Greek renal nurses' attitudes towards death

Measuring undergraduate nursing students' knowledge of Christian, Islamic, and Hindu death rituals: A national study

BACKGROUND

Globally, research indicated undergraduate nursing students have limited knowledge, in caring for people at the time of death. With increasing immigrant populations, undergraduate nursing students and nurses seeking to provide culturally competent care lacked specific knowledge regarding the death rituals of other religions which presents a major knowledge gap that must be addressed. This study measured undergraduate nursing students' knowledge of specific death rituals as practised by three world religions (Christianity, Islam and Hinduism) in the Republic of Ireland.

AIM

The current study aimed to measure undergraduate nursing students' knowledge of specific death rituals as practised by three world religions (Christianity, Islam, and Hinduism).

DESIGN

This study used a quantitative descriptive cross-sectional design.

PARTICIPANTS

Nursing students from all 13 higher education institutions (HEIs) registered with the Nursing and Midwifery Board of Ireland were invited to participate. Out of these, eight HEIs consented, representing a total of 5050 undergraduate nursing students. From this pool, 414 students, spanning from all nursing and midwifery programs from all four provinces of Ireland, participated in the study.

METHODS

A 23-item knowledge survey, The Knowledge Questionnaire (KQ) was developed with input from experts and validated for accuracy, relevance, essentiality, and reliability. Further reliability testing of the tool was done in this study.

RESULTS

The Knowledge Questionnaire (KQ) was found to be reliable showing a Cronbach's alpha coefficient of 0.873 in the national study. The findings highlighted a significant lack of knowledge regarding death rituals across the religious groups. Most students reported seeking information about these rituals from sources outside of formal nursing education.

CONCLUSION

Based on these results, the authors strongly recommends the inclusion of mandatory cultural education in nursing programs to better prepare students for end-of-life care in diverse cultural contexts.

RELEVANCE TO CLINICAL PRACTICE

This study provides an informed starting point from which specifically tailored education programmes could be developed and implemented. The goal is to foster culturally competent care in both clinical and academic settings to meet the needs of increasingly culturally diverse patient populations in a variety of health care settings nationwide.

Critical Care Experience Shapes Respiratory Therapists' Attitudes toward Death: A Survey Study

Respiratory therapists (RTs) frequently encounter death in their work with critically ill patients. Healthcare providers' attitudes toward death significantly affect their approach to caring for dying patients; however, there is a lack of knowledge on RTs' attitudes toward death. This study examines how the work environment and personal characteristics of RTs influence their attitudes toward death. Utilizing the Death Attitude Profile-Revised-Chinese questionnaire, a cross-sectional survey compared non-critical care RTs (non-CCRTs, N = 86) to critical care RTs (CCRTs, N = 85). Non-CCRTs displayed significantly lower scores in overall acceptance of death compared to CCRTs (p = 0.015) and a tendency to actively avoid thoughts about death (p = 0.005). CCRTs scored higher in "neutral acceptance" (p = 0.015), and non-CCRTs exhibited higher scores on items reflecting a negative attitude toward death. RTs with shorter professional tenures showed heightened fear of death and avoidance tendencies. Perception of life and death education correlated with higher "fear of death" and "death avoidance" scores (p = 0.001). The findings indicate that CCRTs demonstrate a more neutral acceptance of death. Additionally, experience, sex, mental health status, and life-death education exposure significantly influence RTs' attitudes toward death.

The relationship between death attitude and professional identity in nursing students from mainland China

BACKGROUND

Professional identity reduces the risk of job burnout in nurses, and attitudes towards death might be a factor affecting nurses' professional identity. Little research has been conducted to directly investigate the relationship between professional identity and death attitudes in nursing students. In addition, there are cultural differences in the formation of death attitudes. It is necessary to explore attitudes towards death in Chinese nursing students and investigate the relationship between death attitudes and professional identity.

OBJECTIVES

To investigate the relationship between professional identity and death attitudes in nursing students in mainland China.

DESIGN

A cross-sectional study.

PARTICIPANTS

A total of 2119 nursing students from mainland China were included in this survey.

METHODS

The survey was conducted online. The questionnaire included the Chinese version of the Professional Identification Scale and the Chinese version of the Death Attitude Profile - Revised to measure the nursing students' professional identity and attitudes towards death. The survey also collected the participants' age, gender, institution type, place of residence and self-assessed health state.

