Chinese cultural dimensions of death,dying, and bereavement: focus group findings

The purpose of this qualitative study is to describe Chinese immigrants and Chinese Americans' attitudes and practices about death, dying, and bereavement. To this end, three focus groups were conducted with social work graduate students, pastors and religious leaders, and service providers working in the Chinese American community in New York City. The United States is becoming increasingly multicultural, and Chinese Americans are the most rapidly growing Asian American group. Findings from this study revealed that many Chinese attitudes and practices about death and dying are rooted in Asian cultural values such as filial piety, centrality of the family, and emphasis of hierarchy. In addition, strains of Confucianism, Buddhism, Taoism, and local folklore are embedded in these death attitudes and practices. Based on themes extrapolated from the focus groups, recommendations are delineated for service providers in order to implement culturally-sensitive bereavement practices.     

The effect of death education and experience on nursing students'' attitude towards death

Nurses face their own fear of death whenever they come to the bedside of a dying patient. This fear must be confronted and reconciled before they can help others meet death with dignity. Examining one's attitude towards death is a difficult task that needs to begin in the student years, when attitudes towards working with the dying are formed. Nurse educators recognize that brief but effective ways of promoting this kind of personal awareness need to be found. An experimental study is described that investigated the effect of death education programmes and personal experience with death on the attitudes of nursing students. It was found that the death attitudes of inexperienced students who were in an experiential programme were more positive than similar students who received a didactic or placebo programme. Experienced students, however, were negatively affected by the experiential approach. The implications of these findings for nursing education are outlined.     

The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students.

Nurse educators have identified that historically nurses have not been prepared to care for dying patients. Research also has identified that nursing students have anxieties about death, dying, and caring for dying patients. Several factors have been identified as affecting nurses' and nursing students' attitudes toward care of the dying. Factors addressed in this research were current and previous death education. This research incorporated experiential learning using a model of death education and transformative learning theory. The educational experiences were geared to help students understand the skills needed to care competently and compassionately for the dying. The use of the End of Life Nursing Education Consortium (ELNEC) education package along with experiences at the hospice, the funeral home, the anatomy laboratory, and role play helped facilitate transformative learning in the nursing students. The study examined the effects of an educational experience to determine if a one-time educational experience provides sufficient, lasting effects in a 6-week format. Results of this study indicate that education can have a positive effect on nursing students' attitudes toward care of the dying. Nursing students in the intervention group had a significant positive increase in their attitudes toward care of the dying after the intervention. The attitude change increased slightly after a 4-week period.     

East meets West: a comparison between undergraduate nursing education in Japan and in the United States

An increasing number of foreign students, especially those of Asian ethnicity, are enrolling in graduate nursing programs in the United States. The transition of these students into graduate nursing programs is not always easy. While a language difference may pose difficulties, a more crucial problem is the difference that often exists between the basic educational nursing preparations of Asian and American graduate students. Some Asian-educated students entering graduate nursing programs may not be prepared to the same degree as their U.S.-educated counterparts. This article presents some of the critical differences in educational philosophy, nursing faculty, types of nursing programs, admission criteria, nursing classroom and clinical experiences, and professional licensure that exist between Japan and the United States. Recommendations are proposed that could help mitigate some of these differences and facilitate the transition of Japanese graduate nursing students into the U.S. educational system.     

Undergraduate nursing students' attitudes and preparedness toward caring for dying persons – A longitudinal study

Nursing education needs to prepare students for care of dying patients. The aim of this study was to describe the development of nursing students' attitudes toward caring for dying patients and their perceived preparedness to perform end-of-life care. A longitudinal study was performed with 117 nursing students at six universities in Sweden. The students completed the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) questionnaire at the beginning of first and second year, and at the end of third year of education. After education, the students completed questions about how prepared they felt by to perform end-of-life care. The total FATCOD increased from 126 to 132 during education. Five weeks' theoretical palliative care education significantly predicted positive changes in attitudes toward caring for dying patients. Students with five weeks' theoretical palliative care training felt more prepared and supported by the education to care for a dying patient than students with shorter education. A minority felt prepared to take care of a dead body or meet relatives.     

Death education in baccalaureate nursing programs

These findings reveal that an emphasis on death and dying in baccalaureate nursing schools has definitely increased over the past 20 years. Ninety-five percent of the schools reported here have some emphasis on death and dying. The majority of nursing students take the death and dying offerings. Overwhelmingly, the professional background of the instructor is nursing. While only 5 percent of the schools do not offer anything in death and dying, nearly half of these plan to offer something "within the next five years." If death and dying offerings influence students' attitudes, as is suggested in research cited above, baccalaureate nursing programs in the United States apparently have taken positive steps toward helping nurses cope with dying over the past 20 years. If nurses themselves cannot deal with death, caring for a dying patient may be difficult. With continued increased emphasis on death and dying in nursing curricula, both nurses, patients, and patients' families will hopefully benefit.     

Attitudes toward death: a survey of nursing students.

