EMTs' Attitudes' toward Death before andafter a Death Education Program

Objective. To test the hypothesis that emergency medical technicians' (EMTs') attitudes toward death will change after exposure to a death education program. Methods. A convenience sample of 83 rural EMTs participated in this pretest–posttest study after exposure to an educational program related to death. Intact groups of EMTs were randomly assigned to one of three conditions. The short-intervention group received a two-hour class solely on making death notifications. The long-intervention group received a 16-hour, two-day workshop based on the Emergency Death Education andCrisis Training (EDECT^SM) program. The control group received a program about toxicology. Each participant completed a questionnaire with items structured in a Likert five-point format with “strongly agree” and“strongly disagree” as the anchors. Results. Before the training programs, most (77%) participants reported that an EMT's actions impact the family's grief. Less than half (43%) reported that an EMT's role should include making a death notification. The majority (84%) reported that their training was inadequate to make a death notification or to help the family with their grief. Most (84%) felt uncomfortable making a death notification. Those EMTs in the long-intervention group were significantly more likely (92%) to feel that their training was adequate after the intervention when compared with those EMTs in the short-intervention group (43%) or those in the control group (21%). Conclusion. The data showed that EMTs' attitudes toward death changed after exposure to a training program about death.     

Emergency Medical Technician Schedule Modification: Impact and Implications during Short- and Long-term Follow-up

Objective: To determine whether modifying work schedules from 24- to 12-hour shifts results in favorable improvements across a range of psychological and social variables among emergency medical technicians (EMTs).
Method: Sequential (before and after) surveys were completed voluntarily by EMTs at 1 month prior to, 2 months after, and 1 year after a workshift modification (change from 24- to 12-hour shifts). The surveys assessed job satisfaction, occupational burnout, and attitudes toward work schedules. The questionnaires were completed at emergency medical service stations.
Results: Of 70 EMTs in the system, 51 (73%) completed the first 2 stages of this study; 35 (50%) completed all 3 stages. Paired-sample t-tests revealed significant differences between baseline and 2-month posttest scores on the following variables: the Maslach Burnout Inventory: Emotional Exhaustion Scale (less perceived exhaustion at 2 months); the Schedule Attitudes Survey: General Affect (perceived more positive view toward schedule at 2 months); Social/Family Impact (perceived less disruption of social/family life at 2 months); and Composite (less overall disruption in quality of life at 2 months). Statistically significant differences between baseline and 1-year posttest scores were found on the following: Schedule Attitudes Survey: General Affect (more positive view toward schedule at 1 year); Social/Family Impact (less disruption in social/family life at 1 year); and Composite (less overall disruption in quality of life at 1 year).
Conclusion: Modifying EMTs' work schedules from 24- to 12-hour shifts was associated with improvements in EMTs' general attitudes toward their schedules, less disruption of social and family life, and decreased levels of emotional exhaustion at 2 months after the change. While the improvements in EMTs' attitudes toward their schedules persisted at the 1-year follow-up, the measure of emotional exhaustion returned to baseline.     

Death education and grief/suicide intervention in the public schools

We surveyed a stratified random sample of 423 public schools, from prekindergarten through 12th grade, with respect to three death-related programs. Using categorical and open-ended questions, we asked the respondents about the structure and characteristics of the programs, types of curriculum materials, and training of personnel. The schools that responded were distributed similarly to the national population by region. The national estimate for schools offering a course or unit on general death education was 11%, 17% offered a grief education/support program, and 25% had suicide prevention/intervention programs. Senior high schools in the midwest had the highest proportions of death-related programs. Of the few death education programs offered, most are taught as part of a health education course and are two weeks or less in duration. Most of the grief and suicide programs are crisis oriented, and typically involve counselors or a team of school staff members. Opportunities for in-service education are limited. The results of this national survey are consistent with previous state surveys, which found little death education in public schools. In addition, only a small proportion of schools provide programs in grief or suicide intervention.     

The evaluation of two death education programs for EMTs using the theory of planned behavior

The goal of this study was to evaluate the effectiveness of two death education programs by comparing pretest and posttest scores of behavioral intentions and (reported) behavior of EMTs when at the scene of a death. After the interventions, the majority of EMTs intended to change their behavior at the scene of a death when compared to the control group. In a three-month follow-up study, the majority of EMTs who received the intervention (and made a death notification) changed their behavior. In this sample, these programs were effective in changing the behavioral intentions of EMTs.     

