Nursing Student End-of-Life Care Attitudes After an Online Death and Dying Course:

The effectiveness of aesthetic care training on nurses' perceptions of end-of-life care in patients with cancer: a quasi-experimental study

BACKGROUND

Supportive end-of-life care plays a significant role for patients with cancer. Significantly, art and aesthetics in nursing are regarded as key components of nursing practice. They may contribute to supportive end-of-life care that nurses provide for patients with cancer. Therefore, this study aimed to examine the effectiveness of aesthetic care training on nurses' perceptions of end-of-life care in patients with cancer.

METHODS

A quasi-experimental study was conducted with two groups of nurses working in the oncology wards of two hospitals in Kerman, Iran. A sample consisting of 100 nurses was selected by census and randomly assigned to an experimental group (n = 49) and a control group (n = 51). The experimental group received educational workshops on aesthetic care over four weekly-held 90-minute sessions. Both groups completed the Oncology Nurses' Perceptions of End-Of-Life Care (ONPEoLC) Scale before, immediately after, and one month after the intervention. The data were analyzed with SPSS software version 21 using t-test, Chi-square, and repeated measures ANOVA. The significance level was set to p < 0.05.

RESULTS

The mean baseline scores on the ONPEoLC Scale were 163.08 ± 13.58 in the experimental group and 163.27 ± 14.57 in the control group. There was no statistically significant difference between the two groups (P > 0.05). Post-intervention mean scores in the experimental and control groups were 187.1 ± 18.22 and 159.11 ± 22.11, respectively, indicating a statistically significant difference between the two groups (P < 0.001). One month after the intervention, the experimental and control groups' mean scores were 190.89 ± 11.13 and 165.80 ± 11.69, respectively, with a significant difference between the groups (P = 0.001).

CONCLUSION

Based on the results of the present study, designing aesthetic care educational programs is an effective way to improve nurses' understanding of end-of-life care. Therefore, it is recommended that nursing faculties and educational policymakers utilize aesthetic care training to improve the nurses' perceptions of end-of-life care.

Increasing palliative care capacity in primary care: study protocol of a cluster randomized controlled trial of the CAPACITI training program

BACKGROUND

Primary care providers play a critical role in providing early palliative care to their patients. Despite the availability of clinical education on best practices in palliative care, primary care providers often lack practical guidance to help them operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to provide an early palliative approach to care. The entire program consists of 12 sessions (1 h each), divided evenly across three modules: (1) Identify and Assess; (2) Enhance Communication Skills; (3) Coordinate for Ongoing Care. We report the protocol for our planned evaluation of CAPACITI on its effectiveness in helping primary care providers increase their identification of patients requiring a palliative approach to care and to strengthen other core competencies.

METHODS

A cluster randomized controlled trial evaluating two modes of CAPACITI program delivery: 1) self-directed learning, consisting of online access to program materials; and 2) facilitated learning, which also includes live webinars where the online materials are presented and discussed. The primary outcomes are 1) percent of patients identified as requiring palliative care (PC), 2) timing of first initiation of PC, and self-reported PC competency (EPCS tool). Secondary outcomes include self-reported confidence in PC, practice change, and team collaboration (AITCS-II tool), as well as qualitative interviews. Covariates that will be examined are readiness for change (ORCA tool), learning preference, and team size. Primary care teams representing interdisciplinary providers, including physicians, nurse practitioners, registered nurses, care coordinators, and allied health professionals will be recruited from across Canada. The completion of all three modules is expected to take participating teams a total of six months.

DISCUSSION

CAPACITI is a national trial aimed at behavior change in primary care providers. This research will help inform future palliative care educational initiatives for generalist health care providers. Specifically, our findings will examine the effectiveness of the two models of education delivery and the participant experience associated with each modality.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05120154.

Evaluating end-of-life care capacity building training for home care nurses

BACKGROUND

With the rapidly aging population, the quality of end-of-life (EOL) care has become a significant issue. As the majority of deaths in Hong Kong (HK) currently occur in public hospitals, promoting palliative home care can relieve hospital burden and provide good deaths. There is a practical need to properly educate and train nurses on the skills to provide EOL care in home care settings.

OBJECTIVES

To evaluate the effect of the first EOL care training program for nurses working in home care settings or nursing homes on quality of life at work, orientation toward dying and death, and self-competence in death work.

DESIGN

A pre-experimental research design was utilized to conduct this study using a one-group pretest and posttest approach.

SETTINGS AND PARTICIPANTS

A convenience sample of 153 nurses working in home care settings or nursing homes in HK was selected.

