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Gong M, Ding F, Zhu YP, Liu NW, Li YL, Qiu D, Fang Q. Knowledge, attitudes and practices towards advance directives among clinical nurses: Multicenter cross-sectional survey. J Clin Nurs 2024; 33:740-751. [PMID: 37888145 DOI: 10.1111/jocn.16911] [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: 12/05/2022] [Revised: 08/08/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to describe the knowledge, attitudes and practices (KAP) of nurses in implementing advance directives (ADs) for older patients and analyze the influencing factors before the establishment of the first advance directives act in China. DESIGN Multicenter cross-sectional survey. The standards for reporting the STROBE checklist are used. METHODS This cross-sectional study developed a self-designed structured questionnaire to assess nurses' knowledge, attitudes and practices about ADs. Nurses were recruited by stratified random sampling through the Nursing Departments of 12 hospitals in southwest China and were asked to fill out the questionnaire face to face about knowledge, attitudes and practices. Data were analyzed following descriptive statistics, rank-sum test and multiple linear regression. RESULTS This study included 950 nurses. The study found that nurses were extremely supportive of ADs. Unmarried nurses had better knowledge of ADs than married ones. Nevertheless, there was a discrepancy between the participants' knowledge, attitude and practice. The participants' practice was lower (4.3%) compared with their attitude (81.9%) and knowledge (42.2%). Knowledge on, attitudes towards and standardized procedures for ADs in the workplace affected nursing practice. CONCLUSIONS The study recommends that courses on ADs and appropriate support from medical institutions should be provided to nurses to increase their knowledge and confidence in implementing ADs. Healthcare professionals should be sufficiently equipped to implement ADs and handle their execution appropriately to provide adequate end-of-life care corresponding to patients' wishes. RELEVANCE TO CLINICAL PRACTICE The study results inform rich insights as it discusses the numerous interrelating factors influencing these three fundamental aspects that affect the success of any AD policy by surveying the knowledge, attitudes and practices of clinical nurses. Furthermore, our results hint at distinct areas of improvement in the nursing practice to facilitate the wider implementation and acceptance of ADs in China. PATIENT OR PUBLIC CONTRIBUTION This study involved no patient.
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Affiliation(s)
- Miao Gong
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fu Ding
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Ping Zhu
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Na Wei Liu
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ya Ling Li
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Qiu
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Fang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lee S, Hong S, Park S, Lim S. Knowledge, Attitudes and Nursing Stress Related to Life-Sustaining Treatment among Oncology Nurses. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2023; 26:112-125. [PMID: 37790738 PMCID: PMC10542995 DOI: 10.14475/jhpc.2023.26.3.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 10/05/2023]
Abstract
Purpose This study investigated knowledge, attitudes, and nursing stress related to life-sustaining treatment among oncology nurses. Methods A descriptive study design was used. Data were collected through a survey from April 1 to May 31, 2022. The participants were 132 nurses working in the oncology ward of a tertiary hospital in Seoul. Data were analyzed using the SPSS 25.0 program with descriptive statics, the independent t-test, analysis of variance, and Pearson correlation coefficients. Results The average scores for knowledge, attitudes, and nursing stress related to life-sustaining treatment were 14.42, 3.29, and 3.96, respectively. Significant differences in knowledge about life-sustaining treatment were observed based on clinical experience (P=0.029) and education about life-sustaining treatment (P=0.044). Attitudes toward life-sustaining treatment varied significantly with education about life-sustaining treatment (P=0.014), while stress levels differed significantly across working units (P=0.004). A positive correlation was found between the dilemma of extending or stopping life-sustaining treatment (a subdomain of nursing stress) and attitudes toward life-sustaining treatment (r=0.260, P=0.003). Conclusion There was no significant correlation between the nursing stress experienced by oncology nurses and their knowledge and attitudes toward life-sustaining treatment. However, a more positive experience with life-sustaining treatment education was associated with higher stress levels related to the dilemma of extending or stopping life-sustaining treatment. Therefore, it is crucial to develop strategies to manage this dilemma and reduce stress in the field.
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Affiliation(s)
- Seul Lee
- St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Suyoun Hong
- St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sojung Park
- St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Soojung Lim
- St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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Fleischmann C, Henking T, Schuler M, Neuderth S. [What do health care professionals know about advance directives?]. Dtsch Med Wochenschr 2023; 148:e76-e86. [PMID: 37327811 PMCID: PMC10328723 DOI: 10.1055/a-2062-8761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Advance directives are important to preserve the autonomy of patients for future situations in which they are uncapable of expressing their will. They are considered helpful by many healthcare professionals in their professional practice. However, their knowledge on these documents is not well known. Misconceptions can adversely affect decisions at the end of life. This study examines healthcare professionals' knowledge of advance directives and relevant correlates. METHODS In 2021 healthcare professionals from various professions and institutions in Wuerzburg were surveyed using a standardized questionnaire on previous experiences with, advice on and use of advance directives, as well as an objective knowledge test containing 30 questions. Apart from the descriptive analysis of single questions out of the knowledge test, various parameters were screened for their influence on knowledge level. RESULTS 363 healthcare professionals from different care settings participated in the study, including physicians, social workers, nurses and emergency services personnel. 77.5% work in patient care, of which 39.8% make decisions based on living wills daily to several times a month. High rates of incorrect answers in the knowledge test show lack in knowledge about decisions concerning patients who are unable to give consent; an average of 18 out of 30 points was achieved. Physicians, male healthcare professionals and respondents with more personal experience regarding advance directives had significantly better results in the knowledge test. CONCLUSION Healthcare professionals have ethically and practically relevant knowledge deficits and a high need for further training on advance directives. Advance directives play an important role in maintaining patient autonomy and should receive more attention in training and further education equally involving non-medical professional groups.
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Affiliation(s)
- Carolin Fleischmann
- Institut für Angewandte Sozialwissenschaften der Technischen Hochschule Würzburg-Schweinfurt, Würzburg, GERMANY
| | - Tanja Henking
- Institut für Angewandte Sozialwissenschaften der Technischen Hochschule Würzburg-Schweinfurt, Würzburg, GERMANY
| | - Michael Schuler
- Department für Angewandte Gesundheitswissenschaften HS Gesundheit Bochum - Hochschule für Gesundheit,
| | - Silke Neuderth
- Institut für Angewandte Sozialwissenschaften der Technischen Hochschule Würzburg-Schweinfurt, Würzburg, GERMANY
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Townsend K, Johnson KS, Jones S, Spurlock A. Nurse Practitioner's Confidence and Competence of Advance Directives: The Benefits of an Educational Program. Hosp Top 2023:1-7. [PMID: 37129933 DOI: 10.1080/00185868.2023.2201693] [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: 05/03/2023]
Abstract
The increase in the number of people developing dementia, the growing number of geriatric patients suffering and dying from serious chronic diseases, and the rising costs of health care as a result of an aging population have centered attention on advance care planning. Advance care planning is the recurrent conversation between competent patients, their families, and the health care provider about end of life care. Although vital, advance care planning discussions between providers and patients are not occurring regularly, and completion rates of advance directives are low. Barriers to health care providers discussing advance directives include lack of time, knowledge, and confidence. The purpose of this project was to evaluate the effectiveness of an educational program regarding advance directives on nurse practitioner's competency and confidence to start advance care planning discussions. Wilcoxon signed rank test indicated that post-education, confidence improved significantly for all items (average rank of 4.5 vs average rank of 10.65). The study showed that most of the nurse practitioners were knowledgeable about advance directives and the educational program increased their level of confidence about initiating advance directive discussions.
