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.

Death education for undergraduate nursing students in the China Midwest region: An exploratory analysis

AIM

The purpose of this study was to comprehend the need for incorporating death education within the curriculum of undergraduate nursing students and to assess the factors that impact the desire for such education.

DESIGN

We enlisted undergraduate nursing students from several nursing colleges located in the central and west region of China. Undergraduate students who fulfilled the eligibility criteria between January and February 2021 were chosen to participate. Data were collected via an online platform called Questionnaire Star. The survey encompassed a general information questionnaire and a scale for assessing the need for education on the topic of death. Descriptive statistical analysis was performed using the SPSS 20.0 software, while multivariate stepwise regression was employed for more complex analysis. Statistical significance was indicated when the p-value was below 0.05, and high statistical significance was noted when the p-value fell below 0.01.

METHODS

We designed a descriptive quantitative approach to investigate the need for death education and its associated factors. The research involved 907 undergraduate nursing students from the central and west region of China. The data collection was done through the Questionnaire Star platform.

RESULTS

Following the collection of completed surveys, individuals displaying contradictory responses were omitted. Out of 911 surveys disseminated, 907 were successfully collected, resulting in a recovery rate of 99.6%. Among the participants, 769 identified as female, constituting 84.8% of the total, while 138 identified as male, making up 15.2%. The survey findings indicated that factors such as residency, parental educational history and exposure to hospice care education significantly impacted the need for death education among undergraduate nurses (p < 0.05).

CONCLUSIONS

Among students pursuing a nursing degree at the undergraduate level, there was a pronounced need for education related to the topic of death. Offering such education to these students is essential, as it helps cultivate a proper understanding of death. This, in turn, contributes to enhancing the overall quality of patient care throughout their life journey.

PATIENT OR PUBLIC CONTRIBUTION

A total of 907 nursing undergraduates from central and western China participated in the questionnaire.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

This study used a qualitative descriptive study design.

SETTINGS

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

PARTICIPANTS

71 nursing sophomores participated in this study.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Views, emotional Reaction, and Bereavement Healing Rituals of Saudi Male Nursing Students: A Qualitative Approach

AIM

The study described the perception and attitude of Saudi male nursing students towards death and dying.

METHODS

This qualitative study recruited Twelve male Saudi nursing students from Nursing Department at University, Riyadh, Saudi Arabia. Data collection was conducted using unstructured one-on-one online interviews from January to February 2021 using thematic approach to analyse the data.

RESULTS

The result of the study presented three themes. The first theme describes the Muslim Saudi male nursing student's religious beliefs and practices in terms of three concepts. The second theme is the emotional reaction of the participants. The third theme is bereavement healing rituals.

CONCLUSION

The knowledge on how nursing students with an Islamic belief view the concept of death and dying provides valuable and critical information on developing educational intervention as well as course and training contents that needs to be included in developing the competencies of these students.

Bereavement and Professional Competencies: Exploring the Personal Experience of Death Among Nursing Students - A Qualitative Study

Purpose: To explore the death experiences of nursing students in their personal lives. Methods: This study employed a qualitative descriptive design using the semi-structured interview approach. A purposive sampling method was used to recruit 24 nursing students from September 2020 to July 2022. Data were analyzed using Colaizzi's analysis method. Lincoln and Guba's criteria was used to evaluate the trustworthiness of the data. Results: Four main themes emerged from the interviews: (a) reactions to encounters with death; (b) adjustment strategies; (c) personal growth induced by the death experiences; and (d) professional reflections for preparing nurse role. Conclusions: Although the death of a loved one makes nursing students suffer from grief and emotional distress, we show that the experience promotes the personal growth and professional competencies of nursing students and thereby, developing their overall aptitude towards the profession. Death experiences of nursing students have shown to allow them to reflect on both life and death, to consider the demands of the nursing profession, and to provide foundation for nursing students to be more empathetic and compassionate when facing death in the future. Exploring death experiences of nursing students is vital in better providing better quality education and personal support for nursing students.

Nursing Students' Understanding of Palliative Care in Palestine

Palliative care is a method of preventing and alleviating suffering for patients who have been diagnosed with terminal diseases by early detection, accurate assessments, and pain and symptom management. Patients and their families can then mitigate related physical, psychological, and spiritual challenges and thus will have a better quality of life. This article reports a study that evaluated undergraduate nursing students' knowledge of and attitude and self-efficacy toward palliative and end-of-life care in Palestine. A descriptive, cross-sectional design was used among a convenience sample of 449 undergraduate nursing students at the end of their second, third, and fourth years. The results of this research revealed that nursing students had low levels of knowledge about palliative care and low self-efficacy toward end-of-life care. The majority of students reported a positive disposition toward the provision of end-of-life care. The most important predictors of knowledge, attitudes, and self-efficacy were age, having attended a seminar/lecture on the issue, experiencing death while providing care, and having experienced a death in the family or close friends. Furthermore, elevated levels of knowledge were significantly associated with higher level of attitude (P < .001) about palliative care.

