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.     

肿瘤科护士对照顾终末期癌症患者的职责认同与负性感受研究

目的:了解肿瘤科护士对照顾终末期癌症患者的态度。方法:采用自行编制的"护士照顾终末期癌症患者的态度评估量表",对全国19家医院的463名肿瘤科护士进行调查,内容包括护士对照顾终末期癌症患者的职责认同程度以及工作中的负性感受两个维度,每个维度均包括症状控制、心理辅导以及家属支持3个方面的测量。结果:①护士对症状控制、心理辅导以及家属支持3方面的职责普遍认同,但在心理辅导方面,对帮助患者应对疾病状况和死亡的职责的认同分值不高,存在不确定性。②护士在3方面的实践中负性感受均较高,其中在帮助家属应对悲伤过程中的负性感受最强,对症状控制的无能为力感受次之。心理辅导方面,护士在帮助患者应对当前疾病状况和谈论死亡问题上感到困难。③护士在症状控制和心理辅导两方面的职责认同程度与工作中的负性感受呈负相关。结论:肿瘤姑息护理的继续教育仍需进一步加强,帮助更多的肿瘤科护士明确职责,更新理念,提高专科护理知识水平和能力,才能为终末期癌症患者提供更加专业、有效的护理,同时也有助于减轻工作中的负性感受和压力。     

Supporting pre-registration nursing students in their exploration of death and dying

Student nurses will be exposed to dying patients from the very start of their education. The authors believe that nurse lecturers have a duty of care towards both the student and the patient in preparing them to cope with this experience. End of life care deserves further emphasis within the forum of nurse education. Within this article the authors outline their introduction of a new teaching session at the beginning of the pre-registration nursing curriculum at Birmingham City University to help prepare student nurses from all four fields of nursing to participate in end of life care. This flexible session entitled ‘perceptions of dying’ allows the students to explore their fears, anxieties and expectations of caring for a patient at the end of their life and discusses the mechanisms available for seeking support. The purpose of this article is to raise debate about the teaching of the subject of death and dying within pre-registration nurse education and to show case the lesson concept that the authors believe could be disseminated further to address this student need.     

Attitudes toward people with disabilities: a comparison between health care professionals and students

The objective of this study was to explore the attitudes of health care professionals and their students towards people in Hong Kong with disabilities. The attitudes of four groups of professionals and students (physiotherapists, occupational therapists, social workers and nurses) were assessed using the well-documented Attitude Toward Disabled Persons scale through the methodology of mailed questionnaires. Comparisons were made among different groups of students and professionals in order to gain insight into factors affecting their behavior. In this study, 511 students and 489 professionals were selected randomly. The results indicated that the overall mean Attitude Toward Disabled Persons scale score of the respondents was comparatively lower than that of their counterparts in foreign countries. The professionals had a significantly higher attitudinal score than the students. Among the four disciplines, nurses held the least favorable attitudes towards people with disabilities. In addition, their attitudes were less positive than those of the student nurses. On the other hand, the social work students had less favorable attitudes than the professional social workers, as well as other types of health care students. The analysis of the data also revealed that the mean Attitude Toward Disabled Persons scale scores for both the occupational therapists and occupational therapy students were above the overall average. Unlike the physiotherapists, the mean Attitude Toward Disabled Persons scale score of the physiotherapy students was below the overall average. In addition, age, year of study, educational level, knowledge and contact with people with disabilities were significant factors in the attitudes held by the students and professional respondents. The quality of the contact was found to be a dominant factor in affecting the scores on attitude. Thus, recommendations were made to modify the current training curriculum and enhance the quality of services to develop more favorable attitudes towards people with disabilities.     

The issue of death and dying: employing problem-based learning in nursing education

Caring for dying patients can be an emotionally painful, distressing and sometimes threatening experience for nurses as the illness is incurable and death is imminent. The avoidance of discussion of dying in the presence of patients in Chinese culture further increases nurses' anxiety. The purpose of this article is to provide an example of how nurses can be helped when caring for dying patients by using a problem-based learning (PBL) approach in Hong Kong. The process and value of using PBL is discussed from the students' perspective. Students went through the PBL process and documented their learning throughout the course in journals. A total of 96 sets of journals were collected and analysed. The case analysis explored the perception of learning in the process of PBL. Three themes, related to nurses' attitudes and caring behaviours towards death and dying, have been derived from the findings. They were (a) increased self-awareness (b) positive attitudes towards death (c) providing culturally sensitive care. Problem-based learning as a pedagogical strategy for achieving learning in death and dying was well received. Problem-based learning was found to be a highly satisfactory method for enabling nurses to reflect on their own attitudes towards death and understanding of the emotional aspects of death and dying. Independent finding of information not only prompted nurses to find information from books and journals, but nurses also interviewed experts and patients for updated and experiential knowledge. Tutorials serve as a safe environment for discussion and sharing of feelings and information. The results definitely support PBL as an effective teaching strategy for nursing educators in the area of death education.     

