally ill and their families. Hospice care could provide many benefits for patients, families, and for hospice caregivers. The aim of this study is to investigate hospice care self-efficacy and identify its predictors among Chinese clinical medical staff in COVID-19 isolation wards of designated hospitals. METHODS A cross-sectional design was used. The Hospice Care Self-Efficacy, Self-Competence in Death Work Scale, Positive Aspects of Caregiving, and Simplified Coping Style Questionnaires were administered between February and April 2020. A total of 281 eligible medical staff responded to the questionnaires, with a response rate of ≥78.9%. RESULTS The mean score of hospice care self-efficacy was 47.04 (SD = 7.72). Self-efficacy was predicted by self-competence in death work (B = 0.433, P < 0.001), positive aspects of caregiving (B = 0.149, P = 0.027), positive coping (B = 0.219, P < 0.001), giving hospice care to dying or dead patients before fighting against COVID-19 (B = -1.487, P = 0.023), occupational exposure while fighting against COVID-19 (B = -5.244, P = 0.004), holding respect for life and professional sentiment as motivation in fighting against COVID-19 (B = 2.372, P = 0.031), and grade of hospital employment (B = -1.426, P = 0.024). The variables co-explained 58.7% variation of hospice care self-efficacy. CONCLUSION Clinical nurses and physicians fighting COVID-19 reported a moderate level of hospice care self-efficacy during this pandemic. Exploring the traditional Chinese philosophy of life to learn from its strengths and make up for its weaknesses and applying it to hospice care may provide a new framework for facing death and dying during the COVID-19 pandemic. Continuous hospice care education to improve self-competence in death work, taking effective measures to mobilize positive psychological resources, and providing safer practice environments to avoid occupational exposure are also essential for the improvement of the hospice care self-efficacy of clinical nurses and physicians. These measures help caregivers deal effectively with death and dying while fighting against the COVID-19 pandemic.
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Affiliation(s)
| | - Zhong-Chen Luo
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - You Zhang
- School of Foreign Languages, Chongqing Medical University, Chongqing, China
| | - Wallace Chi Ho Chan
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Jian-Qiong Li
- School of Nursing, Chongqing Three Gorges Medical College, Tianxing Road, Chongqing, China
| | - Jin Pang
- Nursing Department, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yu-Ling Jia
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Jiao Tang
- School of Nursing, Chongqing Medical University, 1#, Medical College Road, Chongqing, 400016, China.
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