Nursing autonomy plays an important role in nurses' attitudes toward caring for dying patients

The aim of this study was to clarify the relationship of nursing autonomy and other factors related to attitudes toward caring for dying patients. A cross-sectional survey of nurses was conducted in November 2003 using a self-administered questionnaire. We collected demographic data from 178 (75%) participants and used the Frommelt Attitude Toward Care of the Dying scale, Form B, Japanese version (FATCOD-Form B-J), the Pankratz Nursing Questionnaire (PNQ), and the Death Attitude Inventory (DAI). FATCOD-Form B-J measures nurse's attitude toward caring for dying patients. It includes two subscales: positive attitude toward caring for the dying patient and perception of patient- and family-centered care. The PNQ measures nursing autonomy of individual nurses and has three subscales: nursing autonomy and advocacy, patients' rights, and rejection of traditional role limitations. The DAI measures attitudes toward death in context of Japanese cultural characteristics. It includes seven subscales: afterlife beliefs, death anxiety, death relief, death avoidance, life purpose, death concern, and supernatural beliefs. We investigated the factors associated with the FATCOD-Form B-J. Support of a mentor regarding end-of-life issues (beta = .19, P = .001), death avoidance domain of the DAI (beta = -.14, P = 0.03), life purpose domain of the DAI (beta = .23, P = .001), and rejection of traditional role limitations domain of the PNQ (beta = .51, P = .001) were selected as significant independent variables by multivariate analysis to evaluate nurses' positive attitudes toward caring for dying patients. Death anxiety domain of the DAI (beta = -.17, P = .02), patients' rights domain of the PNQ (beta =.46, P = .001), and rejection of traditional role limitations domain of the PNQ (beta = .34, P = .001) were selected as significant independent variables by multivariate analysis to evaluate the nurses' perception of patient-and family-centered care. In conclusion, nursing autonomy plays an important role in the attitudes of Japanese nurses who care for dying patients. Educational and administrative efforts to strengthen nursing autonomy are necessary.     

Attitudes toward care of the terminally ill: an educational intervention

This quasiexperimental study examined the effect of an educational program on attitudes toward caring for terminally ill persons and their families. Participants were 115 undergraduate students: intervention group, N = 49; control group, N = 66. Pre- and post-intervention measurements were done with the Frommelt Attitude Toward Care of the Dying Scale (FATCOD, Form B). Students in the intervention group participated in a semester-long (15-week, 45-hour) educational program. Demographic variables, including age, gender, religion, major area of study, influence of religious beliefs, profession, previous education, and past or present experience with loss were evaluated. Statistical analyses (t-test, ANOVA, ANCOVA, and APVs) indicated a significant positive change in the attitude scores of the intervention group and no significant change in the attitude scores of the control group.     

Thanatophobia and opiophobia of hospice nurses compared with that of other caregivers

In meeting national needs for our terminally ill, health care educators need to become more aware of their students' aptitudes for hospice work. For these reasons we measured hospice nurses' attitudes toward caring for the terminally ill and their views on using opioids, and compared them to those of other health care personnel and their students. Thirty-eight hospice nurses, 64 other nurses, 93 physicians, and 676 senior medical students participated in this study. Our primary measures were scales assessing thanatophobia and opiophobia and a battery of personal and professional role trait measures. Our results indicated that in providing end-of-life care, hospice nurses expressed less discomfort, helplessness, and frustration, and indicated less reluctance to use opioids than did any of the other groups surveyed. Overall, these hospice nurses had 35 percent lower opiophobia and 55 percent lower thanatophobia scores than the other health care professionals. Despite dealing with issues of death and dying on a daily basis, hospice nurses also scored lower on depressed mood. In caring for the terminally ill, hospice nurses' other personal traits were also less maladaptive than those of the other health professionals. Psychiatrists exhibited the most opiophobia, not only scoring higher than physicians practicing oncology, but also higher than senior medical students. To assure cancer patients that they can expect to live their lives free of pain, medical educators can use these thanatophobia and opiophobia scales to develop better teaching, counseling, and monitoring strategies.     

