Investigating factors associate to nurses' attitudes towards perinatal bereavement care

Aim. The purpose of this study was to explore nurses’ attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Method. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May–August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Results. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39·3% (n = 130) of nurses had bereavement related training. By contrast, about 89·8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses’ perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses’ attitudes towards perinatal bereavement care. Conclusions. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively.     

Nurses' attitudes towards perinatal bereavement support in Hong Kong: a pilot study

The purpose of this study is to explore nurses' attitudes towards perinatal bereavement care and to identify required support and training needs for nurses on bereavement care in Hong Kong. Data were collected through a structured questionnaire, and 110 nurses were recruited from the obstetrics and gynaecology unit in one of the largest public hospitals in Hong Kong. The majority of nurses held a positive attitude towards bereavement care. A significant difference in nurses' attitudes towards bereavement support was found in terms of demographics, practical experiences and training factors. The results showed that only 25.5% (n = 28) of nurses had bereavement-related training. In contrast, 90.9% of nurses showed a positive response to grief training and 90.0% would share experiences with colleagues and seek support when feeling under stress. The findings also suggest that nurses' attitudes towards bereavement care are positively correlated with bereavement care training needs (r = 0.53) and hospital policy support (r = 0.55). Hong Kong nurses' attitudes towards perinatal care emphasized their need for increased knowledge and experience, improved communication skills, and greater support from team members and the hospital. These findings may be used for Hong Kong health care professionals to improve support of nurses, to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.     

Retracted: Investigating factors associated with nurses’ attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong

Aims. To explore nurses’ attitudes towards perinatal bereavement care and to identify factors associated with these attitudes. Background. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and that nurses with positive attitudes to bereavement care can help bereaved parents to cope during their grieving period. Design. Survey. Method. Data were collected through a structured questionnaire; 657 nurses were recruited from Obstetrics and Gynaecology units in Hong Kong and Shandong during 2006. Outcome measures included attitudes towards perinatal bereavement care, importance of hospital policy and training support for bereavement care. Results. The majority of nurses in this study had a positive attitude to bereavement care. Results show that only 21·6% (n = 141) of the nurses surveyed had bereavement‐related training. In contrast, about 89·8% (n = 300) believed they needed to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·5% (n = 592) would share their experiences with their colleagues and seek support when feeling under stress. A regression model showed that age, past experience in handling grieving parents, recent ranking and nurses’ perceived attitudes to hospital policy and training provided for bereavement care were the factors associated with nurses’ attitudes to perinatal bereavement care. Conclusions. Nurses in both cities emphasised their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used by nursing educators to educate their students on issues related to delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.     

Nurses’ attitudes towards perinatal bereavement care

Title. Nurses’ attitudes towards perinatal bereavement care. Aim. This paper is a report of a study conducted to explore the factors associated with nurses and midwives’ attitudes towards perinatal bereavement care. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. In some situations nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they feel unable to deal with the enormity of the parental feelings of loss. Method. A correlational questionnaire study using convenience sampling was carried out in Singapore in 2007 with 185 nurses/midwives in one obstetrics and gynaecology unit. Results. Regression models showed that nurses/midwives with religious beliefs and those with more positive attitudes to the importance of hospital policy and training for bereavement care were statistically significantly more likely to have a positive attitude towards perinatal bereavement care. Nurses emphasized their need for increased knowledge and training on how to cope with bereaved parents and requested greater support from team members and the hospital. Conclusion. Bereavement counselling education and preceptorship supervision are recommended to reduce this stressful experience, increase the confidence and expertise of novices, and lead to increased quality of care for bereaved parents.     

Retraction statement: Investigating factors associated with nurses' attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong

The above article from Journal of Clinical Nursing, ‘Investigating factors associated with nurses’ attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong' by Chan, M. F., Lou, F.‐l., Cao, F.‐l., Li, P., Liu, L. and Wu, L. H. published online on 6 July 2009 in Wiley Online Library ( wileyonlinelibrary.com ) and in Volume 18, pp. 2344–2354, has been retracted by agreement between the authors, the journal Editor in Chief and John Wiley & Sons Ltd. The retraction has been agreed following an investigation carried out by the National University of Singapore due to major overlap with a previously published article: Chan MF, Lou F‐l, Arthur DG, Cao F‐l, Wu LH, Li P, Sagara‐Rosemeyer M, Chung LYF & Lui L (2008) Investigating factors associate to nurses' attitudes towards perinatal bereavement care. Journal of Clinical Nursing 17: 509–518. doi:  10.1111/j.1365‐2702.2007.02007.x . Reference Chan MF, Lou F‐l, Cao F‐l, Li P, Liu L & Wu LH (2009) Investigating factors associated with nurses' attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong. Journal of Clinical Nursing 18, 2344–2354. doi: 10.1111/j.1365‐2702.2008.02689.x .     