METHODS

Participating nurses attended two-day entry-level and seven-day advanced-level courses. Quality of life at work, multidimensional orientation toward dying and death, and self-competence in death work were assessed using questionnaires at baseline and immediately after entry- and advanced-level training.

RESULTS

The results revealed that nurses reported a higher level of compassion satisfaction (d = 2.52, p < 0.001), less burnout at work (d = -3.25, p = 0.045), less fear about their own death (d = -1.33, p = 0.019), and more acceptance of others' deaths (d = 1.07, p = 0.004) in post-advanced-level courses. In general, participants were satisfied with the delivery method, duration, and logistical arrangement of the courses.

CONCLUSIONS

Nurses reported improved professional quality of life, less fear, and more acceptance toward death and dying after the training program. More educational strategies, such as role-play and case study discussions, are needed to improve the overall learning experience and effectiveness of the program. Future studies could add a qualitative component to yield deeper insights through the findings. As training programs allow nurses to cultivate their skills in clinical situations, there is an undeniable need to continue implementing standardized education and training for palliative care nurses to improve EOL care quality.

Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study

Background

End-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU).

Methods

This quasi-experimental study was conducted with a pretest–posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected based on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR).

Results

A significant difference was observed between the intervention and control groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P < 0.001). Moreover, the average performance score of nurses in the fields of preparation for providing palliative care, self-assessment of ability to communicate with dying patients and their relatives, self-assessment of knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (P < 0.001).

Conclusions

End-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.

What Intern Nursing Students in Turkey Think About Death and End-of-Life Care? A Qualitative Exploration

This descriptive qualitative study was planned to determine the views of intern nursing students about death and end-of-life care. The study was completed with 12 intern students based on the criterion of data saturation. As a result of the study, the categories of 'end,' 'uncertainty,' 'fear,' 'beginning,' 'helplessness' under the theme of death, 'ensuring peace,' 'continuing communication' 'providing psychosocial/spiritual support,' 'acting in conformity with principles of ethics/morality,' 'continuing to provide physical care,' 'supporting the family,' 'making the best use of the limited remaining time or helping the patient's last wishes come true' under the theme of end-of-life care emerged.

Effectiveness of end-of-life educational interventions at improving nurses and nursing students' attitude toward death and care of dying patients: A systematic review and meta-analysis

OBJECTIVES

To examine the effectiveness of end-of-life educational interventions in improving nurses and nursing students' attitude toward death and care of dying patients.

DESIGN

A systematic review and meta-analysis of randomized controlled trials and controlled clinical trials.

DATA SOURCES

English language studies were sourced from five electronic databases (PubMed, Embase, CINAHL, PsycINFO and ProQuest Dissertations & Theses Global) to November 2020.

REVIEW METHODS

A meta-analysis was conducted using the random-effect model. Standardized mean differences with 95% confidence intervals were used as the effect measure under the inverse-variance method. Heterogeneity was assessed using the I² statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool conducted quality appraisal at the study level while the Grades of Recommendation, Assessment, Development, and Evaluation approach conducted quality appraisal at the outcome level.

RESULTS

Nine studies were included. Meta-analyses showed that end-of-life educational interventions were effective in improving attitude toward death and care of dying patients among nurses and nursing students at post-intervention. The sustainability of improvement of both attitudes could not be determined due to the lack of follow-up assessments by the included studies. Subgroup analyses revealed that both nurses and nursing students showed similar attitude improvement, online educational courses were feasible and attitude toward death may require longer interventions (more than 2 months) to show improvement.

CONCLUSIONS

Future trials could be improved by organizing both group-based segments and combined sessions for nurses and nursing students. Online components could be incorporated for convenience. Topics related to spirituality and grief management should be included. Future research is needed to examine the sustainability of nurses and nursing students' improvement in attitude toward death and care of dying patients, as well as how the change in their attitude affects their clinical practices.

Undergraduate nursing students' palliative care knowledge and attitudes towards end-of-life care: a cross-sectional descriptive study

BACKGROUND

It is crucial that future nurses be prepared with the knowledge and skills to provide palliative care (PC).

AIMS

This study aimed to investigate Mongolian nursing students' PC knowledge and attitudes towards end-of-life (EOL) care, as well as identify related predictors.

METHODS

Participants were 141 students who enrolled in nursing program in Mongolia.

RESULTS

Mean Palliative Care Quiz for Nursing (PCQN) score was 7.15 out of 20. The mean Frommelt Attitudes Toward Care of the Dying (FATCOD) score was 64.2 out of 100. Older age, male gender, and higher satisfaction with nursing school were significant predictors of higher levels of palliative care knowledge. Living in traditional Mongolian housing (Ger) and having clinical EOL experience were significant predictors of positive attitudes towards EOL care.