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Affiliation(s)
| | | | - Stacey Jones
- School of Nursing, Troy University, Troy, AL, USA
| | - Amy Spurlock
- School of Nursing, Troy University, Troy, AL, USA
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Yang J, Kim HJ, Heo S, An M, Park S, Ounpraseuth S, Kim J. Factors associated with attitudes toward advance directives in nurses and comparisons of the levels between emergency nurses and palliative care nurses. Jpn J Nurs Sci 2023; 20:e12508. [PMID: 36054594 DOI: 10.1111/jjns.12508] [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: 05/19/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 01/05/2023]
Abstract
AIM Little is known about attitudes toward advance directives and factors associated with them among emergency and palliative care nurses who often or daily face end-of-life circumstances. Thus, we aimed to compare the levels of attitudes toward advance directives, communication skills, knowledge about end-of-life care (knowledge), and awareness of the concept of a good death (good death awareness) between emergency and palliative care nurses, and to examine factors associated with attitudes toward advance directives in the total sample. METHODS In this cross-sectional, correlational study, data were collected from 153 nurses (59 emergency and 94 palliative care nurses) at three tertiary hospitals using online or offline surveys and were analyzed using t-tests and multiple linear regression analysis. RESULTS The levels of attitudes, communication skills, knowledge, and good death awareness were moderate in both groups. Attitudes in emergency compared to palliative care nurses were less positive (46.78 vs. 48.38; p = .044), and knowledge was significantly lower (13.64 vs. 15.00; p = .004). Communication skills and good death awareness between the two groups were similar. In the total sample, emergency practice (B = -1.59, p = .024), and lower levels of good death awareness (B = 0.30, p < .001), communication skills (B = 0.18, p = .001), and education (B = -2.84, p = .015) were associated with less positive attitudes (F = 9.52, p < .001; R2 = 0.35). CONCLUSIONS The findings demonstrate the need for improvements in attitudes, knowledge, communication skills, and good death awareness in both groups, especially emergency nurses. Two modifiable targets of interventions to improve nurses' attitudes were also noted.
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Affiliation(s)
- Jisun Yang
- Gachon University, College of Nursing, Incheon, South Korea
| | - Hee Jung Kim
- Gachon University, College of Nursing, Incheon, South Korea
| | - Seongkum Heo
- Mercer University, Georgia Baptist College of Nursing 3001 Mercer University Drive, Atlanta, Georgia, USA
| | - Minjeong An
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - SeongHu Park
- College of Nursing Sciences, Sungshin Women's University, Seoul, South Korea
| | - Songthip Ounpraseuth
- University of Arkansas for Medical Sciences, College of Public Health, Little Rock, Arkansas, USA
| | - JinShil Kim
- Gachon University, College of Nursing, Incheon, South Korea
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Stewart-Lord A, Baillie L, Green L, Murphy F, Leary A. Implementation and perceived impact of the SWAN model of end-of-life and bereavement care: a realist evaluation. BMJ Open 2022; 12:e066832. [PMID: 36600439 PMCID: PMC9772680 DOI: 10.1136/bmjopen-2022-066832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the End-of-Life and Bereavement Care model (SWAN) from conception to current use. DESIGN A realist evaluation was conducted to understand what works for whom and in what circumstances. The programme theory, derived from a scoping review, comprised: person and family centred care, institutional approaches and infrastructure. Data were collected across three stages (May 2021 to December 2021): semi-structured, online interviews and analysis of routinely collected local and national data. SETTING Stage 1: Greater Manchester area of England where the SWAN model was developed and implemented. Stage 2: Midlands. Stage 3: National data. PARTICIPANTS Twenty-three participants were interviewed: Trust SWAN leads, end-of-life care nurses, board members, bereavement services, faith leadership, quality improvement, medicine, nursing, patient transport, mortuary, police and coroners. RESULTS Results from all three stages were integrated within themes, linked to the mechanisms, context and outcomes for the SWAN model. The mechanisms are: SWAN is a values-based model, promoting person/family-centred care and emphasising personhood after death. Key features are: memory-making, normalisation of death and 'one chance' to get things right. SWAN is an enablement and empowerment model for all involved. The branding is recognisable and raises the profile of end-of-life and bereavement care. The contextual factors for successful implementation and sustainability include leadership, organisational support, teamwork and integrated working, education and engagement and investment in resources and facilities. The outcomes are perceived to be: a consistent approach to end-of-life and bereavement care; a person/family-centred approach to care; empowered and creative staff; an organisational culture that prioritises end-of-life and bereavement care. CONCLUSION The SWAN model is agile and has transferred to different settings and circumstances. This realist evaluation revealed the mechanisms of the SWAN model, the contextual factors supporting implementation and perceived outcomes for patients, families, staff and the organisation.
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Affiliation(s)
- Adele Stewart-Lord
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Lesley Baillie
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Laura Green
- School of Health Sciences, Divisionof Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Fiona Murphy
- Palliative /End of Life /Bereavement, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Corporate Services, Liverpool Royal Foundation Trust, Liverpool, UK
| | - Alison Leary
- Institute of Health and Social Care, London South Bank University, London, UK
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Terzi K, Kapucu S. End-Of-Life Care From the Perspectives of Patients With Cancer and Their Nurses: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221107722. [PMID: 35758070 DOI: 10.1177/00302228221107722] [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: 11/17/2022]
Abstract
This study aimed to determine the needs of end-of-life cancer patients' and their nurses' perspectives and experiences regarding end of life period. A qualitative descriptive phenomenological study design was adopted comprising face-to-face, semi-structured interviews with patients and their nurses. Content analysis was conducted using the 'Induction' approach. 15 patients and 15 nurses participated in study. This study emerged three categories, nine themes for patients, and seven themes for nurses. Categories were determined according to the Donabedian model. The interviews revealed that although the nurses wanted to provide the necessary care, they could not accomplish it because of excessive workload, inadequately informed patients, and less than desired knowledge and education levels of the nurses and healthcare team. Improved care coordination and partnership working are essential for supporting both patient and their nurses at the end of life.
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Affiliation(s)
- Kübra Terzi
- Internal Medicine Nursing Department, Hacettepe University, Ankara, Turkey
| | - Sevgisun Kapucu
- Internal Medicine Nursing Department, Hacettepe University, Ankara, Turkey
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Chaverra Castellar MI, Osorio Castaño JH. Voluntades anticipadas como referente ético de conocimiento en los enfermeros que laboran en servicios de oncología. REVISTA LATINOAMERICANA DE BIOÉTICA 2022. [DOI: 10.18359/rlbi.5694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
El propósito del presente artículo es identificar los conocimientos sobre la Voluntad Anticipada (VA) en enfermeros que laboran en servicios de oncología. Para ello, se utilizó como metodología un estudio observacional con intención analítica que midió el nivel de conocimiento a través de un cuestionario autodiligenciado. En él participaron 50 enfermeros, seleccionados por muestreo no probabilístico. Así, se analizaron las variables cualitativas con distribuciones de frecuencia, y las cuantitativas con estadística descriptiva y análisis bivariado. El nivel de conocimiento se categorizó así: 0 a 10 puntos (nivel bajo), 11 a 20 puntos (nivel medio), 21 a 30 puntos (nivel alto). Los resultados de la investigación arrojaron como dato que, para un grupo donde el 86 % eran mujeres, con promedio de edad de 37 años, el promedio de años de experiencia como enfermeros fue de 11.5 años. Por otra parte, el promedio de años de experiencia en el área de oncología fue de 6.2 años. De los que hacían parte de este último promedio, el 48 % tenían diplomado en oncología y el 46 % especialización. El 70 % de los participantes tenía un conocimiento medio, el 26 % un conocimiento alto, y el 4 %un nivel bajo. Cabe mencionar que solo el nivel de formación de postgrado se relacionó de manera significativa con el nivel de conocimientos. Como conclusión, se encontró que los profesionales en enfermería poseen un nivel de conocimiento medio sobre la legislación que aborda las voluntades anticipadas en Colombia y esto está relacionado con el nivel de formación.