The Evaluation of Two Death Education Programs for EMTs Using theTheory of Planned Behavior

The goal of this study was to evaluate the effectiveness of two death education programs by comparing pretest and posttest scores of behavioral intentions and (reported) behavior of EMTs when at the scene of a death. After the interventions, the majority of EMTs intended to change their behavior at the scene of a death when compared to the control group. In a three-month follow-up study, the majority of EMTs who received the intervention (and made a death notification) changed their behavior. In this sample, these programs were effective in changing the behavioral intentions of EMTs.     

The cadre of death education instructors in paramedic programs

OBJECTIVE: This study addresses the paucity of literature on death education offerings in emergency medical services schools. The study examines the cadre of death education instructors in paramedic training programs. Examining death education offerings in paramedic programs can provide insight into how well emergency medical services personnel are prepared when encountering bereaved persons on death-related responses. METHODS: In an exploratory study, information was gathered from paramedic programs on the instructors who teach death-related education. A self-administered survey was sent to each (n = 537) paramedic programs in the USA. The survey solicited the number of instructors teaching death education, their backgrounds, and their formal training in death-related instruction. RESULTS: The response rate was 45.4%. The majority of programs (78%) reported using a paramedic as the primary instructor to teach death-related content. Nurses (66%) and physicians (32%) also were utilized frequently. More than two-thirds (68%) of the responding programs utilize faculty members who have had no formal training in death and dying. Only one-third of the programs utilizes a multidisciplinary staff. Less than 40% of responding programs teach all of their death-related curricula with instructors who are trained in death education. CONCLUSION: This study indicates that the majority of paramedic programs are not utilizing an instructor cadre that is formally trained in death education, nor are they using a multidisciplinary staff. Reasons for using these instructors to teach death education in paramedic programs are discussed.     

Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program

This study measures the attitudes of the psychiatric nurses, after having received an education and training intervention program (ETI-PROGRAM) in family systems nursing, towards the importance of the families in their care. Nurses' knowledge of the impact that family nursing intervention can have on family members may increase positive attitudes towards families. However, little is known about the impact that education and training intervention can have on nurses' attitudes, towards families in clinical practice. Quasi-experimental design was used to assess the change in nurses' attitudes towards families in psychiatric care after the intervention, which included a one-day seminar on the Calgary family nursing conceptual frameworks and skills training with clinical vignettes of families from psychiatry. The Families Importance in Nursing Care - Nurses' Attitude questionnaire was used to evaluate nurses' attitudes. A total of 81 nurses (65%) working in psychiatric care responded to the questionnaire. Nurses with more than 15 years of work experience were significantly more supportive of families in their care compared with less experienced nurses. Out of the 81 nurses, 52 (64%) answered the questionnaire again 14 months later. Furthermore, psychiatric nurses saw families significantly less burdensome after having participated in the ETI-PROGRAM.     

Teacher intervention with elementary school children in death-related situations

Review of recent research in death education reveals a dearth of information in at least two areas: (1) what forms death education already is taking with elementary school children in actual death-related situations and (2) what influence the teacher's attitude toward death may have in such death education. This paper describes a study that deals with both issues and provides a basis for the future work of classroom teachers as therapeutic agents with children in grief.     

A SURVEY OF PROFESSIONALS' TRAINING AND EXPERIENCES IN DELIVERING DEATH NOTIFICATIONS

A mail survey was conducted of 240 people from different professions that routinely encountered death to assess their previous training and experiences in delivering death notifications. Nearly 40% of these persons had received neither classroom nor experiential training in death notification, although 70% of respondents had performed at least one notification. The causes of death that contributed to notifiers' distress during notification included (a) violent crime, (b) drunk driving crashes, (c) suicide, and (d) the death of a child. Survivor reactions that were the most difficult for notifiers to manage during the notification included (a) attempts to harm self or others (b) physical acting-out, and (c) intense anxiety. Notifiers indicated that they most frequently coped with the stresses of notification by (a) spending time with family, (b) talking with coworkers, and (c) spending time alone. The implications of the results and the needs for systematic death notification education were discussed.     

A survey of professionals' training and experiences in delivering death notifications

A mail survey was conducted of 240 people from different professions that routinely encountered death to assess their previous training and experiences in delivering death notifications. Nearly 40% of these persons had received neither classroom nor experiential training in death notification, although 70% of respondents had performed at least one notification. The causes of death that contributed to notifiers' distress during notification included (a) violent crime, (b) drunk driving crashes, (c) suicide, and (d) the death of a child. Survivor reactions that were the most difficult for notifiers to manage during the notification included (a) attempts to harm self or others (b) physical acting-out, and (c) intense anxiety. Notifiers indicated that they most frequently coped with the stresses of notification by (a) spending time with family, (b) talking with coworkers, and (c) spending time alone. The implications of the results and the needs for systematic death notification education were discussed.     