The literature devoted to the topics of death and care of the dying is expanding rapidly. As nurses are inevitably involved in terminal illness, death and grief, their attitudes toward death and factors which affect these attitudes, are worthy of study. This report describes the results of a continuing two-year survey of one class of students in a baccalaureate nursing program. A questionnaire was used at the beginning and end of one academic year. Data were obtained regarding background experiences with death, involvement in the care of dying patients, and common ideas, concerns and feelings about death. Data from the second testing also included perceived changes in "positive" and "negative" attitudes toward death, and the relative effect on attitudes of various factors during the year. Suggestions are offered for curriculum development and research in the challenging area of death education in nursing.     

Student nurses' attitudes towards death and dying in south-east Iran

In this study, the attitudes of student nurses from Kerman and Bam in Iran towards death and caring for dying patients were compared. Two types of questionnaire were used: the DAP-R (Death Attitude Profile Revised) and FATCOD (Frommelt Attitude Towards Caring for Dying patients). The Bam student nurses, who had more experience of death due to the Bam earthquake in December 2003, were found to be less afraid of death and also less likely to give care to people at the end of life compared to their counterparts in Kerman. In both groups, those who were educated about death and dying had more positive attitudes towards caring for people who are dying than non-educated participants. The study suggests that adding palliative care education, accompanied by a reflective narrative approach, to the nursing curriculum is necessary to improve quality of care at the end of life.     

Selected correlates of white nursing students' attitudes toward black American patients

Multivariate analyses were used to examine the relationships between white nursing students' attitudes toward black American patients and variables selected within a theoretical framework of prejudice which included socialization factors and personality-based factors. The variables selected were: authoritarianism and self-esteem (personality-based factors), parents' attitudes toward black Americans, peer attitudes toward black Americans, interracial contact and socioeconomic status (socialization factors). The study also examined the differences in the relationship among white nursing students enrolled in baccalaureate degree, associate degree and diploma nursing programs. Data were collected from 201 senior nursing students enrolled in the three types of nursing programs in Rhode Island during the late fall and winter of 1979-1980. Although baccalaureate degree, associate degree and diploma students were similar in terms of peer attitudes toward black Americans, fathers' attitudes toward black Americans, self-esteem and attitudes toward black American patients, they were significantly different in terms of age, socioeconomic status, mothers' attitudes toward black Americans, interracial contact and authoritarianism. The major findings of this study indicate that the socialization explanation of prejudice is more significant than the personality-based explanation. The variables socioeconomic status, interracial contact and peer attitudes toward black Americans (all socialization variables) accounted for 22.0% of the total variance in attitudes toward black American patients for the total sample of nursing students. However, this relationship was not generalizable across the three different types of nursing programs.     

Critical nursing behaviors in care for the dying

A beginning list of seven critical nursing behaviors in care for the dying was identified in a qualitative study. Ten experienced palliative care nurses and 10 nurse educators were asked to describe situations in which a student or graduate nurse had displayed very positive or very negative attitudes to care for the dying. Behaviors identified after content analysis of transcribed interviews were responding during death scene, providing comfort, responding to anger, enhancing personal growth, responding to colleagues, enhancing quality of life during dying, and responding to the family. Three of these behaviors were not well described in the nursing literature.     

AIDS attitudes and attitudes toward caring for dying patients

This article reports on a survey of nursing staff working in AIDS residential health care facilities. More than two - thirds of respondents expressed non - punitive attitudes towards AIDS. Certified nursing assistants were more likely to report negative attitudes toward caring for dying patients than registered nurses. In general, respondents who had less punitive AIDS attitudes also reported less negative attitudes toward caring for dying patients. Nursing staff in AIDS residential facilities may benefit from further training that addresses issues involved in working with AIDS patients and caring for dying patients.     

Differential dimensions of death anxiety in nursing students with and without nursing experience

Researchers have demonstrated death anxiety in nursing professionals; however, it is unclear as to when this anxiety develops. This study used a multidimensional measure to investigate death anxiety in a group of experienced (n = 53) and inexperienced (n = 49) nursing students and a control group of non-nursing students (n = 50). Experienced nursing students reported significantly more fear of the dying process than inexperienced nursing students and controls whereas both experienced and inexperienced nursing students reported more fear of the unknown than controls. The results suggest that death anxiety may develop early in a nurse's training.     

Effects of counsellor race on racial stereotypes of rehabilitation counselling clients

Purpose: This study investigated perceptions of European American, African American, and Asian American rehabilitation graduate students in rehabilitation counselling by assessing their clinical impressions of African American, European American, and Asian American clients. This investigation is a continuation of several studies investigating clinical perceptions and client race.

Method: Rehabilitation graduate students in rehabilitation counselling participating in this study were randomly assigned to one of three groups and were asked to review case materials for a client portrayed either as African American, European American, or Asian American. In pursuit of the main effect of client race, three separate MANOVA analyses were conducted: one for African American graduate students in rehabilitation counselling, one for Asian American graduate students in rehabilitation counselling, and one for European American graduate students in rehabilitation counselling.