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Cheon J, You SY. Nursing students' witnessed experience of patient death during clinical practice: A qualitative study using focus groups. NURSE EDUCATION TODAY 2022; 111:105304. [PMID: 35255291 DOI: 10.1016/j.nedt.2022.105304] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Witnessing the death and dying of patients is a strong, often overwhelming experience during clinical practice. It is necessary to explore how nursing students experience care for dying patients and to understand their perceptions of death and dying. OBJECTIVE This study aimed to explore the experiences of nursing students who witness dying patients and terminal care in their clinical practice. DESIGN A qualitative study using focus group discussion methodology. SETTING(S) A university in Seoul, South Korea. PARTICIPANTS A total of 16 nursing students with more than 1 year of clinical practice experience participated. Their median age was 21.9 years (range 21-24), and all were women. METHODS A qualitative study using three focus groups (10 juniors in two focus groups and 6 seniors in one focus group) was conducted from December 2018 to January 2019. Data were analyzed using the Colaizzi analysis method. RESULTS The analysis resulted in 26 themes, 9 theme clusters, and 3 categories. Three categories emerged: 1) Experience the distance death up close; 2) Dilemma at the end of life; and 3) Strategy on a better end to life. CONCLUSIONS For nursing students, it is necessary to develop and apply internal and external reinforcement programs on providing person-centered care so that they can accept the death of others with equanimity. Nursing students, who are future nurses, should receive education covering various aspects of clinical scenarios involving dying patients and their family members.
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Affiliation(s)
- Jooyoung Cheon
- College of Nursing, Sungshin Women's University, Republic of Korea
| | - Sun Young You
- Department of Nursing, KC University, 47, Kkachisan-ro 24-gil, Gangseo-gu, Seoul 07661, Republic of Korea.
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Baughman KR, Ludwick R, Jarjoura D, Yeager M, Kropp D. Multi-Site Study of Provider Self-Efficacy and Beliefs in Explaining Judgments About Need and Responsibility for Advance Care Planning. Am J Hosp Palliat Care 2021; 38:1276-1281. [PMID: 33291962 PMCID: PMC8490652 DOI: 10.1177/1049909120979977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We examined the impact of advance care planning (ACP) self-efficacy and beliefs in explaining skilled nursing facility (SNF) provider judgments about resident need and provider responsibility for initiating ACP conversations. RESEARCH DESIGN AND METHODS This observational multi-site study of 348 registered nurses, licensed practical nurses, and social workers within 29 SNFs used an anonymous survey in which providers judged vignettes with assigned situational features of a typical SNF resident. Mixed modeling was used to analyze the vignette responses. RESULTS Providers who had more negative beliefs about ACP were less likely to judge residents in need of ACP and less likely to feel responsible for ensuring ACP took place. Self-efficacy did not have a significant impact on judgments of need, but did significantly increase judgments of responsibility for ensuring ACP conversations. Providers with the highest levels of ACP self-efficacy were most likely to feel responsible for ensuring ACP conversations. In an exploratory analysis, these relationships remained the same whether responding to high or low risk residents (i.e., based on risk of hospitalization, type of diagnosis, functional status, and rate of declining health). DISCUSSION AND IMPLICATIONS Both negative beliefs about ACP and self-efficacy in one's ability to conduct ACP discussions were associated with professional judgments regarding ACP. The findings illustrate the importance of addressing negative beliefs about ACP and increasing provider ACP self-efficacy through education and policies that empower nurses and social workers.
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Affiliation(s)
- Kristin R. Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Ruth Ludwick
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Kent State University, OH, USA
| | | | - Mia Yeager
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Denise Kropp
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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Park MH, Seong M, Sok S. Perception, knowledge and attitudes on advance medical directives among hospital staff: Using mixed methodology. J Clin Nurs 2021; 31:2621-2631. [PMID: 34655256 DOI: 10.1111/jocn.16090] [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: 05/04/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is necessary to examine the level of perception, knowledge and attitudes of the medical staff for advance medical directives, which are practical alternatives to good practice for end-of-life care in the actual medical field. PURPOSE This study was conducted to determine the degree of perception, knowledge and attitude of cancer hospital medical staff about advance medical directives, and to confirm the relationship between them. It also explored their experiences with advance medical directives. METHODS This study used a convergent design to collect quantitative and qualitative data separately in the mixed methodology. This design adheres to the STROBE guidelines. Participants were a total of 140 subjects (70 doctors and 70 nurses) with more than 3 years and considered to have sufficient experience related to the study purpose. Focus group participants were a total 19 persons (9 doctors and 10 nurses). RESULTS Mean score for perception was 35.40, which indicates lower perception when compared to the median value (37.50 points). Perception of advance medical directives had significant, positive relations with attitude of advance medical directives (p = .032). The perception on attitude of advance medical directives factor was significantly influencing (p = .021). As a result of the analysis based on qualitative research questions, six subjects and 11 categories were created by deriving meaningful sentences from the statements. CONCLUSION This study suggests that the perception of medical professionals about advance medical directives has a positive correlation with attitudes, as well as a causal relationship. RELEVANCE TO CLINICAL PRACTICE Based on the finding from this study, concrete strategies and interventions to improve the perception of advance medical directives among cancer hospital medical staff are needed.
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Affiliation(s)
- Mi Hee Park
- Department of Nursing, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Mihyeon Seong
- Department of Nursing, Changshin University, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Sohyune Sok
- College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
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Fernández-Rodríguez Á, Molina-Mula J, Sarabia-Cobo C. Educational intervention: Improving the knowledge and attitudes of health professionals on living wills. NURSE EDUCATION TODAY 2021; 105:105016. [PMID: 34237513 DOI: 10.1016/j.nedt.2021.105016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/20/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Health professionals have limited knowledge of advanced directives or living wills, which may hamper understandings among the general population. This could impact on the current low registration rates for advanced directives. OBJECTIVE To evaluate a single-group educational intervention to improve the knowledge and attitudes concerning advanced directives in the short and medium term among health professionals working in nursing homes for older adults. DESIGN An educational intervention was carried out. SETTINGS Fourteen nursing homes in Cantabria, Spain. PARTICIPANTS 201 healthcare professionals. METHODS A theoretical presentation, questions and debates took place between November 2018 and May 2019. Baseline, post-intervention, and follow-up measurements were made to evaluate knowledge and attitudes towards advanced directives. Descriptive and inferential statistical analyses were performed using the Student's t-test and the one-factor ANOVA. ETHICAL CONSIDERATIONS This study was approved by the Clinical Research Ethics Committee of Cantabria. FINDINGS No statistically significant differences were found for any of the socio-demographic variables at baseline, post-intervention, or follow-up. In relation to the baseline questionnaire, knowledge and attitudes increased after the intervention (p = .000 for both blocks of questions) as well as in the follow-up questionnaire (p = .000 for both blocks). DISCUSSION A single-group educational intervention increases knowledge and improves attitudes towards advanced directives. Educated professionals can become health agents in this area, which can lead to an increase in the registration of advanced directives. CONCLUSIONS Educational interventions represent a cost-effective measure that may provide benefits at the end of life for patients and their families, as well as for the healthcare team.
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Affiliation(s)
| | - Jesús Molina-Mula
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Mallorca, Spain
| | - Carmen Sarabia-Cobo
- Faculty of Nursing, University of Cantabria; IDIVAL Nursing Research Group, Santander, Spain
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Berg GV, Slettebø Å, Johnsen K, Findal Dahl A, Fossum M. Interviews with Community Healthcare Registered Nurses in Norway: Examination Practices and Clinical Evaluation Processes. Nurs Open 2021; 8:3291-3298. [PMID: 34478247 PMCID: PMC8510713 DOI: 10.1002/nop2.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 12/29/2022] Open
Abstract
Aim This study describes the examination practices and clinical evaluation processes that Registered Nurses in Norway perform in the community healthcare sector. Design A qualitative exploratory design. Methods Twenty interviews were conducted with Registered Nurses employed in the community healthcare sector in Norway. The data were analysed using a thematic analysis. Results We found four major themes: (1) evaluations are embedded in nurses’ daily work, (2) significance of a Registered Nurse's clinical competency, (3) different tasks require various roles and (4) access to resources and equipment. Registered Nurses possess several skills in a range of different examination techniques and clinical evaluation processes in the community healthcare sector. They perform complex assessments in their daily work and must rely on other healthcare professionals, facilities and equipment to provide high‐quality care. Ongoing education and training will enable Registered Nurses to complete accurate assessments in their community healthcare practice.