Evaluation of a nurse education workshop on children's grief

This paper provides an overview of the development and evaluation of an educational program to increase the knowledge of hospice and paediatric nurses who support grieving children and improve their attitudes toward death and bereavement. The specific target groups for the project included nurses providing care through community-based hospice services and inpatient palliative care units, as well as nurses providing inpatient and community-based care at a children's teaching hospital. Fifty-nine nurses from hospice, community and inpatient settings participated in three workshops. Results indicated that the workshop produced a sustained improvement in bereavement knowledge among the nurses and an improvement in their attitudes toward death and bereavement.     

粤港两地部分急诊科医护人员对哀伤关顾认识的调查分析

目的 调查粤港两地部分急诊科医护人员对哀伤关顾的认识情况,为国内开展哀伤关顾护理提供理论依据.方法 自行设计对哀伤关顾的认识调查问卷,对香港各大联网医院的急诊科医护人员、本省各地区赴港学习的急诊科专科护士和本院急诊科医护人员进行调查,了解他们对哀伤关顾的认识情况.结果 香港急诊科医护人员对哀伤关顾的认识(100.0％)、参加过哀伤关顾培训(100.0％)、实施过哀伤关顾(100.0％)以及具备的哀伤关顾技能(100.0％)都比较好,并认为有必要开展哀伤关顾(98.8％)和愿意加入哀伤关顾小组(86.3％);而赴港学习的本省急诊科专科护士和本院急诊科医护人员对哀伤关顾的认识、参加过哀伤关顾培训、实施哀伤关顾以及所具备的哀伤关顾技能基本处于较少或无的状态,对于是否有必要开展哀伤关顾和愿意加入哀伤关顾小组,赴港学习的本省急诊科专科护士有92.6％认为有必要,85.2％愿意加入;而本院急诊科医护人员84.1％认为有必要,63.2％愿意加入.结论 国内医护人员对哀伤关顾的认识以及对病人实施哀伤关顾较少,学习并引进香港以及国外关于哀伤关顾的知识,结合本国国情发展和完善本土哀伤关顾文化非常重要.     

The perceptions and experiences of nurses and bereaved families towards bereavement care in an oncology unit

Background

Existing bereavement literature focuses on the care provided in palliative care units or community settings. However, nurses in oncology units are in a unique position to provide bereavement care, which is care extended to the families after the death of cancer patients. This study aimed to explore the perceptions and experiences of bereavement care among nurses and bereaved family members in an oncology unit in Hong Kong.

Method

Semi-structured qualitative interviews were carried out in one oncology unit in Hong Kong with 15 nurses and ten bereaved family members. All interviews were audiotaped, transcribed verbatim and analysed by using qualitative content analysis.

Results

Among the bereaved family members, three themes emerged: being informed, being supported and being with the patient before and after the patient’s death. Among the oncology nurses, however, the three identified themes were: elements of good bereavement care, emotional response in providing bereavement care and educational needs in the provision of bereavement care. Comparatively, the experiences of and the opinions on bereavement care identified by the bereaved were more specific than those identified by the nurses.

Conclusion

The findings revealed that there is room for improvement in current bereavement care. Family members were committed to patient care and they expressed their need for more involvement in the patient care, which could result in a positive impact on their grief and loss experience. Nurses were committed to quality care, and they expressed their need for more training on knowledge, skills and attitudes to improve their readiness and competencies in the provision of bereavement care.     

A cluster analysis to investigating nurses' knowledge, attitudes, and skills regarding the clinical management system

Nurses' knowledge, attitudes, and skills regarding the Clinical Management System are explored by identifying profiles of nurses working in Hong Kong. A total of 282 nurses from four hospitals completed a self-reported questionnaire during the period from December 2004 to May 2005. Two-step cluster analysis yielded two clusters. The first cluster (n = 159, 56.4%) was labeled "negative attitudes, less skillful, and average knowledge" group. The second cluster (n = 123, 43.6%) was labeled "positive attitudes, good knowledge, but less skillful." There was a positive correlation in cluster 1 for nurses' knowledge and attitudes (rs = 0.28) and in cluster 2 for nurses' skills and attitudes (rs = 0.25) toward computerization. The study showed that senior and more highly educated nurses generally held more positive attitudes to computerization, whereas the attitudes among younger and less well educated nurses generally were more negative. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' computer knowledge and skills and improve their attitudes toward computerization.     