CONCLUSIONS

Mongolian senior nursing students were inadequately prepared to provide PC. PC nursing education in Mongolia needs to be improved to meet an appropriate global standard.

The effect of creative drama education on first-year undergraduate nursing student attitudes toward caring for dying patients

BACKGROUND

Being faced with death and caring for dying patients is one of the most difficult aspects of the nursing profession. As they are the nurses of the future, it is important to prepare nursing students for this difficult role so that they are able to provide a qualified caring service. Ensuring nursing students are given a qualified education plays a key role in nursing education.

OBJECTIVES

This study was conducted to determine the effect of a creative drama education program on first year nursing students' attitudes toward caring for dying patients.

DESIGN

This study was designed according to a quasi-experimental model with a pretest-posttest control group.

SETTING

A medium-sized urban university school of nursing in Turkey.

PARTICIPANTS

Forty (n = 40) first grade Bachelor of Nursing Science (BSN) students.

METHOD

A personal data form, Frommelt Attitude Scale for Caring for Dying (FATCOD), and Individual Patient Feedback Form for Creative Drama Education were used to collect the study data. Data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test.

RESULTS

The intervention group's mean posttest FATCOD score (112.45 ± 8.43) was higher than that of the control group (105.35 ± 8.67), and this difference was found to be statistically significant (U = 111.500; p = 0.017). There was a non-significant difference between the intervention (97.90 ± 8.25) and control group (101.55 ± 7.41) in the pretests (U = 148.500; p = 0.163).

CONCLUSION

Compared with the expression technique, creative drama education was found to be a more effective method for developing students' attitudes toward caring for dying individuals.

Do Perceptions of Spiritual Care Affect Attitudes Towards Care for Dying Patients in a Group of Turkish Nursing Students?

The present study was designed to determine the relation between attitudes to death and perceptions of spiritual care in nursing students. It is a descriptive study and included 290 fourth-year nursing students (intern students). Data were collected with a descriptive characteristics form, Frommelt Attitude Towards Care of the Dying Instrument and Spirituality and Spiritual Care Rating Scale. SPSS version 21 was used for data analysis. There was a significant positive relation between the mean scores for Spirituality and Spiritual Care Rating Scale and Frommelt Attitude Towards Care of the Dying Instrument. It can be recommended that courses about death and spiritual care should be offered and integrated into nursing curricula.

Effect of Storytelling Technique on the Attitudes of Nursing Students Toward Death

This study was conducted to determine the effect of the storytelling technique on the attitudes of nursing students toward death as a mixed research design. The study sample consisted of 94 senior students attending the nursing department of a university in Turkey. Quantitative data were collected by using the introductory characteristics form and the Death Attitude Profile-Revised, while qualitative data were collected through focus group interviews with the semistructured interview form. The data were analyzed according to number, percentage, Wilcoxon test, paired samples ttest, and descriptive analysis method. The mean Death Attitude Profile-Revised Scale score of the students before receiving the relevant education was 4.17 ± 0.21. This score increased to 4.25 ± 0.24 after the students received the education and the difference was found to be statistically significant ( p < .05). In the qualitative section of the study, the data obtained from the attitudes of the students toward death were coded, and four themes were determined. The qualitative data obtained from the focus group interviews with the participating students were presented under four themes: the contribution of the storytelling technique to learning, the effect of the storytelling technique on the attitude toward death, thoughts about the storytelling technique, and contribution of the course to knowledge, skills and attitude in giving care to the dying patient. As a result of the study, explaining the subject of death with the storytelling technique was determined to positively affect the attitudes of the students toward death.

Person-centred end-of-life curriculum design in adult pre-registration undergraduate nurse education: A three-year longitudinal evaluation study

BACKGROUND

The need to provide quality end-of-life care is universally accepted. International research and policies encourage innovative ways that effective culturally appropriate care can be provided. Higher education institutions and practice settings are tasked with ensuring that nurse graduates have the knowledge, skills and insight to deliver person-centred end-of-life care.

RESEARCH AIMS AND OBJECTIVES

The aim was to explore student evaluation of end-of-life care learning within a three-year undergraduate adult nursing degree programme. Objectives were to assess student perceptions of the content and level of learning achieved, explore usefulness of learning, highlight areas that were most useful, and identify suggestions to improve learning.