Follow-up study of recent graduates: the value of death education in their curriculum

Graduates from three coordinated dietetics programs who had participated in a research project in which a death education curriculum unit for dietetic students was developed, implemented, and evaluated, were mailed questionnaires to ask their opinion of their undergraduate preparation to work with terminally/seriously ill clients. Graduates agreed that including death education was important in their preparation as dietitians and suggested expanding the topics. For the subjects in this sample, neither death education as a student nor work experience with the dying since graduation has changed their attitude score on three scales: Death Fear, Disengagement from Death Fear, and Dietetic Attitude. Although this is a very small sample, the findings suggest that attitudes about death and working with the dying are resistant to change. Members of this group, both as students and as graduates, indicated that the unit was helpful to them in doing what they perceive as a difficult part of their job. This project suggests that developing support systems for students in their clinical experience and for professional dietitians to help manage the stress of working with seriously and terminally ill clients should be one of the goals of death education rather than trying to change attitudes toward death on either a pre-service or an in-service basis.     

The effectiveness of a short curriculum unit in death education for dietetic students

Dietetic educators are concerned with preparing their students to interact effectively with seriously/terminally ill patients in clinical settings. In this study, a short death education curriculum unit including multi-media teaching materials was designed, implemented, and evaluated. The subjects were 47 junior students enrolled in three coordinated programs. Instruments were adopted or adapted to assess the following items: knowledge of the grief process, personality traits of empathy and dogmatism, fear of death, fear of interacting with the dying, attitudes toward working with terminally ill clients as part of the professional role of dietitians, and clinical performance. Scores for the traits of empathy and dogmatism were negatively related, and students with a higher degree of religious conviction had lower death fear scores. Although no significant changes were found in any of the attitude scores after the curriculum unit, most students indicated that the unit made them feel more comfortable about working with the seriously ill. Students and faculty recommended that death education be included for dietetic students.     

To Explore the Neonatal Nurses’ Beliefs and Attitudes Towards Caring for Dying Neonates in Taiwan

(1) To explore attitudes and beliefs of neonatal nurses toward nursing care for dying neonates; (2) to estimate the influence of neonatal nurses’ personal and professional characteristics on their attitudes towards end-of life care for dying infants. A cross-sectional design was used. A questionnaire was used to collect data from 80 neonatal nurses. Research setting was four level III NICUs at four medical centers around the central region of Taiwan. Research participants were neonatal nurses who had worked for at least 1 year in one of level III NICUs and had been directly involved with the care of dying infants. Research participants were 80 neonatal nurses (response rate 100 %). Research findings identified eight barriers hindering neonatal palliative care practice. These barriers were insufficient communication due to the lack of an in-service educational program; the lack of available counseling help for neonatal clinicians; inability to express personal opinions, values and beliefs towards neonatal palliative care; insufficient staffing; the lack of unit policies/guidelines for supporting palliative care; the technological imperative; parental demands and personal beliefs about death and previous experience caring for dying infants. Further studies are needed to explore each barrier and to provide in-service neonatal palliative care educational programs that are needed to decrease these barriers.     

Physicians and the dying: a historical sketch.

The tradition fo Western medicine established during the period of classical antiquity and extending through the early modern period encouraged the physician to avoid or to refuse to treat the seriously and/or terminally ill patient. The cultural environment and general attitudes toward death and dying helped to maintain this practice. Since the nineteenth century, however, the physician has increasingly accepted more responsibility, until he has become the central figure in management of the terminally ill patient. This paper examines the evolution of the relationship between the physician and the dying patient with the intention of illuminating various factors which helped to determine that relationship.     

Nursing support for family members of critically ill adults

Researchers have identified the needs of family members of critically ill adults, explored their experiences, and investigated interventions. To address a gap in the theoretical knowledge about how nurses help these individuals, the authors developed a grounded theory of nursing support from the perspective of family members. Results indicated that family members were initiated into a cycle of Work to meet perceived responsibilities to Get Through the experience. Supportive nurses engaged in the process of Lightening Our Load to mitigate the negative effects of the critical care experience on family members by Engaging With Us, Sustaining Us, and Disengaging From Us. No previous research has yet identified the Work of these family members, the steps they take to gain nurses' respect, and the significance to them of nurses' Welcoming us and Saying goodbye. This theory extends the understanding of nursing support beyond current knowledge of family needs, caring, comfort, supportive care, and social support.     