RESULTS

The professional identity of the nursing students (average scores: 33.68 ± 5.12) from mainland China was above an intermediate level, and their attitudes towards death were positive overall (escape acceptance: 3.37 ± 0.96, approach acceptance: 3.36 ± 0.79, fear of death: 2.88 ± 0.77, death avoidance: 2.74 ± 0.84, neutral acceptance: 2.29 ± 0.77). Among the nursing students, professional identity was correlated with attitudes towards death. Specifically, professional identity was positively correlated with approach acceptance (p < 0.001), escape acceptance (p < 0.001) and neutral acceptance (p < 0.001) but negatively correlated with fear of death (p < 0.001) and death avoidance (p < 0.001). The nursing students with relatively low professional identity showed stronger death anxiety than those with relatively high professional identity (p < 0.001).

CONCLUSION

The outcome of this study suggests that education on life and death and internship experience in palliative care contribute to the development of a high level of professional identity in nursing work.

Attitudes towards the dying and death anxiety in acute care nurses - can a workshop make any difference? A mixed-methods evaluation

OBJECTIVES

In Singapore, the core curriculum for end-of-life (EOL) care used in nurse training courses is limited. Only 45% of nurses indicated familiarity with inpatient palliative care. Nurses who lack skills in palliative care may develop anxiety and negative attitudes towards caring for dying patients. We explored whether a two-day, multimodal EOL care workshop could reduce nurses' death anxiety and improve nurses' skills, knowledge, and attitude towards palliative care.

METHODS

Forty-five nurses participated in the workshop. At baseline before and at six weeks after, a 20-item knowledge-based questionnaire and the Death Attitude Profile-Revised (DAP-R) were administered. Six weeks post-workshop, in-depth interviews were conducted. We employed descriptive statistics, student paired samples t-test and inductive thematic analysis.

RESULTS

There was a significant improvement in nurses' knowledge score (p < 0.01) and reduction in their death anxiety score (p < 0.01). Fear of Death (p = 0.025) and Death Avoidance (p = 0.047) sub-scores decreased significantly. However, the remaining domains such as Neutral Acceptance, Approach Acceptance, and Escape Acceptance did not show any significant difference, although Escape Acceptance showed a trend towards a reduced score (p = 0.063). After the workshop, more nurses adopted the Neutral Acceptance stance (76.2%), and none of them fell into the Fear of Death subdomain. Most nurses interviewed reported a positive change in their knowledge, attitudes, and practice even after the workshop.

SIGNIFICANCE OF RESULTS

The multimodal palliative care workshop was useful in improving nurses' EOL knowledge and reducing their anxiety towards death. The positive change in nurses' attitudes and practices were noted to be sustained for at least six weeks after the intervention.

Nurses' Attitudes Towards Death and Their Effects on Spirituality and Spiritual Care

This study aimed to determine the effect of nurses' attitudes towards death on spirituality and spiritual care. This is a descriptive and correlational study. There was a moderate correlation between the total score on the Spirituality and Spiritual Care Rating Scale and the total and subdimension scores on the Attitude Towards Death Scale. It was found that the scores on the subdimensions of objective acceptance, escaping/acceptance and fear of death explained 41.7% of nurses' perceptions of spirituality and spiritual care. For holistic nursing care, it is very important that nurses are aware of their patients' spiritual needs and are capable of providing supportive spiritual service without regard for their own attitudes towards or spiritual thoughts about death.

Care staff's self-efficacy regarding end-of-life communication in the long-term care setting: Results of the PACE cross-sectional study in six European countries

BACKGROUND

An important part of palliative care is discussing preferences at end of life, however such conversations may not often occur. Care staff with greater self-efficacy towards end-of-life communication are probably more likely to have such discussions, however, there is a lack of research on self-efficacy towards end-of-life discussions among long-term care staff in Europe and related factors.

OBJECTIVES

Firstly, to describe and compare the self-efficacy level of long-term care staff regarding end-of-life communication across six countries; secondly, to analyse characteristics of staff and facilities which are associated to self-efficacy towards end-of-life communication.

DESIGN

Cross-sectional survey.

SETTINGS

Long-term care facilities in Belgium, England, Finland, Italy, the Netherlands and Poland (n = 290).