EMS Provider Perceptions on Termination of Resuscitation in a Large,Urban EMS System

Objective: Despite the value of out-of-hospital Termination of Resuscitation (TOR) and the scientific evidence in favor of this practice, TOR has not been uniformly adopted or consistently practiced in EMS systems. Previous focus group studies have identified multiple barriers to implementation of out of hospital TOR but existing literature on EMS provider perceptions is limited. We sought to identify EMS providers' perceived barriers to performing out-of-hospital TOR in a large urban EMS system. Methods: The Chicago EMS System is a regional collaborative of EMS physicians, nurses and provider agencies, including the Chicago Fire Department (CFD), which provides exclusive emergency response for 9-1-1 calls in Chicago. CFD is an urban, fire-based EMS agency with a tiered response, with fire-fighter EMTs and paramedics providing initial care, and single role paramedics providing supplemental care and transport. A 2-page written survey was distributed to understand providers' experiences with managing OHCA and perceived barriers to TOR to inform subsequent improvements in protocol development and education. Results: Of 3500 EMS providers that received the survey, 2309 were completed (66%). Survey respondent demographics were fire-fighter/EMTB (69%), fire-fighter/paramedic (14%), and single role paramedic (17%). The most frequent barrier to field TOR was scene safety (86%). The most common safety issue identified was family reaction to TOR (68%) and many providers felt threatened by family when trying to perform

TOR (38%). Providers with a higher career numbers of OHCA were more likely to have felt threatened by the family (OR 6.70, 95% CI 2.99–15.00) and single role paramedics were more likely than FF/EMTBs to have felt threatened (OR 3.34, 95% CI 2.65–4.22). Barriers to delivering a death notification after TOR, include being uncomfortable or threatened with possible family reaction (52%) and family asking to continue the resuscitation (45%). There was lack of formal prior death notification training, the majority learned from colleagues through on the job training. Conclusions: Our study identifies scene safety, death notification delivery, and lack of formal training in death notification as barriers that EMS providers face while performing TOR in a large urban EMS system. These findings informed educational and operational initiatives to overcome the identified provider level issues and improve compliance with TOR policies.     

Death education in paramedic programs: a nationwide assessment

In an exploratory study, we obtained information on death education in paramedic programs. A self-administered survey was sent to all U.S. paramedic training programs (N = 537). The survey ascertained the method of instruction, educational supplements, assessment techniques, and integration of death education into general course work. The status of past, present, and future death education offerings in paramedic program was also elicited. Analysis was performed on the usable surveys (response rate = 51%). The overwhelming majority (95%) of programs offer death educatio, with more offerings now than 10 years ago. Legal-thical topics were the most often included death-related instruction. In the majority of programs, a lecture (didactic) format was used for instruction and closed-ended tests were used for assessment. Results on other educational supplements and assessment techniques are also presented.     

The knowledge and perceptions of medical personnel relating to outcome after cardiac arrest

OBJECTIVE: We sought to evaluate the knowledge of probable outcome by medical personnel for in-hospital and out-of-hospital cardiac arrests, and self-reported history of CPR training referrals for family members of cardiac patients. METHODS: One hundred people from each of three population lists were randomly selected at a large, urban school of medicine and affiliated medical center: (1) year III and IV medical students; (2) residents in family medicine, emergency medicine, internal medicine, anesthesia, and surgery; (3) attending physicians in the same departments. A questionnaire was distributed that elicited estimates of in-hospital and out-of-hospital cardiac arrest (IHCA and OHCA, respectively) survival rates, and CPR training referral history. Estimates were compared against published data for accuracy (IHCA: 5-20%; OHCA 1-10%) RESULTS: The overall response rate was 63%. Accurate in-hospital cardiac arrest estimates [% (95% CI)] of survival were provided by 51.1% (36.8-63.4%), 47.3% (35.9-58.7%), and 36.7% (23.2-50.2%) of students, residents, and attending physicians, respectively. Accurate out-of-hospital estimates of survival were provided by 51.1% (36.8-63.4%), 52.1% (40.6-63.5%), and 70.8% (57.9-83.7%), respectively. Most thought that family members of cardiac patients ought to be CPR trained (92.6%). However, few had referred any for training in the past year (16.5%). There was strong support across respondent groups for including death notification information in the ACLS training program, with 80.4% of all respondents in favor. CONCLUSIONS: This study demonstrates that medical experience is not associated with accurate estimates of cardiac arrest survival. Overwhelmingly, medical personnel believe family members should be trained to perform CPR, however, few refer family members for CPR training.     