DESIGN

A 3-year quantitative longitudinal design was used. A questionnaire containing open and closed questions was designed to incorporate the personal and professional learning strategies indicated by the Nursing and Midwifery Council (NMC) (2010).

SETTING AND PARTICIPANTS

The evaluation was completed at the same time point over a three-year period from April 2015-April 2017. The participants were year three student nurses, from 3 consecutive years, enrolled on a pre-registration adult nursing course at one university. There was a 66% response rate (n = 336).

METHODS

Participant information sheets and questionnaires were distributed and time to complete them facilitated. Responses from closed questions were coded and analysed using descriptive statistics (SPSS 24) and thematic analysis used for open questions.

RESULTS

Students expressed satisfaction with their learning, 88.7-97% of students reported a positive impact on their knowledge. They developed an understanding of the impact the nurse can have on the patient and family experience, reporting more confidence and competence in most aspects of end-of-life care. They noted improved ability to utilise this in their subsequent practice experience 88.1-97%.

CONCLUSIONS

Structured end-of-life care within the curriculum is essential to equip graduate nurses to provide effective evidence informed care. Planning should continue for curriculum development that encompasses person-centred end-of-life care across cultures.

Integration of a Hospice Clinical Experience: Nursing Students' Perceptions

Prelicensure nursing programs have been slow to integrate end-of-life care into their curricula. In those prelicensure nursing programs that do offer courses on end-of-life care, student outcomes include positive attitudes toward dying patients. This mixed-method study had 2 purposes: first to compare 2 teaching strategies, hospice simulation and hospice clinical. The second purpose of this study was to strengthen understanding of the attitudes and perceptions of nursing students caring for dying patients and their families in both simulated and hospice clinical settings. Fourth-year nursing students enrolled in a Medical-Surgical Nursing III course participated in the study (n = 134). Participants were placed in an inpatient hospice clinical setting or a hospice simulation. Students completed the Frommelt Attitudes Toward Care of the Dying Scale and a reflection journal, before and after the assigned clinical or hospice day. Thematic analysis of the reflection journals was conducted. Key phrases and themes were identified, and the major themes were described. Prior to the hospice clinical or simulated educational experience, students reported feeling anxious caring for a dying patient or a patient who has just died. After the hospice clinical or simulation, students reported feeling more comfortable discussing end-of-life preferences with the patient and interdisciplinary team.

Nursing students' relationships among resilience, life satisfaction, psychological well-being, and attitude to death

PURPOSE

This study attempted to examine the influence of resilience, life satisfaction, and psychological well-being on attitude to death.

METHODS

A predictive correlational design was used. The participants were 184 nursing students from three universities of Korea. They responded to a self-report questionnaire, with items on demographics, resilience, life satisfaction, psychological well-being, and attitude to death.

RESULTS

The mean score for attitude to death was 2.77±0.39 (range, 1-4), and a significant difference was observed depending on age, grade, and death-related education. Attitude to death was positively correlated with death-related education, resilience, life satisfaction, and psychological well-being. Results of the hierarchical multiple regression analysis indicated that death-related education and psychological well-being were significant predictors of attitude to death, explaining 26.6% of the latter. The most important factor was psychological well-being.

CONCLUSION

Although death-related education and psychological well-being are two of the most influential factors among nursing students, no more than 30.4% of this study's participants received death-related education. Death-related education is necessary to help nursing students so that they can cope positively with stressful situations by finding positive meaning. It is necessary to develop a systematic curriculum so that these students can establish a positive attitude to death.

TRANSLATION AND CULTURAL ADAPTATION OF DEATH ATTITUDE PROFILE REVISED (DAP-R) FOR USE IN BRAZIL

ABSTRACT Objectives: to perform the translation, cultural adaptation, and content validation of Death Attitude Profile Revised to the Brazilian context. Method: a methodological study that comprised the following stages: initial translation, synthesis of these translations, back translation, expert committee and pre-test conducted with 40 nursing students. The cultural adaptation process, which preceded content validation, carried out with three expert judges. Results: the Brazilian version of Death Attitude Profile Revised maintained semantic, idiomatic, conceptual and experiential equivalences to the original version. The final content validity coefficient of the scale reached 0.85 for language clarity and theoretical relevance and 0.86 for practical relevance. Regarding the theoretical dimensions, a substantial Kappa mean value among evaluators was obtained (0.709). Data analysis on internal consistency, performed by calculating Cronbach's alpha coefficient, displayed a reliability considered high (α = 0.892). Conclusion: it is extremely important to have an instrument adapted to the Brazilian reality that allows for measuring the attitudes towards death from both a positive and negative point of view because, by identifying these attitudes, interventions and training are designed to improve the care process in nursing. Thus, the cultural adaptation process resulted in a reliable adapted version with valid content. However, it is necessary to test the psychometric properties before using in care practice and research.