PARTICIPANTS

Nurses and care assistants (n = 1680) completed a self-efficacy scale and were included in the analyses.

METHODS

Care staff rated their self-efficacy (confidence in their own ability) on a scale of 0 (cannot do at all) to 7 -(certain can do) of the 8-item communication subscale of the Self-efficacy in End-of-Life Care survey. Staff characteristics included age, gender, professional role, education level, training in palliative care and years working in direct care. Facility characteristics included facility type and availability of palliative care guidelines, palliative care team and palliative care advice. Analyses were conducted using Generalized Estimating Equations, to account for clustering of data at facility level.

RESULTS

Thde proportion of staff with a mean self-efficacy score >5 was highest in the Netherlands (76.4%), ranged between 55.9% and 60.0% in Belgium, Poland, England and Finland and was lowest in Italy (29.6%). Higher levels of self-efficacy (>5) were associated with: staff over 50 years of age (OR 1.86 95% CI[1.30-2.65]); nurses (compared to care assistants) (1.75 [1.20-2.54]); completion of higher secondary or tertiary education (respectively 2.22 [1.53-3.21] and 3.11 [2.05-4.71]; formal palliative care training (1.71 [1.32-2.21]); working in direct care for over 10 years (1.53 [1.14-2.05]); working in a facility with care provided by onsite nurses and care assistants and offsite physicians (1.86 [1.30-2.65]); and working in a facility where guidelines for palliative care were available (1.39 [1.03-1.88]).

CONCLUSION

Self-efficacy towards end-of-life communication was most often low in Italy and most often high in the Netherlands. In all countries, low self-efficacy was found relatively often for discussion of prognosis. Palliative care education and guidelines for palliative care could improve the self-efficacy of care staff.

Clinical nurses' attitudes towards death and caring for dying patients in China

OBJECTIVE

To examine Chinese clinical nurses' attitudes towards death and caring for dying patients, and to examine the relationships between clinical nurses' attitudes towards death and caring for dying patients.

METHODS

A convenience sample of 770 clinical nurses from 15 hospitals in China. All participants completed the Chinese version of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B-C), the Chinese version of the Death Attitude Profile-Revised (DAP-R-C), and a demographic questionnaire.

RESULTS

The mean score of the FATCOD-B-C items was 95.62 (SD = 7.45). The majority of Chinese clinical nurses were likely to provide care for the dying person's family (mean = 3.77), but did not have a positive attitude towards communication with the dying person(mean = 2.62). The majority of Chinese clinical nurses showed low scores on death avoidance (mean=1.96) and natural acceptance (mean = 1.61), and most of them viewed death as a passageway to a happy afterlife (mean = 4.33). Attitudes towards caring for dying patients were significantly negatively correlated with fear of death (r = -0.120) and positively correlated with approach acceptance (r = 0.127) and natural acceptance (r = 0.117). Factors that predicted clinical nurses' attitudes towards the care of dying patients included education level, fear of death, approach acceptance, religious beliefs, previous education on death and dying, natural acceptance, professional title, and experience with death or dying patients, which accounted for 18.7% of the variance.

CONCLUSION

Nurses' personal attitudes towards death were associated with their attitudes towards the care of dying patients. Training and educational programmes for clinical nurses should take into consideration nurses' personal attitudes towards death as well as their cultural backgrounds and religious beliefs.

AVALIAÇÃO DO PERFIL DE ATITUDES ACERCA DA MORTE: ESTUDO COM GRADUANDOS DA ÁREA DE SAÚDE

RESUMO Objetivo: identificar o perfil de atitudes frente à morte pelos graduandos da área de saúde. Método: estudo transversal realizado com graduandos de seis cursos de saúde de uma universidade pública do Distrito Federal. Aplicou-se a Escala de Avaliação do Perfil de Atitudes Acerca da Morte e um questionário sociodemográfico. Resultados: participaram da pesquisa 1.005 estudantes. A atitude de aceitação neutra obteve maiores médias dentre os graduandos da amostra, médias mais elevadas na dimensão medo da morte apresentam-se em graduandos mais jovens e médias mais baixas de evitamento da morte em graduandos com maior idade, que cursavam os primeiros semestres da graduação. As dimensões aceitação de escape e religiosa obtiveram médias mais elevadas nos graduandos do sexo masculino. Observou-se que 59,9% dos participantes não tiveram experiência prévia de perda e 75,4% referiram não ter participado de discussões acerca da morte e do morrer. Conclusão: com base nos resultados encontrados na pesquisa, reforça-se a necessidade de discussões sobre a temática da morte e do morrer desde os primeiros semestres na graduação, com a finalidade de oportunizar uma atitude positiva frente à morte e o exercício de um cuidado mais qualificado entre os futuros profissionais de saúde.