Assessment of Knowledge and Attitude towards Palliative Care and Associated Factors among Nurses Working in North Wollo Hospitals

BackgroundPalliative care improves the quality of life of patients facing a life-threatening illness. Nurses should improve their caregiving capacity. In Ethiopia, palliative care is underestimated. The availability of data regarding the knowledge and attitude of nurses towards palliative care is critically important. Thus, this study aimed to assess the level of knowledge and attitude of nurses towards palliative care.MethodsInstitution-based, cross-sectional study was conducted in North Wollo hospitals. A simple random sampling technique was used. The data was collected using structured self-administered questionnaires from February to March 2019. The analysis was done using a binary logistic regression model. P-value < 0.05 was considered as statistically significant.ResultsThe result revealed that 59.7% of the respondents had good knowledge and 44.2% had a favorable attitude towards palliative care. Level of education, experience in caring for chronically ill patients, and experience in caring for dying family members within the last 6 months had a significant association with the knowledge of nurses. Monthly income, experience in caring for chronically ill patients, formal palliative care education, and knowledge were found statistically significant with the attitude of nurses towards palliative care.ConclusionMore than half of the nurses had good knowledge, but less than half of the respondents had a favorable attitude towards palliative care. Attention should be given towards palliative care by the health policy and needs to be incorporated into the national curriculum of nursing education.     

Informal care and terminal illness

This paper is based on a study of the care and services received by people in the year before death in one Yorkshire health authority. In the spring of 1997 in-depth interviews were carried out with bereaved relatives and carers of a weighted sample of 33 people who had died in one Yorkshire health authority in the previous 18 months. Deaths where people were judged to have needed no input from palliative care services were excluded. The sample covers a range of different caring arrangements, experiences of caring for someone who is dying, support from formal services, place and manner of death. All those interviewed were providing some form of informal care or support to those who died, in some cases 24-h care. The interviews provided a valuable insight into ordinary people's experiences of death and of caring for someone who is dying. Most importantly for the purposes of this study, they gave insight into their experiences of services to support both the dying person and themselves in their caring role. The paper discusses the ways in which care of the terminally ill is distinctive. It explores the role of informal care in relation to the wider character and history of the local community, in particular the significance of its declining industrial base, and secondly, the availability of appropriate services to support those caring for the terminally ill. Finally, it makes recommendations about service planning and delivery which challenge the current framework for providing services to the terminally ill.     

Do smoking and health education influence student nurses' knowledge, attitudes, and professional behavior?

BACKGROUND: Student nurses are an important target group for smoking prevention. This study analyzes (a) the relation between student nurses' smoking behavior and their knowledge, attitudes, and behavior toward smoking prevention and (b) the effect of targeted health education in improving student nurses' knowledge, attitudes, and preventive behavior. METHODS: A controlled trial was performed with school classes as the randomization unit. One hundred fifty-five first-year students from a school in nursing in Copenhagen, Denmark, participated in a baseline study and a follow-up study 7 weeks later. The intervention included eight lectures on the health consequences of smoking. RESULTS: About 40% of student nurses in both the intervention and the control groups were smokers, and this percentage did not change during follow-up. Compared with nonsmokers, smokers had less favorable attitudes and behavior toward smoking prevention. Student nurses' knowledge about the health consequences of smoking improved during the study period in both groups, but the change was larger in the intervention group. This difference was not present in multivariate analyses that controlled for age and smoking status. During follow-up the attitude improved in the intervention classes, while it deteriorated in the controls, revealing a significant difference, which persisted after multivariate adjustment. The amount of education had no effect on student nurse's preventive behavior. CONCLUSION: Targeted health education improves knowledge and attitudes toward smoking prevention in first-year student nurses.     