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Affiliation(s)
- Geir V Berg
- Division Gjøvik and Lillehammer, Faculty of Medicine and Health Sciences (MH), Department of Health Sciences in Gjøvik, NTNU/Innlandet Hospital Trust, Gjøvik, Norway
| | - Åshild Slettebø
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Kjersti Johnsen
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Aud Findal Dahl
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Mariann Fossum
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Lin HY, Chen CI, Lu CY, Lin SC, Huang CY. Nurses' knowledge, attitude, and competence regarding palliative and end-of-life care: a path analysis. PeerJ 2021; 9:e11864. [PMID: 34395091 PMCID: PMC8320516 DOI: 10.7717/peerj.11864] [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: 12/03/2020] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nurses’ knowledge regarding palliative and end-of-life (EOL) care has been documented, but the competence of nurses in Taiwan has not been deeply analyzed and may affect the use of EOL care. Purpose We aimed to (1) assess the palliative care knowledge, competence and attitude of nurses in a general hospital and (2) examine the paths connecting nurses’ demographic characteristics, previous experiences, knowledge, competence, and attitude. Method A correlational, cross-sectional survey design was implemented to recruit 682 eligible nurses. The questionnaires included demographic information and palliative and EOL care knowledge, attitude, and competence scales. Path analysis was employed for statistical analysis using structural equation modeling. Results Overall, 76% of the questions assessing palliative and hospice knowledge were answered correctly. Nurses’ palliative attitudes were divided into “positive perception” and “negative perception”. “Positive perception” was highly correlated with competence (r = 0.48, p < 0.001), but “negative perception” was not significantly correlated with competence (r = −0.07, p = 0.25). “Positive perception” (β = −0.01, p = 0.84) and competence (β = 0.02, p = 0.80) were not related to palliative knowledge. “Negative perception”, however, was negatively associated with palliative knowledge (β = −0.20, p < 0.01). Conclusions This study suggests continuing education to decrease nurses’ “negative perception” attitude regarding the provision of information to patients and families to provide better palliative and EOL care. Implications for Practice Nurses’ attitudes and competences with respect to palliative care and EOL care are critical. Areas for further research and advanced palliative and EOL care-related education and training are suggested and may be applied in future clinical interventions.
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Affiliation(s)
- Hung-Yu Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan, ROC.,Division of Urology, Department of Surgery, E-Da Cancer & E-Da Hospital, Kaohsiung, Taiwan, ROC
| | - Chun-I Chen
- Management College, I-Shou University, Kaohsiung, Taiwan
| | - Chu-Yun Lu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Chuan Lin
- Department of Nursing, E-Da Hospital, Kaohsiung, Taiwan
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15
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The Role Complexities in Advance Care Planning for End-of-Life Care-Nursing Students' Perception of the Nursing Profession. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126574. [PMID: 34207258 PMCID: PMC8296407 DOI: 10.3390/ijerph18126574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 11/28/2022]
Abstract
Nurses’ perceptions of being responsible for advance care planning (ACP) vary greatly across different studies. It could, however, affect their involvement in advance care planning and patients’ quality of death. Recent studies on this topic have mostly focused on advance directives but not ACP and nurses in the ward setting. This study aimed to assess the perception of Hong Kong nursing undergraduates of the nurse’s role in advance care planning and examine its associations with knowledge, attitude, and experience. A cross-sectional 57-item survey was delivered to nursing undergraduates between June and August 2020. The chi-squared test or Fisher’s exact test were used for univariate analysis. The multiple logistic regression model was used for multivariate analysis. A total of 469 participants were assessed for eligibility; 242 of them were included in the data analysis, with a response rate of 97.6%. The majority of respondents—77.3% (95% CI: 72.0–82.6%)—perceived having a role in ACP, but large discrepancies were found between their perception of their role regarding different aspects of ACP. Participants who had a better knowledge status (p = 0.029) or supported the use of ACP (p < 0.001) were more likely to have a positive perception of their role in ACP. A negative correlation was found between the experience of life threat and positive role perception (p < 0.001). Through strengthening training, the role clarity of nursing undergraduates could be achieved, maximizing their cooperation with and implementation of ACP in their future nursing career. The enhancement of end-of-life education could also be undertaken to fill nursing undergraduates’ knowledge gap in this area and change their attitudes.
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16
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Kim S, Tak SH. Family Members' Knowledge and Attitude Toward Life-Sustaining Treatment Decisions for Patients in the Intensive Care Unit. J Hosp Palliat Nurs 2021; 23:256-263. [PMID: 33840799 PMCID: PMC8104012 DOI: 10.1097/njh.0000000000000750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The decision to withhold or withdraw life-sustaining treatment (LST) lies sometimes in the hands of intensive care unit patients' families. Since 2018, family members of dying patients in South Korea have had the legal right to make decisions for the patients. This study aimed to examine knowledge and attitude toward LST among the family members of patients under intensive care since the foundation of the new legislation. Their perceptions of the roles of nurses were also explored. In this cross-sectional study, 89 participants completed survey questionnaires on demographic characteristics, relationship to patient, reason for admission, length of stay, awareness of the new legislation, knowledge and attitude toward LST, and perception of the role of nurses. The results indicated that knowledge was significantly associated with attitude and was, in fact, the only predictor of attitude toward LST (P = .021). Explaining the disease and prognosis in detail and relieving patients of their physical pain were the roles of nurses most valued by family members. The findings suggest that it is crucial for nurses to support family members and provide information about critical changes and medical options for collaborative decision making according to the patients' wishes during the dying process.
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17
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Tang MY, Li XL, Shi ZY, Fu WJ. Knowledge of and willingness to promote advanced care planning among oncology nurses in southwest China. Int J Palliat Nurs 2021; 26:175-182. [PMID: 32378488 DOI: 10.12968/ijpn.2020.26.4.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nurses feature prominently in promoting advance care planning (ACP), but only a limited amount of relevant research has been conducted from the nurses' viewpoint, and little is known about the nurses' knowledge of and their willingness to promote ACP in China. AIMS The aims of this study were to investigate oncology nurses' knowledge of and their willingness to promote ACP, and to explore associated factors. METHODS A multi-centre study was conducted to investigate 350 nurses in the oncology departments of four university hospitals in southwestern China. Cluster sampling was used in data collection, which involved three categories of questionnaires concerning demographic characteristics, knowledge about ACP and willingness to promote ACP. Chi-squared tests and multiple linear regression were employed in data analysis. RESULTS Some 293 valid questionnaires were collected, among which, 60.1% of respondents never received palliative care education, 89.1% never received training about ACP and 72.7% had not even heard of ACP. Nurses with higher position titles (χ2=18.41, p<0.001) and longer working experience (χ2=12.25, p=0.001) were more likely to have received palliative care education; nurses with higher educational background levels (χ2=12.91, p<0.001), higher position titles (χ2=9.77, p=0.003) and longer working experience (χ2=7.92, p=0.006) were more likely to have learned about ACP; nurses with higher position titles had more access to relevant training (χ2=5.10, p=0.03). Furthermore, whether the nurse had 'heard about ACP' (B=3.113, p=0.018) and 'received training about ACP' (B=3.894, p=0.04) were both associated with their willingness to promote ACP. CONCLUSIONS The findings of this study indicated that oncology nurses were highly inclined to promote ACP, but limited by their lack of knowledge and understanding of it. Therefore, a systematic and adequate training programme about ACP for nurses is an urgent requirement to effectively enhance the implementation of ACP in China.