The Meaning of Death for Nursing Students and Their Attitudes Toward Dignified Death Principles

This study aims to determine the meaning of death for nursing students and their attitudes toward dignified death principles. The descriptive study was conducted with nursing students studying at a state university in Turkey. The data were collected using the Personal Information Form, the Personal Meanings of Death Scale (PMDS), and the Assessment Scale of Attitudes toward the Principles of Dying with Dignity (ASAPDD). A positive and low-level significant relationship was determined between the students' age and the scores for the PMDS subdimensions and the ASAPDD. It was found that the students had positive perceptions of death and adopted the principles of a dignified death. It was determined that an increase in the students' perceptions of death positively affected their adoption of the principles of a dignified death.

Student nurses' end-of-life and post mortem care self-efficacy: A descriptive study

BACKGROUND

Student nurses providing end-of-life care reported that caring for a person dying created anxiety, fear, and increased stress and reflected low self-efficacy. New nurses felt unprepared academically and emotionally. High self-efficacy is necessary to handle adverse emotional reactions. However, the literature lacks an instrument to evaluate nursing students' self-efficacy in caring for someone who is dying.

OBJECTIVE

The study aims to investigate the reliability and validity of the "End-of-Life and Postmortem Self-Efficacy Scale" and explore nursing students' self-efficacy associated with the nursing duties and responsibilities of caring for individuals during the active phase of dying and immediately after death.

DESIGN

The study was a quantitative descriptive, cross-sectional design.

PARTICIPANTS

National Student Nurses' Association members enrolled in undergraduate registered nurse associate's, bachelor's degree programs, or a nursing diploma program.

METHOD

National Student Nurses' Association members responded to an electronic survey containing 18 items related to end-of-life and post mortem nursing responsibilities.

RESULTS

A total of 498 responses were analyzed. Cronbach's alpha (α = 0.938) showed high reliability of the 18 items on the instrument. The Kaiser-Meyer-Olkin was 0.925 and indicated sampling adequacy. Bartlett's test of sphericity was highly significant (p = .001). The nursing students' mean end-of-life and post mortem self-efficacy score was 62 (scale of 0-100).

CONCLUSION

The "End-of-Life and Postmortem Self-Efficacy Scale" showed high reliability in evaluating the latent concept of end-of-life and post mortem self-efficacy. The low mean self-efficacy score indicated that nursing students might be underprepared to provide EOL and post mortem care as new graduates. Faculty can use the "End-of-Life and Postmortem Self-Efficacy Scale" to assess student readiness and identify gaps in knowledge in the care of someone who is dying. Future research is needed to determine how increasing nursing students' end-of-life and post mortem self-efficacy influences the perception of end-of-life preparedness.

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

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

Nursing Students' Compassion and Their Attitudes Toward Death and the Care of the Dying: An Intervention Study ın Turkey

This pretest-posttest quasi-experimental study investigated the effect of an educational intervention on nursing students' compassion levels and their attitudes toward death and the care of the dying. Data were collected using the Death Attitude Profile - Revised (DAP-R), the Frommelt Attitude Toward Care Of The Dying (FATCOD) Scale, and the Compassion Scale (CS). The intervention improved participants' DAP-R scores. Participants had higher posttest FATCOD scores than the pretest scores. However, the difference was statistically insignificant. Participants had high CS scores. There was a slight increase in CS scores after the intervention. The results showed that the intervention improved participants' attitudes toward death and the care of the dying. The results also showed that compassion was an important factor.

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

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

Are we teaching health science students in the United States what they need to know about death and dying coping strategies?

PURPOSE

This investigation aimed to answer the following questions: are health science students provided with death and dying education before attending clinical rotations, and if so, do the students receiving this type of education perceive it as effective?

METHODS

In this descriptive cross-sectional survey, 96 Midwestern State University health science students were surveyed to determine the percentage of students who had received death and dying education before clinical rotations, as well as the students’ perception of educational effectiveness for those who had received end-of-life training. A self-report questionnaire presented nursing, radiologic sciences, and respiratory care students with a series of questions pertaining to the education they had received concerning the death and dying process of patients.