Nurses’ attitudes toward parent participation: Personal and professional characteristics

A nonrandom sample of 273 registered nurses completed a questionnaire that included the Parent Participation Attitude Scale and a personal and professional data section. Analysis of variance indicated that subjects who were married, were parents, were nursing supervisors, had a collegiate nursing education, or worked in Hospital 1 or 4 had more positive attitudes toward parent participation than did subjects who did not possess these characteristics. Further study of nurses from 28 hospitals found that head nurses, nursing supervisors, nurses with a professional nursing education, and nurses with a master's degree in nursing had significantly more accepting attitudes than did nurses without these characteristics.     

Nurses' attitudes toward parent participation: personal and professional characteristics.

A nonrandom sample of 273 registered nurses completed a questionnaire that included the Parent Participation Attitude Scale and a personal and professional data section. Analysis of variance indicated that subjects who were married, were parents, were nursing supervisors, had a collegiate nursing education, or worked in Hospital 1 or 4 had more positive attitudes toward parent participation than did subjects who did not possess these characteristics. Further study of nurses from 28 hospitals found that head nurses, nursing supervisors, nurses with a professional nursing education, and nurses with a master's degree in nursing had significantly more accepting attitudes than did nurses without these characteristics.     

Care of the dying: a Catholic perspective. Part I, Cultural context: a CHA document challenges care givers to define appropriate care for the dying

In a society tempted to adopt legalized assisted suicide and euthanasia as appropriate responses to dying, the healthcare community is challenged to nurture positive attitudes toward death among all ages and to help those with terminal illnesses to live well while dying. Whereas family and friends were once the primary care givers, now members of the healthcare professions are. This shift has introduced tensions between medical professionals and patients, including their families, in defining appropriate behavior toward the dying. To enable the terminally ill to live well while dying, we need to allow them to retain as much control as possible within the limits of belonging to a community. Also, we need to secure their network of significant relationships so they can experience the affective bonds of trust and love that support personal dignity and enhance the meaning of life. Medical technology is to be used in service of the total good of the patient. This includes not only the relief or cure that therapy can bring, but also what the patient prefers, values about life, and regards as giving ultimate meaning to life. Catholic healthcare institutions are challenged to promote a sensitivity and respect for cultural diversity as they respond to the needs of the dying and those who care for them.     

Physician and nurse attitudes toward artificial hydration for terminally ill cancer patients in Japan: results of 2 nationwide surveys

This study investigated physician and nurse attitudes toward artificial hydration in terminally ill cancer patients and compared differences in attitudes between these 2 professions and among clinical settings in Japan. The response rate was 53% (584/1,123) for physicians and 79% for nurses (3,328/4,210). More physicians answered that artificial hydration alleviates the sensation of thirst. More palliative care unit physicians and nurses answered that withholding artificial hydration alleviated several physical symptoms. Oncologists answered that artificial hydration alleviated the sensation of thirst and fatigue. Discussion among patient-centered teams and individualized decision making are important. Because the differences identified here are attributable to differences in knowledge of artificial hydration for terminal cancer patients, oncologists should place greater emphasis on the opinion of palliative care specialists. Medical practitioners caring for terminal cancer patients should consider a broader range of views on hydration therapy, with a focus on effective hydration techniques and alternative interventions.     

School Nurses: Improve the Reception and Sharpen the Image

Many educators and community members misunderstand the present-day school nurses. These nurses' roles encompass a much broader range of health-related activities than did their predecessors' roles. Continued education and professional autonomy have enabled school nurses to direct their attention to primary and secondary prevention and to the maintenance of health. By utilizing a systems approach, school nurses can plan strategies that promote visibility and clarify their images. The outcome could result in better understanding and cooperation between the nurses and other school personnel, resulting in an ultimate benefit to children. The organization of a city school district's health service program and the functions of some of its team members are described. Pertinent statistics regarding the district and the nurses working within it are provided. Examples are given of typical school nurses experiences and responsibilities. Numerous suggestions are made for establishing networks with those persons having formal and informal power in order to achieve visibility and credibility. Some of the suggestions include participation at parent association meetings, presidents' council, teacher-faculty meetings, community council meetings and spreading the message via school and local newspapers.     