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Affiliation(s)
- Meng-Yan Tang
- Master's Student, School of Nursing, Sichuan University, China
| | - Xiao-Ling Li
- Professor, School of Nursing, Sichuan University; Department of Nursing, West China Hospital of Sichuan University, China
| | - Zheng-Yan Shi
- Master's Student, School of Nursing, Sichuan University, China
| | - Wen-Jing Fu
- Master's Student, School of Nursing, Sichuan University, China
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18
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Scheinberg-Andrews C, Ganz FD. Israeli Nurses' Palliative Care Knowledge, Attitudes, Behaviors, and Practices. Oncol Nurs Forum 2021; 47:213-221. [PMID: 32078607 DOI: 10.1188/20.onf.213-221] [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: 11/17/2022]
Abstract
OBJECTIVES To describe and compare self-perceived end-of-life (EOL) knowledge, attitudes, behaviors, and practices of intensive care unit (ICU) nurses compared to oncology nurses. SAMPLE & SETTING 126 Israeli nurses (79 oncology nurses and 47 ICU nurses) who were members of the Israel Association of Cardiology and Critical Care Nurses and the Israeli Oncology Nurses Organization. METHODS & VARIABLES This cross-sectional study used an online survey to gather demographic information, clinical setting, and study measures (EOL knowledge, attitudes, behaviors, and practices). RESULTS Oncology nurses and ICU nurses showed moderate levels of self-perceived knowledge and attitudes toward palliative care; however, their self-reported behaviors were low. Oncology nurses scored slightly higher than ICU nurses on knowledge and attitudes but not behaviors, although the difference was not statistically significant. IMPLICATIONS FOR NURSING Contrary to the current authors' expectations, oncology nurses and ICU nurses have similar levels of knowledge, attitudes, and behaviors regarding palliative care. Nurses in both settings need to be better trained and empowered to provide such care.
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19
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Montagnini M, Smith HM, Price DM, Strodtman L, Ghosh B. An Instrument to Assess Self-Perceived Competencies in End-of-Life Care for Health Care Professionals: The End-of-Life Care Questionnaire. Am J Hosp Palliat Care 2021; 38:1426-1432. [PMID: 33787330 DOI: 10.1177/10499091211005735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE We describe the development and the psychometric properties of an instrument to assess self-perceived EOL care competencies for healthcare professionals: The End-of-Life Care Questionnaire (EOL-Q). METHODS The EOL-Q consists of 28 questions assessing knowledge, attitudes and behaviors with subscale items addressing seven domains of care: decision-making, communication, continuity of care, emotional support for patients/families, symptom management, spiritual support for patients/families, and support for clinicians. The EOL-Q was used to assess competencies of 1,197 healthcare professionals from multiple work units at a large medical center. Cronbach's alpha coefficients were calculated for the survey and subscales. A factor analysis was also conducted. RESULTS Internal consistency reliability was for was high for the total scale (0.93) and for the subscales addressing knowledge, behaviors, decision-making, communication, emotional support and symptom management (0.84-0.92); and moderate (>0.68) for the attitudes and continuity of care subscales. The factor analysis demonstrated robust consolidation of the communication and continuity of care subscales (eigenvalue 9.47), decision-making subscale (eigenvalue 3.38), symptom management subscale (eigenvalue 1.51), and emotional and spiritual support subscales (eigenvalue 1.13). CONCLUSION Analysis of the psychometric properties of the EOL-Q care across settings supports its reliability and validity as a measure of self-perceived EOL care competencies in the domains of communication and continuity of care, decision-making, symptom management, and emotional and spiritual support. The EOL-Q displays promise as a tool for use in a variety of educational, research, and program development initiatives in EOL care.
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Affiliation(s)
| | - Heather M Smith
- Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Deborah M Price
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Linda Strodtman
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Bidisha Ghosh
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
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20
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Cho HJ, Kang J. [Family's Perception of Proxy Decision Making to Authorize Do Not Resuscitate Order of Elderly Patients in Long Term Care Facility: A Q-Methodological Study]. J Korean Acad Nurs 2021; 51:15-26. [PMID: 33706328 DOI: 10.4040/jkan.20188] [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: 08/04/2020] [Revised: 12/04/2020] [Accepted: 12/21/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to distinguish and describe the types of perceptions of do not resuscitate (DNR) proxy decisions among families of elderly patients in a long-term care facility. METHODS This exploratory study applied Q-methodology, which focuses on individual subjectivity. Thirty-four Q-statements were selected from 130 Q-populations formed based on the results of in-depth interviews and literature reviews. The P-samples were 34 families of elderly patients in a long-term care hospital in Busan, Korea. They categorized the Q-statements using a 9-point scale. Using the PC-QUANL program, factor analysis was performed with the P-samples along an axis. RESULTS The families' perceptions of the DNR proxy decision were categorized into three types. Type I, rational acceptance, valued consensus among family members based on comprehensive support from medical staff. Type II, psychological burden, involved hesitance in making a DNR proxy decision because of negative emotions and psychological conflict. Type III, discreet decisions, valued the patients' right to self-determination and desire for a legitimate proxy decision. Type I included 18 participants, which was the most common type, and types II and III each included eight participants. CONCLUSION Families' perceptions of DNR proxy decisions vary, requiring tailored care and intervention. We suggest developing and providing interventions that may psychologically support families.
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Affiliation(s)
- Hyeon Jin Cho
- Department of Nursing, Dong-A University Daesin Intermediate Care Hospital, Busan, Korea
| | - Jiyeon Kang
- College of Nursing, Dong-A University, Busan, Korea.
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21
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Fliedner M, Halfens RJG, King CR, Eychmueller S, Lohrmann C, Schols JMGA. Roles and Responsibilities of Nurses in Advance Care Planning in Palliative Care in the Acute Care Setting: A Scoping Review. J Hosp Palliat Nurs 2021; 23:59-68. [PMID: 33284145 DOI: 10.1097/njh.0000000000000715] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Palliative care focuses on symptom management, discussion of treatment and care decisions, network organization, and support of the family. As part of the advance care planning (ACP) process, staff nurses in the acute care setting are often involved in all of the above areas. It is yet unclear what nurses' roles and responsibilities are and what skills are needed in the ACP process. The themes that staff nurses and advanced practice registered nurses (APRNs) discuss in relationship to ACP are manifold. This scoping review demonstrates that staff nurses' core role is advocating for the wishes and values of patients with any life-limiting disease. Staff nurses also serve as facilitators, educators, and advocates to help start ACP conversations and ease patients' transitions between settings based on well-discussed decisions. To be able to engage in ACP discussions, APRNs must have excellent communication skills. Continuous training to improve these skills is mandatory. In the future, clarifying the contribution of staff nurses and APRNs in the ACP process in relation to other members of the interprofessional team can lay the groundwork for improved interprofessional collaboration.
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22
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Advance Care Planning in Asia: A Systematic Narrative Review of Healthcare Professionals’ Knowledge, Attitude, and Experience. J Am Med Dir Assoc 2021; 22:349.e1-349.e28. [DOI: 10.1016/j.jamda.2020.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
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23
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Hökkä M, Martins Pereira S, Pölkki T, Kyngäs H, Hernández-Marrero P. Nursing competencies across different levels of palliative care provision: A systematic integrative review with thematic synthesis. Palliat Med 2020; 34:851-870. [PMID: 32452294 DOI: 10.1177/0269216320918798] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care exists in diverse healthcare settings. Nurses play a crucial role in its provision. Different levels of palliative care provision and education have been recognized in the literature. Therefore, nurses need a set of various competencies to provide high-quality palliative care. AIMS To systematically synthesize the empirical evidence of (1) nursing competencies needed in palliative care and (2) whether these competencies differ across the level of palliative care. DESIGN Systematic integrative review with thematic synthesis. Prospero: CRD42018114869. DATA SOURCES CINAHL, PubMed, Academic Search Premier, Scopus and Medic databases. Studies on nursing competencies linked to palliative care reported in English, Swedish, Finnish, Spanish, Portuguese or German were considered. Search terms: 'palliative care or hospice care or end-of-life care', 'competency or professional competence or skills' and 'nursing'. Articles were independently screened and reviewed by two researchers. Quality appraisal was conducted following Hawker's criteria. RESULTS A total of 7454 articles were retrieved, 21 articles were included in the analysis. Six diverse nursing competencies dimensions, namely leadership, communication, collaboration, clinical, ethico-legal and psycho-social and spiritual were identified. The reports rarely defined the level of palliative care and covered a wide array of healthcare settings. CONCLUSION Nurses need a wide range of competencies to provide quality palliative care. Few studies focused on which competencies are relevant to a specific level of palliative care. Further research is needed to systematize the nursing competencies and define which nursing competencies are central for different levels of palliative care to enhance palliative care development, education and practice.