Exploring bereavement care in inpatient settings

This paper compares the attitudes and practices of health professionals to the provision of family-centred bereavement care in different Australian inpatient settings: palliative care services, acute care and long stay residential aged care settings. Semi-structured interviews (88) were conducted with doctors, nurses, pastoral carers and allied health staff. Comprehensive bereavement care was not being provided or resourced in the acute and aged care hospitals to the same level as that provided in palliative care services. Residential care provided continuity of care and good support for grieving relatives and other residents. A structured bereavement program is needed in all inpatient settings with palliative care patients, along with resource and education support for health professionals.     

Knowledge and attitudes in pain management: Hong Kong nurses' perspective

Effective pain management requires accurate knowledge, attitudes and assessment skills. To determine the current knowledge level and attitudes of nurses in pain management, 1,604 registered nurses working in three different hospitals in Hong Kong were invited to participate in this study. The sample consisted of 601 registered nurses, 63 nursing officers, and 14 nursing specialists (N = 678). The response rate was 43%. The Nurses' Knowledge and Attitudes Survey Instrument questionnaire developed by McCaffery and Ferrell was translated into Chinese and used with permission. To ensure the contextual relevancy and consistency of the questionnaire, content validity and test-retest reliability tests were performed. The content validity index was 0.87 and the test-retest reliability (Spearman's p coefficient) was 0.812. The percentage of correctly answered questions was 44%. There was statistical significant in educational preparation and clinical experiences with correct scores. The findings of our study support the concern of inadequate knowledge and attitudes in relation to pain management. Further intensive continuing education and staff development is highly indicated for nurses in Hong Kong.     

Attitudes of Hong Kong Chinese to traditional Chinese medicine and Western medicine: survey and cluster analysis

OBJECTIVES: To determine whether within a cohort of Hong Kong out-patients definable subtypes exist based on their attitudes to traditional Chinese medicine and Western medicine. DESIGN: Data were collected using a structured questionnaire. SETTING: The sample of 503 subjects was recruited at two local outpatient clinics in Hong Kong. MAIN OUTCOME MEASURES: The study employs demographic variables, illness status, the Chinese-Western Medical Belief Scale, trust of physicians and subjects' preferences on consultation fees, attitude of health care professional, efficacy of service and waiting time during consultation. RESULTS: A cluster analysis yielded three clusters based on their attitudes towards traditional Chinese and Western medicine. One cluster, 24% of the sample, is noted for being older, poorer, more likely to be female and to have chronic conditions; they are sceptical of western physicians. The second cluster (63% of the sample) is younger and have considerably more belief in Western than traditional Chinese medicine. The third group (14%) is intermediate in age and is noted for a marked faith in both forms of medicine. CONCLUSIONS: A clear profile of these attitudes of Hong Kong Chinese may benefit health care professionals in making appropriate patient-doctor relationships and planning patient care.     

Measuring emergency department nurses' attitudes towards deliberate self-harm using the Self-Harm Antipathy Scale

The emergency department is an important gateway for the treatment of self-harm patients. Nurses' attitudes towards patients who self-harm can be negative and often nurses experience frustration, helplessness, ambivalence and antipathy. Patients are often dissatisfied with the care provided, and meeting with positive or negative attitudes greatly influences whether they seek additional help. A quantitative design was utilised to measure emergency department nurses' attitudes towards deliberate self-harm. The 'Self-Harm Antipathy Scale', a validated questionnaire, was administered to a random sample of nurses in four emergency departments in the Republic of Ireland. A total of 87 questionnaires were returned (87% response rate). Results reveal that nurses show slightly negative antipathy overall, indicating positive attitudes towards self-harming patients. Attitudes were significantly different in accordance with a nurse's age. Education and social judgment also contribute to the way nurses view, interact and make moral decisions regarding self-harm patients. Evidence indicates there is need to improve the training, supervision and support of nurses caring for patients who self-harm, and that practical strategies should be implemented to manage the alienation process and inform practice.     

Caring for dying infants: experiences of neonatal intensive care nurses in Hong Kong

Ten registered nurses working in a neonatal intensive care unit in Hong Kong were interviewed to explore their experiences of caring for infants whose disease is not responsive to curative treatment, their perceptions of palliative care, and factors influencing their care. Eight categories emerged from the content analysis of the interviews: disbelieving; feeling ambivalent and helpless; protecting emotional self; providing optimal physical care to the infant; providing emotional support to the family; expressing empathy; lack of knowledge and counselling skills; and conflicting values in care. The subtle cultural upbringing and socialization in nurse training and workplace environment also contributed to their moral distress. Hospital and nurse administrators should consider different ways of facilitating palliative care in their acute care settings. For example, by culture-specific death education, peer support groups, bereavement teams, modification of departmental policies, and a supportive work environment. Future research could include the identification of family needs and coping as well as ethical decision-making among nurses.     