Proactive identification of seizure risk improves terminal care

Seizures are a common neurologic consequence of various etiologies in the end-stage cancer patient. Because dying cancer patients and their families are often coping with new challenges daily, any intervention that can prevent further patient or family discomfort should be implemented. The purpose of this study was to evaluate four pharmacy interventions aimed at improving nursing care to cancer patients at a facility for the terminally ill. The four interventions were development of a seizure risk factor assessment toll, assembly or availability of a diazepam seizure kit, nursing education via in-service training, and development of a manual for nursing stations. Successful implementation of this project indicated that nurses perceived an empowerment in improving quality of life of their patients.     

Rural generalist nurses' perceptions of the effectiveness of their therapeutic interventions for patients with mental illness

OBJECTIVE: To explore generalist nurses' perceptions of their efficacy in caring for mentally ill clients in rural and remote settings, and their educational needs in the area of mental health care. DESIGN: A self-administered questionnaire adapted from the Mental Health Problems Perception Questionnaire; a Likert scale used to rate the perceptions of nursing staff of their own ability to adequately treat and care for patients experiencing mental illness. Setting: The Roma and Charleville Health Service Districts, Queensland, Australia. SUBJECTS: Nurses (Registered Nurses, Assistants in Nursing and Enrolled Nurses) in the Roma and Charleville health service districts (n = 163). MAIN OUTCOME MEASURES: Generalist nurses' perceptions regarding their therapeutic commitment, role competency and role support. Results: Seventy per cent of respondents indicated that limited knowledge of mental health problems was an issue preventing nursing staff in rural and remote settings from providing optimum care to patients with mental illness. Twenty-nine per cent of respondents indicated that they had never received or undertaken training or education in relation to the care, treatment or assessment of patients with mental illness. CONCLUSION: Rural nurses do not feel competent, nor adequately supported, to deal with patients with mental health problems. In addition, the nurses' education and ongoing training do not adequately prepare them for this sphere.     

Internalizing stigma associated with mental illness: findings from a general population survey in Jamaica.

OBJECTIVES: The culture of stigma associated with mental illness is particularly intense when persons who are normally victims of that stigmatization (mentally ill persons and their family members) themselves act negatively toward others whom they associate with mental illness. We attempt to determine the extent of this internalization and assimilation of stigmatizing attitudes, cognitions, and behaviors in persons who are at risk for such stigmatization in Jamaica. METHODS: Data from a 2006 national survey on mental health were analyzed. Demographic variables, the presence or absence of mental illness in respondents and in their family members, and responses pertaining to behaviors and attitudes toward mentally ill persons were examined. Subsamples (respondents with mental illness, respondents with a family member with mental illness, respondents with neither) were compared using the chi-square test. RESULTS: Respondents with family members with mental illness were less likely to demonstrate a number of different manifestations of stigmatization than others (P=0.009-0.019). Respondents with mental illness showed no difference in the demonstration of a number of different manifestations of stigmatization from other respondents (P=0.069-0.515). CONCLUSIONS: The small number of mentally ill respondents resulted in low statistical power for demonstrating differences between that subgroup and other respondents. The significantly more positive attitudes and behavior of respondents with family members with mental illness suggest that some benefit may be gained by creating more opportunities for the general public to interact with persons with mental illness.     

Immediate effectiveness of brief psychological training for health professionals dealing with terminally ill cancer patients: a controlled study

The usefulness of a psychological training for health professionals dealing with terminally ill cancer patients is beginning to be widely recognized, but little has been done to elaborate its content and form. The study of the effectiveness of brief psychological training groups is of special interest for the quality of treatment to be achieved. The principal aim of the training group, assessed here, was to develop a better understanding of death and dying issues and ways to cope with them. Subjects (n = 122) who attended the training groups were compared to a control group (n = 43). Attitudes about oneself, toward illness and death, occupation, personal growth, and professional relationship were assessed with a semantic differential questionnaire before and after training. Results show a significant change in attitudes for the trained subjects. Subjects reporting more negative attitudes at the beginning of the training were those which benefit the most. The attitude change is a first step aimed at assessing the effectiveness of psychological training; it will be completed by the assessment of long term attitudes and behavior modifications of the health care professionals trained.