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Affiliation(s)
- Minna Hökkä
- Research Unit of Nursing Science and Health Management, Medical Department, Oulu University, Oulu, Finland.,School of Health, Kajaani University of Applied Sciences, Kajaani, Finland
| | - Sandra Martins Pereira
- CEGE - Research Center in Management and Economics, Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal.,Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,UNESCO Chair in Bioethics, Institute of Bioethics, Universidade Católica Portuguesa, Porto, Portugal
| | - Tarja Pölkki
- Department of Children and Women, Oulu University Hospital, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, Medical Department, Oulu University, Oulu, Finland
| | - Pablo Hernández-Marrero
- CEGE - Research Center in Management and Economics, Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal.,Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,UNESCO Chair in Bioethics, Institute of Bioethics, Universidade Católica Portuguesa, Porto, Portugal
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24
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Kim MH, Lee YM. Factors Influencing General Hospital Nurses’ Confidence about Advance Directives. ACTA ACUST UNITED AC 2020. [DOI: 10.34250/jkccn.2020.13.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Son YJ, Choi J, Ahn JW. Nurses' perspectives on advance directives before the establishment of the new well-dying law in Korea: A mixed methods study. Appl Nurs Res 2020; 51:151187. [DOI: 10.1016/j.apnr.2019.151187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
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26
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Marland E, Davies B. In the child's best interests: should life be sustained when further treatment is futile? Nurs Child Young People 2019; 31:23-27. [PMID: 31637896 DOI: 10.7748/ncyp.2019.e1107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
The aim of this article is to explore the concept of medical futility and the withdrawal of care for children in intensive care units. There have been several recent cases where medical staff have considered that there was no possibility of recovery for a child, yet their clinical judgments were challenged by the parents. The private anguish of these families became public, social media heightened emotions and this was followed by political and religious intrusion. Innovations in medical treatment and technological advances raise issues for all those involved in the care of children and young people especially when decisions need to be made about end of life care. Healthcare professionals have a moral and legal obligation to determine when treatment should cease in cases where it is determined to be futile. The aim should be to work collaboratively with parents but all decisions must be made in the best interests of the child. However, medical staff and parents may have differing opinions about care decisions. In part, this may be as a result of their unique relationships with the child and different understanding of the extent to which the child is in discomfort or can endure pain.
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Affiliation(s)
- Emma Marland
- Neonatal department, Royal Victoria Infirmary, Newcastle upon Tyne, England
| | - Barbara Davies
- Children's nursing, University of Northumbria, Newcastle upon Tyne, England
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27
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A Multicenter Study to Identify Clinician Barriers to Participating in Goals of Care Discussions in Long-Term Care. J Am Med Dir Assoc 2019; 21:647-652. [PMID: 31672570 DOI: 10.1016/j.jamda.2019.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Long-term care (LTC) is an important setting for goals of care (GoC) discussions. Understanding clinician barriers to GoC discussions could identify opportunities for LTC-specific interventions to improve quantity and quality of GoC discussions in the context of serious illness. DESIGN A multicenter, cross-sectional survey study. SETTING AND PARTICIPANTS 1184 LTC clinicians from 34 Ontario LTC homes were invited to participate. MEASURES The questionnaire assessed (1) clinician barriers related to the LTC resident power of attorney (POA), the health care provider, and the health care system; (2) willingness to engage in GoC discussions; and (3) suggestions to address identified barriers. Responses were rated on a 7-point scale (1 = extremely unimportant/unwilling, 7 = extremely important/willing). A linear mixed-effects model determined significance between mean importance ratings for each barrier and the willingness to engage in GoC discussion between physicians and nurses. A simple content analysis was performed on written suggestions to address GoC discussion barriers. RESULTS The overall response rate was 49% (581/1184). The top 3 rated barriers were (1) POA's difficulty accepting their loved one's poor prognosis, (2) POA's difficulty understanding the limitations and complications of life-sustaining therapies, and (3) lack of adequate documentation of prior discussions with LTC resident or POA. Barriers related to the health care provider, and the health care system, were deemed statistically more important by nurses. LTC physicians were more willing to exchange information, be a decision coach, and participate in the final decision than nurses. Suggestions to improve GoC discussions include a dedicated team to have these conversations in LTC, and updating policies to mandate and standardize these conversations at all family meetings. CONCLUSIONS AND IMPLICATIONS This study has identified key LTC clinician-identified barriers to GoC discussions. Developing targeted interventions to these barriers could be the foundation for developing new interventions that support high-quality GoC discussions.
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Maffoni M, Argentero P, Giorgi I, Giardini A. Healthcare professionals' perceptions about the Italian law on advance directives. Nurs Ethics 2019; 27:796-808. [PMID: 31631774 DOI: 10.1177/0969733019878831] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the variegated legislative framework on advance directives, the first specific regulation in Italy on this issue came into force only in 2018. RESEARCH OBJECTIVE This qualitative study aimed to investigate the implications of the new Italian law on advance directives in clinical practice from the perspective of those who deal with this delicate ethical issue on an everyday basis, that is, Italian healthcare professionals. RESEARCH DESIGN A qualitative research design using semi-structured audio-recorded interviews was adopted. The data collection and analysis were performed according to the Grounded Theory approach. PARTICIPANTS Nineteen healthcare professionals (16 nurses, 3 physicians) working in a palliative care unit of a research and clinical institute in Italy. ETHICAL CONSIDERATIONS The study is part of the WeDistress HELL Project (WEllness and DISTRESS in HEalth care professionals dealing with end of Life and bioethicaL issues) approved by the Ethical Committee of ICS Maugeri - Institute of Pavia (Italy). FINDINGS The authors identified a main overall category, 'Pros and Cons of the Italian law on advance directives', composed of six constituent categories: Positive welcome, Self-determination and protection, Prompts for future betterment, Uncertainties, Lack of knowledge, and Neutrality and no suggestions. DISCUSSION The Italian law n. 219/2017 on advance directives was seen as a legal instrument possessing both strengths and weaknesses, but able to guarantee the patient's self-determination and support healthcare professionals in providing care according to patients' wishes. CONCLUSION An understanding of the healthcare providers' perspective may support the discussion on advance directives and bridge the gaps that currently persist in handling ethical issues.
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Affiliation(s)
- Marina Maffoni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Ines Giorgi
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit - Institute of Pavia, Italy
| | - Anna Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit - Institute of Montescano, Italy
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29
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Tekpınar L, Uludağ A. Perspective of Doctors and Nurses on the Principle of Extended Autonomy in Konya, Turkey. OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:884-897. [PMID: 31460839 DOI: 10.1177/0030222819872086] [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: 11/17/2022]
Abstract
Despite the support with legislation in Turkey regarding extended autonomy and advance directive, there is no clear provision and sufficient practice on the subject. Turkish doctors and nurses are generally unfamiliar with the conception of extended autonomy or advance directive, which raises dilemmas in terms of life-support choice, and this situation can even affect clinical decision-making processes. This study investigated the awareness level about extended autonomy and advance directive in Turkey and assessed doctors and nurses' attitudes toward patient autonomy. This was a quantitative descriptive study. It was found that the 46.8% of the respondents supported the principle of extended autonomy in health service delivery. However, 53.8% of the respondents had poor knowledge regarding advance directive. Majority (77.9%) of the respondents indicated that the legislative arrangements should be made concerning the principle of extended autonomy and the advance directive, which is its field of application.