Results: Contrary to previous findings from comparable research, MANOVA results did not reveal a significant main effect of bias by European American, Asian American, and African American graduate students in rehabilitation counselling against any of the three groups.

Conclusions: Understanding of the conditions in which racial biases and subsequent judgmental errors are likely to occur (or not occur) should allow clinicians to recognise tendencies for their assessments to be influenced by client characteristics that elicit stereotypes and thereby to make more accurate judgements.     

Effects of counsellor race on racial stereotypes of rehabilitation counselling clients

Purpose:?This study investigated perceptions of European American, African American, and Asian American rehabilitation graduate students in rehabilitation counselling by assessing their clinical impressions of African American, European American, and Asian American clients. This investigation is a continuation of several studies investigating clinical perceptions and client race.

Method:?Rehabilitation graduate students in rehabilitation counselling participating in this study were randomly assigned to one of three groups and were asked to review case materials for a client portrayed either as African American, European American, or Asian American. In pursuit of the main effect of client race, three separate MANOVA analyses were conducted: one for African American graduate students in rehabilitation counselling, one for Asian American graduate students in rehabilitation counselling, and one for European American graduate students in rehabilitation counselling.

Results:?Contrary to previous findings from comparable research, MANOVA results did not reveal a significant main effect of bias by European American, Asian American, and African American graduate students in rehabilitation counselling against any of the three groups.

Conclusions:?Understanding of the conditions in which racial biases and subsequent judgmental errors are likely to occur (or not occur) should allow clinicians to recognise tendencies for their assessments to be influenced by client characteristics that elicit stereotypes and thereby to make more accurate judgements.     

Nursing faculty and students' attitudes regarding HIV.

A multidisciplinary group of health professional educators examined the faculty and student attitudes related to AIDS in undergraduate and graduate nursing programs and in a dental hygiene program. Results indicated consistent differences in attitudes toward homosexuality and intravenous drug users, AIDS-phobia, AIDS-related work stress, and willingness to work with HIV, homosexual, or intravenous-drug-using patients among faculty, undergraduate, and graduate nursing students, and certificate-level dental hygiene students. Faculty and master's-level nursing students consistently indicated the most positive attitudes and behavioral intentions. A one-year follow-up of a sample of undergraduate students revealed little change in these attitudes or behavioral intentions. Implications of these findings for nursing educators are discussed.     

''We didn''t want him to die on his own''— nurses'' accounts of nursing dying patients

This paper is based on nurses' accounts of their experiences of nursing dying patients, and the attitudes towards such work which they expressed. Nurses reported high levels of emotional involvement with their dying patients and expressed a preference for being honest with them about their condition. They preferred to nurse patients who were aware of their death rather than those who were not. Structural aspects of the ward organization which facilitate such action and attitudes are identified.     

Care of dying patients and patients after death: Patterns of care in nursing history

Nursing literature at the turn of the century was examined to determine patterns of nursing care given to dying and to dead patients by nurses at that time. Two nursing periodicals and two nursing textbooks were reviewed to identify patterns of care. These patterns included knowledge of the symptoms of death, care of the family of the dying, spiritual care, comforting the dying, nurses' close association with death, methods of giving postmortem care, preparation of the patient's room after death, disposition of the body after death, and nurses' attitudes toward the deaths of patients.     

The availability of education on death and dying: A survey of U.S. nursing schools

A stratified random sample of 226 U.S. nursing schools was surveyed to determine the extent and nature of current death education training for nursing students. Of the 205 responding schools, 5 percent reported offering a required death and dying course, while an additional 39.5 percent indicated that a death and dying course was available for their students on an elective basis. The authors challenge the current pedagogical approach toward death education in U.S. nursing schools. They propose the need for the development of a model that would formally link a death education course, or courses, with the clinical phase of training. It is hypothesized that such an approach would enhance the nursing students' recognition and management of their feelings regarding death and dying and therefore result in more effective means of relating to terminally ill patients.     

Nursing students' and faculty members' knowledge of, experience with, and attitudes toward complementary and alternative therapies

This study was designed to describe and compare the knowledge, experience, and attitudes of nursing faculty and students (undergraduate and graduate) regarding complementary and alternative therapies (CAT). A cross-sectional survey (N = 153) of undergraduate (n = 41) and graduate (n = 57) students and faculty (n = 55) was conducted in one school of nursing. Most participants were White (87%) and female (78%). More than 70% of the students and faculty agreed that clinical care should integrate the use of CAT. More than 85% desired more education about CAT, especially in undergraduate nursing curricula. More than 65% agreed that the clinical nurse specialist or nurse practitioner role should include the use of CAT in their practice, and more than 50% agreed that they had some knowledge of CAT, but only approximately 30% had some experience with CAT. Faculty and students expressed positive attitudes toward integrating CAT into the undergraduate nursing curriculum and nursing practice. Faculty development and nursing research are needed to facilitate curriculum change and integrate CAT into nursing programs at all levels.