DEATH EDUCATION: KNOWLEDGE,ATTITUDES, AND PERSPECTIVES OF IRISH PARENTS AND TEACHERS

This article reports on a cross-sectional survey of the knowledge, attitudes and perspectives of Irish parents and school teachers concerning children's grief and the concept of death education. The sample comprised 119 parents and 142 teachers of Irish Primary-school children (5-12 years of age) who completed a self administered questionnaire. Both parents and teachers reported high levels of understanding of the nature of children's grief and strongly supported the view that death should be discussed with children before they encounter it. Although discussions of death were reported in the classroom and in the home, both teachers and parents, particularly men, reported being uncomfortable talking to children about death. There was general support for the inclusion of death education in the school curriculum, with both teachers and parents supporting the need for further teacher training to undertake its delivery. There were few significant differences between the expressed attitudes of parents and teachers. However, teachers were more likely than parents to agree that death education would take away from parental responsibility. The implications of the findings for further work in this area are considered.     

Death education: knowledge, attitudes, and perspectives of Irish parents and teachers

This article reports on a cross-sectional survey of the knowledge, attitudes and perspectives of Irish parents and school teachers concerning children's grief and the concept of death education. The sample comprised 119 parents and 142 teachers of Irish Primary-school children (5-12 years of age) who completed a self administered questionnaire. Both parents and teachers reported high levels of understanding of the nature of children's grief and strongly supported the view that death should be discussed with children before they encounter it. Although discussions of death were reported in the classroom and in the home, both teachers and parents, particularly men, reported being uncomfortable talking to children about death. There was general support for the inclusion of death education in the school curriculum, with both teachers and parents supporting the need for further teacher training to undertake its delivery. There were few significant differences between the expressed attitudes of parents and teachers. However, teachers were more likely than parents to agree that death education would take away from parental responsibility. The implications of the findings for further work in this area are considered.     

Evaluation of death attitude change resulting from a death education instructional unit

The purpose of the study was to evaluate death attitude change among university students involved in a death education instructional unit within an introductory health education course. A quasi-experimental research design was employed. Pre-and post-tests of death attitudes, utilizing the Hardt Death Attitude Scale and the Watts-Andrews Death Attitude Questionnaire, were conducted in both the death education group (N = 39) and the control group (N = 40). A one-way analysis of covariance using pretest mean scores as the covariate showed significant posttest mean differences between the groups on both death attitude measures. Thus it was concluded that death-related attitudes can be favorably influenced as a result of a death education instructional unit within an introductory health education course.     

A Review of: “Death and Grief: A Course for Nurses”

Abstract

The purpose of the study was to evaluate death attitude change among university students involved in a death education instructional unit within an introductory health education course. A quasi-experimental research design was employed. Pre-and post-tests of death attitudes, utilizing the Hardt Death Attitude Scale and the Watts-Andrews Death Attitude Questionnaire, were conducted in both the death education group (N = 39) and the control group (N = 40). A one-way analysis of covariance using pretest mean scores as the covariate showed significant posttest mean differences between the groups on both death attitude measures. Thus it was concluded that death-related attitudes can be favorably influenced as a result of a death education instructional unit within an introductory health education course.     

Termination of Nontraumatic Cardiac Arrest Resuscitative Efforts in the Field: A National Survey

Objectives : 1) To describe elements of adult nontraumatic cardiac arrest protocols in those U.S. cities in which resuscitative efforts are being terminated in the out-of-hospital setting. 2) To determine the prevalence and methods of on-scene family grief counseling delivered in this setting.
Methods : Emergency medical services (EMS) systems in each of the 200 largest cities in the United States were surveyed by telephone regarding the content of their adult cardiac arrest protocols. Type of arrest (medical vs trauma), final dysrhythmia, termination policies, and presence or absence of a grief counseling protocol were recorded.
Results : All of the target population responded to the telephone survey. Most (135; 68%) EMS systems currently have written protocols that allow in-field termination of resuscitative efforts for adult nontraumatic cardiac arrest patients who remain asystolic. Only 47 (24%) EMS systems allow cessation of efforts for patients without return of spontaneous circulation regardless of the dysrhythmia. Base station contact is required for authorization to end resuscitative efforts in 120/135 (89%) EMS systems. Only 26/135 (19%) EMS systems that cease efforts in the field have written policies concerning on-scene family grief counseling. This counseling is most likely to be conducted by the out-of-hospital providers themselves.
Conclusion : Many U.S. urban EMS systems are terminating efforts for selected adult nontraumatic cardiac arrest patients, although few have written policies to address grief intervention for family members at the scene.