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Affiliation(s)
- Lütfiye Tekpınar
- Department of Health Management, Faculty of Economics and Administrative Sciences, Süleyman Demirel University, Isparta, Turkey
| | - Ayhan Uludağ
- Department of Health Management, Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
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30
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Abate AT, Amdie FZ, Bayu NH, Gebeyehu D, G/Mariam T. Knowledge, attitude and associated factors towards end of life care among nurses' working in Amhara Referral Hospitals, Northwest Ethiopia: a cross-sectional study. BMC Res Notes 2019; 12:521. [PMID: 31426854 PMCID: PMC6700991 DOI: 10.1186/s13104-019-4567-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 08/13/2019] [Indexed: 12/31/2022] Open
Abstract
Objective The aim of this study was to assess nurses’ Knowledge, Attitude and Associated Factors towards end of life care in Amhara Referral Hospitals, Northwest Ethiopia, 2017. Results A total of 331 participants were included with a response rate of 93.2%. From these, 129 (39.0%) of them had good knowledge and 234 (70.7%) had favorable attitude towards end of life care. Being Bachelor of Science holder and above in nursing (AOR = 4.261, 95% CI 1.524–11.912), working in Emergency department (AOR = 4.911, 95% CI 1.796–13.426), having daily experience of caring for chronically ill patients (AOR = 2.764, 95% CI 1.366–5.591) and taking training on end of life care (AOR = 10.269, 95% CI 4.730–22.296) were significantly associated with good knowledge of nurses towards end of life care. On the other hand, having 6–10 years of working experience in nursing (AOR = 2.199, 95% CI 1.147–4.215), being trained in end of life care (AOR = 3.027, 95% CI 1.285–7.13), Bachelor of Science holder and above in nursing (AOR = 4.414, 95% CI 2.230–8.738) were found to be statistically significant with more positive attitude of nurses towards end of life care. Electronic supplementary material The online version of this article (10.1186/s13104-019-4567-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Addisu Taye Abate
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Fisseha Zewdu Amdie
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Netsanet Habte Bayu
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Gebeyehu
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfamichael G/Mariam
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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CE: Original Research: Advance Care Planning: An Exploration of the Beliefs, Self-Efficacy, Education, and Practices of RNs and LPNs. Am J Nurs 2019; 118:26-32. [PMID: 30418182 DOI: 10.1097/01.naj.0000549664.43827.ce] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Objective: This study compared the advance care planning (ACP)-related beliefs, sense of self-efficacy, education, and practices of RNs and LPNs. METHODS Data were extrapolated from a larger multisite study that was conducted across seven counties in one midwestern state. The sample consisted of RNs and LPNs working in 29 urban skilled nursing facilities in zip code areas with greater than 10% African American residents. The survey tool, a self-administered written questionnaire, gathered data on participants' demographics and ACP-related beliefs, sense of self-efficacy, education, and practices. The two main outcome variables were the percentage of residents with whom a nurse discussed ACP and the timing of the most recent such discussion. RESULTS A total of 136 RNs and 178 LPNs completed the survey. Multivariate mixed-model analysis of the two main outcome variables showed that negative beliefs were not significantly associated with the percentage of residents with whom nurses discussed ACP but were significantly associated with the timing of the most recent ACP discussion. Having higher levels of ACP-related self-efficacy and education were significantly and positively associated with both outcome variables. RNs and LPNs did not differ significantly in their ACP-related beliefs, but RNs reported significantly higher levels of self-efficacy and education than LPNs did. CONCLUSIONS There has been a paucity of research comparing RNs and LPNs regarding their ACP practices in skilled nursing facilities. Better education and policies that empower nurses to take a more active role are critical to increasing conversations about ACP. Further research exploring how the complementary roles of RNs and LPNs can be used to improve ACP processes and inform ACP policies is needed.
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AlFayyad IN, Al-Tannir MA, AlEssa WA, Heena HM, Abu-Shaheen AK. Physicians and nurses' knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia. PLoS One 2019; 14:e0213938. [PMID: 30978182 PMCID: PMC6461283 DOI: 10.1371/journal.pone.0213938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/04/2019] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate physicians' and nurses' knowledge and attitudes toward advance directives (ADs) for cancer patients, which empower patients to take decisions on end-of-life needs if they lose their capacity to make medical decisions. A cross-sectional study was conducted using convenience sampling. The outcomes were responses to the knowledge and attitude questions, and the main outcome variables were the total scores for knowledge and attitudes toward ADs. This study included 281 physicians and nurses (60.5%). Most physicians were men (95, 80.5%), whereas most nurses were women (147, 86.5%). The mean (standard deviation; SD) total knowledge score was 6.8 (4.0) for physicians and 9.1 (3.0) for nurses (p < 0.001). There was a significant difference in the total knowledge score between nurses and physicians, with an adjusted mean difference of 1.54 (95% confidence interval [CI]; 0.08-2.97). Other significant independent predictors of knowledge of ADs were female sex (1.60, 95% CI; 0.27-3.13) and education level (master's versus bachelor's: 1.26, 95% CI; 0.30-2.33 and Ph.D. versus bachelor's: 2.22, 95% CI; 0.16-4.52). Nurses' attitudes appeared to be significantly more positive than those of physicians, and the mean total attitude score (SD) was 19.5 for nurses (6.2) and 15.1 (8.1) for physicians (p < 0.001). The adjusted mean difference (95% CI) for nurses versus physicians was 3.71 (0.57-6.98). All participants showed a high level of knowledge of ADs; however, nurses showed considerably more positive attitudes than physicians.
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Affiliation(s)
| | | | - Waleed A. AlEssa
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Kang JH, Bynum JPW, Zhang L, Grodstein F, Stevenson DG. Predictors of Advance Care Planning in Older Women: The Nurses' Health Study. J Am Geriatr Soc 2018; 67:292-301. [PMID: 30537051 DOI: 10.1111/jgs.15656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/13/2018] [Accepted: 09/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Relatively little is known regarding predictors of advance care planning (ACP) in former nurses. We aimed to evaluate potential predictors of ACP documentation and discussion. DESIGN Cross-sectional study, 2012-2014. SETTING Nurses' Health Study. PARTICIPANTS A total of 60,917 community-dwelling female nurses aged 66 to 93 years living across the United States. MEASUREMENTS Based on self-reports, participants were categorized as having (1) only ACP documentation, (2) ACP documentation and a recent ACP discussion with a healthcare provider, or (3) neither. Multivariable log-binomial models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of the two separate ACP categories vs those with neither. We evaluated various demographic, health, and social factors. RESULTS The large majority (84%) reported ACP documentation; 35% reported a recent ACP discussion. Demographic factors such as age and race were associated with both ACP categories. In multivariable analyses, race was most strongly associated: compared with whites, African Americans were 27% less likely (PR = 0.73; 95% CI = 0.69-0.78) to report ACP documentation alone and 41% (PR = 0.59; 95% CI = 0.54-0.66) less likely to report documentation with discussion. Additionally, health/healthcare-related characteristics were more strongly associated with ACP documentation plus discussion. Women with functional limitations (PR = 1.15; 95% CI = 1.10-1.20), women who were recently hospitalized (PR: 1.10; 95% CI = 1.08-1.12) or women who had seen a physician for health symptoms (PR = 1.43; 95% CI = 1.35-1.52) or screening (PR = 1.40; 95% CI = 1.32-1.49) were more likely to report having both ACP documentation and discussion. Social factors showed limited relationships with ACP documentation only; for documentation plus discussion, being widowed and living alone was associated with higher prevalence (PR = 1.21; 95% CI = 1.19-1.24) and having little emotional support was associated with lower prevalence (PR = 0.84; 95% CI = 0.81-0.86). CONCLUSIONS Among older nurses, most of whom reported having documented ACP, 35% reported recent patient-clinician ACP discussions, indicating a major participatory gap in an element critical to ACP effectiveness. Even in nurses, African Americans reported less ACP documentation or discussion. J Am Geriatr Soc 67:292-301, 2019.
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Affiliation(s)
- Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Julie P W Bynum
- Division of Geriatrics and Palliative Care, University of Michigan School of Medicine, Ann Arbor, Michigan.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Lu Zhang
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,IBM-Watson Health, Cambridge, Massachusetts
| | - Francine Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - David G Stevenson
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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Cummings GG, McLane P, Reid RC, Tate K, Cooper SL, Rowe BH, Estabrooks CA, Cummings GE, Abel SL, Lee JS, Robinson CA, Wagg A. Fractured Care: A Window Into Emergency Transitions in Care for LTC Residents With Complex Health Needs. J Aging Health 2018; 32:119-133. [PMID: 30442040 DOI: 10.1177/0898264318808908] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: For long-term care (LTC) residents, transfers to emergency departments (EDs) can be associated with poor health outcomes. We aimed to describe characteristics of residents transferred, factors related to decisions during transfer, care received in emergency medical services (EMS), ED settings, outcomes on return to LTC, and times of transfer segments along the transition. Method: We prospectively followed 637 transitions to an ED in British Columbia and Alberta, Canada, over a 12-month period. Data were captured through an electronic Transition Tracking Tool and interviews with health care professionals. Results: Common events triggering transfer were falls (26.8%), sudden change in condition (23.5%), and shortness of breath (19.8%). Discrepancies existed between reason for transfer, EMS reported chief complaint, and ED diagnosis. Many transfers resulted in resident return directly to LTC (42.7%). Discussion: Avoidable transfers may put residents at risk of receiving inappropriate care. Standardized communication strategies to highlight changes in resident condition are warranted.