RESULTS

Of the 93 students who had already started their clinical rotations, 55 stated they had not received death and dying education before starting clinical courses. Of the 38 who had received death and dying education, only 17 students believed the training was effective.

CONCLUSION

It is imperative that health science educational programs implement death and dying education and training into the curriculum, and that criteria for evaluating effectiveness be an essential part of death and dying education and training in order to ensure effectiveness.

Nursing students' attitudes towards death and caring for dying patients

Aim

To examine the attitudes of undergraduate Jordanian nursing students towards death and caring for dying patients.

Design

A cross‐sectional correlational design.

Methods

The Frommelt Attitude Toward Care of the Dying and Death Attitude Profile‐Revised scales were used in this study with a convenience sample of 555 students from nursing schools in Jordan.

Results

Nursing students had positive attitudes towards death (M = 153.7, SD = 21.5) and a positive attitude towards caring for dying patients (M = 98.1, SD = 9.2). Fear of death, escape acceptance and death avoidance were significant negative predictors, while neutral acceptance, higher academic level and female gender were significant positive predictors of caring for dying patients (F = 4.5).

Conclusion

Nursing students had positive attitudes towards caring for dying patients that was influenced by university type, academic level and gender. Nursing education must further focus on death, dying and end‐of‐life care across the core courses of nursing curricula, theory and practicum.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

A multicenter cross-sectional study was conducted.

SETTINGS

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

PARTICIPANTS

The sample included 1193 students.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Nursing student attitudes toward dying patient care: A European multicenter cross-sectional study

Background and aim of the work:

Nursing education plays a key role in preparing future nurses to deal with dying patients, which represents one of the most emotionally involving aspect of nursing. The aims of the study were to explore nursing students’ attitudes towards care of dying patients in three different European contexts and to analyze the variables that can influence them.

Methods:

We conducted an international multicenter cross-sectional study. We administered the Frommelt Attitude Toward Care of the Dying Scale form B (FATCOD-B) and a demographic form to 569 students, enrolled in three Nursing Programmes in different countries (Italy, Spain and United Kingdom), who accepted to participate in the study. The data were analyzed using SPSS software version 26.0.

Results:

Median total FATCOD-B scores indicated intermediate levels of students’ attitudes towards care for dying patients, with a statistically significant difference among the three student groups. The median total FATCOD-B scores did not statistically significantly change in students with different age, gender, year of study, religious beliefs, nursing education on palliative care, previous experiences of dying patient care and personal grieving.

Conclusions:

In our study, nursing students feel partially prepared in caring for dying patients and their attitudes do not change as the course of study progresses. No selected variables had an impact on students’ attitudes towards palliative care. Since nurses play a vital role in ensuring the quality of care, education on end-of-life care should be offered as a core part of undergraduate nursing programs. (www.actabiomedica.it)

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

METHOD

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

RESULTS

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

CONCLUSION

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

The Relationship Between Nurses' Ethical Sensitivity Levels and Their Attitudes Toward Principles About Die with Dignity

This study was conducted to determine the relationship between nurses' ethical sensitivity levels and their attitudes toward principles about die with dignity. The study was descriptive and correlational in design. The data were obtained from 226 nurses. The results of the correlation analysis conducted to determine whether there is a relationship between the nurses' ethical sensitivity level and their attitudes toward principles about die with dignity are among the autonomy, meaning and relation showed a significant, negative and low-level relationship between. As a result of the research, it was found that there was a negatively, significant and low-level relationship between autonomy, meaning and relation and attitudes toward respectable principles of death.

The effect of professional education on medical and nursing students' attitudes toward death

This qualitative study aims to reveal the effect of professional education on medical and nursing students' attitudes toward death. The study was carried out with nursing and medical students (N = 197). Research data was collected through semi-structured interview questions and 23 focus group interviews. The data was assessed using thematic analysis method. The themes were evaluated within the context of perception of death, ethical dilemmas, and, death education. To achieve professional competency in attitudes toward death, it is imperative to form a common educational curriculum and practice that would help students develop a mutual language and value system about death.

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

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

Perceptions of Palliative Care Nurses Related to Death and Palliative Care Practices

This study has been conducted with the purpose of identifying the perceptions of palliative nurses about death and determining palliative care practices. We conducted qualitative interviews with 23 palliative care nurses in Turkey. Content analysis was used in the evaluation of the data. Three themes have been identified about perception of death. Furthermore, three themes have been identified about palliative care practices. It was concluded that the palliative nurses perceive death as a natural and inevitable process and that as long as their working period increases, they become desensitized. It was identified that the participants generally perform the following procedures in palliative care practices.

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

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