The management of bereavement on intensive care units

Objective To investigate the management of the bereaved on Intensive Care Units (ICU) throughout the United Kingdom, and to identify inadequacies that may exist either in the provision of staff training in dealing with bereavement or in the facilities or support available for the bereaved.Design Questionnaires were sent to the senior nurse and senior doctor in all general ICUs with more than four beds nationwide. The questions asked about nursing and medical practice around the time of a patient's death, as well as about staff attitudes towards, and training in, dealing with bereavement and the support they received for this role.Results We obtained a 68% (293/430) response rate. Most ICUs had facilities for relatives, but little for the specific needs of the bereaved. Only 6% of doctors and 21% of nurses had training in dealing with bereavement and grieving. A staff support group was available in 23% of ICUs, and 75% of the remainder thought it would be useful to have one. Lack of staff training and poor facilities for relatives were identified as the major concerns of ICU staff.Conclusion Many doctors and nurses working in Intensive Care Units feel inadequately trained to deal confidently with the bereaved. A minority of ICUs have support mechanisms available for their staff, inspite of the perceived need for them. Furthermore, many ICU staff feel the facilities they are able to offer the bereaved are inadequate. We have identified the major inadequacies and the needs of ICU staff for improved training. Meeting these needs would play a significant role not only in reducing staff stress but also minimising the morbidity in surviving relatives.     

Evolving towards professionalism in emergency nursing in Hong Kong

This paper aims to share with the readers about the experience of emergency nursing development and related roles in Hong Kong. The roles of emergency nurses are evolving and triggered by three major historical milestones. The three milestones consist of: (1) Transition of nursing education from hospital training to nursing degree program at universities in 1990; (2) The re-evolution after the establishment of Hospital Authority in 1993; (3) Hong Kong's return to China in 1997. These milestones have contributed immensely to the development of quality nursing education, nursing professionalism with emphasis on specialty knowledge and skill training in Accident and Emergency departments (AED) in Hong Kong. Since 1991, the emergency nursing role has been expanded and extended. Wound management remains one of the major extending roles for emergency nurses, who confine themselves to manage simple wounds. Nurse initiated tetanus immunization, intravenous access; investigations such as electrocardiogram, blood glucose, and urinalysis are well implemented in all AEDs under the governance of guidelines and protocols. Initial triage analgesic for the minor musculoskeletal injury and fever are also part of the triage care in some AEDs in Hong Kong now. To meet the demand and challenge, innovative role development such as lecturer practitioners and emergency nurse practitioners have been piloted and implemented recently. Besides the normal duty, emergency nurses also participate in the work outside the hospitals such as involvement in emergency medical teams to assist in various rescue missions or volunteer for Flight Nursing (Government Flying Services). However, the nursing shortage is another common problem faced by the Hong Kong health care body. With the help of advanced technology, better pre-graduate and specialty-training programs, Hong Kong health care strives to achieve the highest standards of quality care. Emergency nursing role development in Hong Kong is evolving and starts to chart its way to meet the demand.     

The difficulties faced by informal caregivers of patients with terminal cancer in Hong Kong and the available social support

This study aimed to explore the difficulties experienced by primary informal caregivers of Chinese patients with terminal cancer in Hong Kong and the social support available for such caregivers. For this exploratory study, 21 primary informal caregivers of patients with terminal cancer were recruited from a hospice home service to complete a questionnaire. The results show that all but one of the caregivers (95.2%) perceived difficulties in rendering care. They reported experiencing four major kinds of difficulties: relationship with the care receiver (n = 11, 52.4%), emotional reactions to caring (n = 9, 42.9%), physical demands (n = 10, 47.6%), and restricted social life (n = 11, 52.4%). Of the 21 caregivers, 20 (95.2%) felt that the support received from hospice home care nurses was useful, especially in skill training (n = 16, 76.2%), informational support (n = 20, 95.2%), and emotional support (n = 20, 95.2%). Informal caregivers also indicated that home care nurses provided more useful overall support than family members and friends (chi2 = 11.35; P =.003). With a better understanding of the difficulties experienced by caregivers and the support they receive, hospice home care nurses will be in a better position to identify effective strategies for helping informal caregivers cope with their difficult circumstances.