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Affiliation(s)
| | | | - R Colin Reid
- The University of British Columbia, Okanagan campus, Kelowna, Canada
| | | | | | - Brian H Rowe
- University of Alberta, Edmonton, Canada.,Alberta Health Services, Edmonton, Canada
| | | | | | | | - Jacques S Lee
- University of Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Carole A Robinson
- The University of British Columbia, Okanagan campus, Kelowna, Canada
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Feder SL, Collett D, Haron Y, Conley S, Meron T, Cherny N, Schulman-Green D. How skilled do Israeli nurses perceive themselves to be in providing palliative care? Results of a national survey. Int J Palliat Nurs 2018; 24:56-63. [PMID: 29469647 DOI: 10.12968/ijpn.2018.24.2.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shelli L Feder
- Post-Doctoral Fellow, at Yale School of Nursing, West Haven, Connecticut, USA
| | - David Collett
- Nurse Practitioner, at Yale School of Nursing, West Haven, Connecticut, USA
| | - Yafa Haron
- Director, Research Department, Nursing Division, Ministry of Health, Jerusalem, Israel
| | - Samantha Conley
- Post-Doctoral Fellow, at Yale School of Nursing, West Haven, Connecticut, USA
| | - Tikva Meron
- Palliative Clinical Nurse Specialist, Shelba Medical Center, Ramat Gan, Israel
| | - Nathan Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
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George TP, DeCristofaro C, Murphy PF, Remle CR. Knowledge, Attitudes, and Experience With Advance Directives Among Prelicensure Nursing Students. J Nurs Educ 2018; 57:35-39. [PMID: 29381158 DOI: 10.3928/01484834-20180102-07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 07/11/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND End-of-life decision making can be distressing for nursing students, and the purpose of this investigation was to assess undergraduate nursing students' knowledge, attitudes, and experiences with advance directives. METHOD One hundred sixty-six Bachelor of Science in Nursing students at four different program levels were surveyed about their knowledge, personal and professional experience, and personal and professional attitudes regarding advance directives. RESULTS There was a statistically significant progression of knowledge from the junior 1 to the senior 2 semesters. In addition, there was a statistically significant difference in personal attitudes about advance directives by progressive semesters, in personal and professional attitudes between White/Caucasian and Black/African American students, and in knowledge of advance directives and professional attitudes between students 18 to 25 years old and those 26 years and older. CONCLUSION It is important that nursing students are exposed to advance directives in the prelicensure curriculum to prepare them for their role as professional nurses. [J Nurs Educ. 2018;57(1):35-39.].
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Chen IH, Lin KY, Hu SH, Chuang YH, Long CO, Chang CC, Liu MF. Palliative care for advanced dementia: Knowledge and attitudes of long-term care staff. J Clin Nurs 2017; 27:848-858. [PMID: 29076605 DOI: 10.1111/jocn.14132] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVES To investigate the knowledge of and attitudes towards palliative care for advanced dementia and their associations with demographics among nursing staff, including nurses and nursing assistants, in long-term care settings. BACKGROUND Nursing facilities are places where persons with dementia die; therefore, providing quality end-of-life care to residents with advanced dementia is crucial. To date, little attention has been paid to palliative care practice for patients with advanced dementia. DESIGN A descriptive, cross-sectional, survey design was used. METHODS In total, a sample of 300 nurses (n = 125) and nursing assistants (n = 175) working in long-term care settings in Taiwan participated in this study. Two instruments were administered: demographic characteristics and responses to the Questionnaire of Palliative Care for Advanced Dementia. Descriptive statistics and multiple regression were used for data analysis. RESULTS Overall, the nurses and nursing assistants had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Additionally, nursing staff who were nurses with greater work experience and those who had received palliative care and hospice training had greater knowledge of palliative care. In addition, nursing staff who had received dementia care training and who had worked in nursing homes had higher levels of positive attitudes towards palliative care. CONCLUSIONS This study indicates the need to provide nurses and nursing assistants with more information about palliative care practice for people with advanced dementia. Particularly, providing education to those who are nursing assistants, who have less working experience, who have not received palliative and dementia care training, and who have not worked in nursing homes can improve overall nursing staff knowledge of and attitudes towards palliative care. RELEVANCE TO CLINICAL PRACTICE Continuing education in principles of palliative care for advanced dementia is necessary for currently practicing nursing staff and should be developed according to their educational background and needs.
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Affiliation(s)
- I-Hui Chen
- Master Program of Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yu Lin
- Furoto Medical & Welfare Co., Ltd., Taipei, Taiwan
| | - Sophia H Hu
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yeu-Hui Chuang
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Carol O Long
- Capstone Healthcare, Palliative Care Essentials, Phoenix, AZ, USA.,Transcultural Nursing Society, Phoenix, AZ, USA.,College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Chia-Chi Chang
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Megan F Liu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
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38
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Factors Associated With Willingness to Accept Palliative Care in Patients With Chronic Obstructive Pulmonary Disease. J Hosp Palliat Nurs 2017. [DOI: 10.1097/njh.0000000000000321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Costello J. Research roundup. Int J Palliat Nurs 2016; 22:360-1. [PMID: 27444165 DOI: 10.12968/ijpn.2016.22.7.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- John Costello
- Senior Lecturer, University of Manchester School of Nursing, Midwifery and Social Work
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40
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Costello J. Research roundup. Int J Palliat Nurs 2016. [DOI: 10.12968/ijpn.2016.22.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- John Costello
- Senior Lecturer, University of Manchester School of Nursing, Midwifery and Social Work
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41
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Coffey A, McCarthy G, Weathers E, Friedman MI, Gallo K, Ehrenfeld M, Chan S, Li WHC, Poletti P, Zanotti R, Molloy DW, McGlade C, Fitzpatrick JJ, Itzhaki M. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries. Int J Nurs Pract 2016; 22:247-57. [PMID: 26823112 PMCID: PMC5066738 DOI: 10.1111/ijn.12417] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 09/18/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
Nurses' knowledge regarding advance directives may affect their administration and completion in end‐of‐life care. Confidence among nurses is a barrier to the provision of quality end‐of‐life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end‐of‐life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross‐sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end‐of‐life and more comfortable stopping preventive medications at end‐of‐life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end‐of‐life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end‐of‐life care.
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Affiliation(s)
- Alice Coffey
- Senior Lecturer /Director International Programmes, School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Geraldine McCarthy
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Elizabeth Weathers
- Research Assistant, Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - M Isabel Friedman
- Clinical Education Specialist, Center for Learning and Innovation, North Shore-LIJ Health System, Lake Success, New York, USA
| | - Katherine Gallo
- Senior Vice President, Chief Learning Officer, Center for Learning and Innovation, North Shore-LIJ Health System, Lake Success, New York, USA
| | - Mally Ehrenfeld
- Associate Professor, Head of School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sophia Chan
- Professor in Nursing and Director of Research, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - William H C Li
- Assistant Professor, Director of Master of Nursing Programme, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - Piera Poletti
- Director, CEREF Centre for Research & Continuing Education, Padova, Italy
| | - Renzo Zanotti
- Associate Professor and Dean, Master in Nursing Sciences, Padua University, Padua, Italy
| | - D William Molloy
- Consultant in Geriatric Medicine, Centre of Gerontology and Rehabilitation, St. Finbarr's Hospital, Cork, Ireland
| | - Ciara McGlade
- Research Fellow and Consultant in Geriatric Medicine, Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - Joyce J Fitzpatrick
- Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michal Itzhaki
- Lecturer, Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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