End-of-Life Communication: Nurses Cocreating the Closing Composition With Patients and Families

Communication is imperative for end-of-life decision-making; however, descriptions of key strategies used by nurses are missing. A phenomenological approach was used to interpret interviews from 10 hospice/palliative nurses. The overarching pattern is the closing composition. Key communication strategies/patterns include establishing context, acknowledging through attentive listening, making it safe for them to die, planning goals of care, and being honest. Essential is the awareness that nurse, patient, and family all hold expertise in the subject matter. It is imperative that pre-/postnursing licensure curriculum be expanded to include training in mutual influence communication practices and mentoring in the skill of orchestration.

Influence of Training on First-Year Nursing Department Students’ Attitudes on Death and Caring for Dying Patients: A Single-Group Pretest–Posttest Experimental Study

The study examined the influence of training on first-year nursing department students’ attitudes on death and caring for dying patients. Utilizing the experimental model, the study sample consisted of 81 first-year students attending the nursing department of a university. Death Attitude Profile-Revised and Frommelt Attitude toward Care of the Dying Scale were used for data collection. Data analysis included means, standard deviation, and t test for related samples. Student attitudes toward death were measured as 146.43 (16.741) and 152.75 (15.132) for pre- and posttraining, respectively. Student attitudes toward caring for dying patients were established to be 103.02 (7.655) during pretraining period and 111.02 (10.359) at posttraining period. The difference between pre- and posttests for mean attitudes toward death and caring for the dying patient was statistically significant. Study results determined that training was effective in forming positive student attitudes toward death and caring for dying patients.

Effect of Terminal Patient Care Training on the Nurses' Attitudes Toward Death in an Oncology Hospital in Turkey

This is an experimental research aiming at identifying the effect of terminal patient care training on the nurses' attitudes toward death. The sample of this study (n = 41) involves 20 nurses in the training group and 21 nurses in the control group. Nurses were offered terminal patient care training and their attitudes toward death were assessed before and after the intervention. The Death Attitude Profile-Revised (DAP-R) subscale mean scores for fear of death (3.9-4.6, p < .05) and approach acceptance (2.9-3.3, p < .05) were found to significantly increase at the end of training in the training group while mean scores in the control group displayed no significant change (p > .05) in any of the five DAP-R subscales. In accordance with these findings, this study suggests that terminal patient care training should be implemented in the nursing curriculum more extensively and should be frequently repeated as part of the nurses' in-service education.

Improving End-of-Life Care Knowledge Among Senior Baccalaureate Nursing Students

Objective:

It is imperative that nurses are proficient and comfortable providing care to patients at the end of life. Recent studies show that nurses’ knowledge of end-of-life care is less than optimal. Effective, evidence-based methods to infuse palliative and end-of-life care education into the undergraduate nursing curriculum are needed.

Methods:

A descriptive pre- and postassessment evaluating senior nursing students’ acquisition of knowledge on end-of-life care after attending the End-of-Life Nursing Education Consortium (ELNEC) core course was conducted. The course evaluation included qualitative statements.

Results:

Before the ELNEC course, one-third of the students had cared for a dying patient during clinical rotations, yet 85% reported they had not received adequate training in end-of-life care. Posttest questions related to palliative care, symptom management, communication, and grief indicated that students acquired significant knowledge after participating in the ELNEC course ( P < .05).

Conclusion:

The ELNEC core course is an effective way to improve nursing students’ knowledge of palliative and end-of-life care.

Attitude of Palestinian Nursing Students Toward Caring for Dying Patients

Death is a natural process that occurs each day. Some nursing students may encounter the experience of taking care of a dying patient while others do not. Therefore, their attitude toward death and caring for dying patients may vary. The purpose of this study was to assess Palestinian student nurses’ attitudes toward death and caring for dying patients and their families. In a cross-sectional, descriptive study, all fourth-year students at the College of Nursing, Islamic University of Gaza, Palestine, were invited to participate in this study. A total of 141 students completed the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B). Results revealed that the mean score on the FATCOD-B was (96.96 ± 8.30). Overall, nursing students in the sample demonstrated a relatively low attitude toward caring for dying patients and their families. No statistically significant differences of students’ attitudes toward caring for dying patients were found between male and female students nor between students who attended death cases and those who did not. The results suggest that theoretical nursing education should place more emphasis on palliative care to improve the quality of care at the end of life.