Thanatophobia (Death Anxiety) in the Elderly: The Problem of the Child's Inability to Assess Their Own Parent's Death Anxiety State

Thanatophobia is omnipresent in our lives. Research has shown separate but connected constructs: fear of death or fear of the dying process. The influences on death anxiety are varied including religiosity, gender, psychological state, and age. It is often assumed by the children of the elderly that the fear of death is prevalent in their parents. Daily the medical staff encounters the presence of death anxiety: from family members or the staff itself. In order to understand this phenomenon, a three-tier study was conducted on non-terminal elderly inpatients in an acute geriatric care ward. The study showed that the elderly had low levels of anxiety (scoring 4/15 on Templer's Death Anxiety Scale) but their children scored higher for themselves (6.9/15) and for their parents (8.9/15). A regression model showed that only the presence of generalized anxiety and religiosity of parent had an effect explaining 33.6% of the variance. Death anxiety of death is usually absent in the elderly but rather they fear the dying process. On the other hand, their children do fear death, which they extrapolate onto their parents. This causes conflicts since the children prevent disclosure of relevant medical information to their parents. This has to be addressed by the staff when dealing with family members, to allow open and honest communication with their patients. The staff need to explain to the family that the elderly are not afraid of death but of the suffering from the dying process.

Factors associated with the attitudes of oncology nurses toward hospice care in China

OBJECTIVE

To examine factors that are associated with the apprehension levels of oncology nurses toward hospice care. Factors examined in this study included demographics, nursing experience, education levels, title and post, personal experiences, and attitudes toward end-of-life care.

METHODS

Questionnaires were provided to nurses (n=201) from three first-tier hospitals in China. A quantitative scale, Professional End-of-life Care Attitude Scale (PEAS), was used to assess personal and professional apprehension levels toward hospice care. The PEAS was translated to Chinese with terms adapted to the cultural environment in China. Statistical analyses were performed to examine the relationships between the apprehension levels and various factors.

RESULTS

The total PEAS scores exhibited internal consistency and reliability, with a Cronbach α=0.897 and Pearson's r=0.9030. Of the 201 nurses, 184 provided a valid response (91.5%). Education level was significantly correlated with personal (P<0.01) and professional apprehension levels (P<0.05). Higher apprehension level was found in nurses with less education.

CONCLUSION

The PEAS quantitative survey is useful for evaluating apprehension levels of nurses toward hospice care. Nurses with more education experienced less anxiety when providing care for terminally ill patients. The findings suggested that education programs on hospice care could be strengthened to help nurses cope with negative attitudes toward end-of-life care.

How death anxiety impacts nurses' caring for patients at the end of life: a review of literature

Nurses are frequently exposed to dying patients and death in the course of their work. This experience makes individuals conscious of their own mortality, often giving rise to anxiety and unease. Nurses who have a strong anxiety about death may be less comfortable providing nursing care for patients at the end of their life. This paper explores the literature on death anxiety and nurses’ attitudes to determine whether fear of death impacts on nurses’ caring for dying patients. Fifteen quantitative studies published between 1990 and 2012 exploring nurses’ own attitudes towards death were critically reviewed. Three key themes identified were: i). nurses’ level of death anxiety; ii). death anxiety and attitudes towards caring for the dying, and iii). death education was necessary for such emotional work. Based on quantitative surveys using valid instruments, results suggested that the level of death anxiety of nurses working in hospitals in general, oncology, renal, hospice care or in community services was not high. Some studies showed an inverse association between nurses’ attitude towards death and their attitude towards caring for dying patients. Younger nurses consistently reported stronger fear of death and more negative attitudes towards end-of-life patient care. Nurses need to be aware of their own beliefs. Studies from several countries showed that a worksite death education program could reduce death anxiety. This offers potential for improving nurses’ caring for patients at the end of their life.