护理专业实习生从事生活护理意愿和态度的研究

目的调查护理专业实习生从事生活护理的意愿和态度。方法抽取在天津市某三甲医院实习的147名护理专业实习生为调查对象,采用问卷调查实习生从事生活护理的意愿和态度。结果实习生对执行各项生活护理的意愿评分均低于3分,学历高的实习生从事生活护理的意愿相对消极(P<0.05);独生子女对生活护理的态度比非独生子女消极(P<0.05);实习生对生活护理的意义和内涵认知积极,尤其是高学历实习生,但对从事生活护理的感受较为消极。结论实习生从事生活护理的行为意愿不积极,实施生活护理时存在负面心理感受。应注重引导实习生更新服务理念,加强职业态度,提高对生活护理的认知和行为意愿。     

Registered nurses’ knowledge,attitudes and beliefs about end-of-life care in non-specialist palliative care settings: A mixed studies review

AimThe aim of this study was to describe, evaluate and synthesise the literature on registered nurses’ knowledge, attitudes and beliefs towards end-of-life care in adult non-specialist palliative care settings.BackgroundLittle is known about the knowledge, attitudes and beliefs of Registered Nurses working in non-specialist palliative care settings about end-of-life care.DesignA mixed-methods systematic review and narrative synthesis was conducted (PROSPERO Registration No: CRD4202148114). Five databases (Medline, CINAHL, PubMed, PsycINFO and Web of Science) were searched from inception to August 2020. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsNineteen studies met the inclusion criteria. Registered nurses in non-specialist palliative care settings demonstrated good knowledge of pain symptoms and management and positive attitudes towards caring for dying patients and their families. Knowledge deficits were identified in the psychosocial and spiritual aspects of end-of-life care and registered nurses reported negative attitudes towards communication about death. Only five of the included studies explored registered nurses’ beliefs towards end-of-life care.ConclusionsThere is a need to enhance palliative care education in clinical practice settings and in undergraduate programs to improve registered nurses’ knowledge, attitudes and beliefs about end-of-life care. Future studies that use reliable and validated methods to measure registered nurses’ beliefs about end-of-life care should be conducted.Tweetable abstractRNs in non-specialist palliative care settings want more education on pain management & greater knowledge on communicating about death/dying.     

Attitudes of nurses in a general hospital towards people with learning disabilities: influences of contact, and graduate-non-graduate status, a comparative study

A review of the literature suggests people with learning disabilities are viewed negatively by others in society Such negative views have also been found among many health care professionals, including nurses This study measured the attitudes of a randomly selected sample of nurses in a general hospital (n=31) towards people with learning disabilities The study involved a triangulation approach utilizing a Likert scale attitude measurement questionnaire Two comparisons between subjects in the study were undertaken—a comparison of the attitudes of graduate nurses and those who were non-graduates, a comparison between nurses who had most contact, and those who had least contact with people who have learning disabilities From the sample of 31 nurses, 10 subjects were selected for more in-depth interviews which were tape recorded, transcribed and, using the process of 'content analysis', quantified
Findings suggest the attitudes held by the total sample towards people with learning disabilities were more negative than would be expected from those in a caring profession The graduate nurses were found to be more positive in their perceived attitudes towards people with learning disabilities than non-graduate nurses Nurses in the sample who had high contact were found to have more positive attitudes than nurses who had lower amounts of contact with people who had learning disabilities     

Iranian nurses’ preparation for loss: finding a balance in end‐of‐life care

Aim. To explore the nurse–patient interaction in terminally ill situations in acute care, focusing on the nurses’ preparation for loss. Background. Caring for dying patients can be a distressing and sometimes even threatening experience for nurses. Despite the vast body of literature on nurse/patient interaction and the quality of end‐of‐life care, few studies focus specifically on nurses’ experience. Design. A grounded theory approach was used to explore nurses’ interaction with dying patients and their families and examine how nurses deal with situations in which the patient’s death is inevitable. Method. Eighteen nurses were interviewed up to three times each at three teaching hospitals in Isfahan, Iran, during autumn 2006. A shortlist of possible participants was obtained by means of theoretical sampling and those who had experienced the death of patients and were able to express their feelings verbally were selected. Results. The results clarified a core consideration: striking a balance between restorative and palliative care, information and hope, expectations and abilities and intimacy and distance. Conclusion. Attaining a balance in caring for dying patients is a major challenge to nurses: it concerns not only their interactions with patients and their families, but also their perceptions of themselves and their actions in end‐of‐life care. Relevance to clinical practice. In end‐of‐life care, it is important for nurses to be able to change the focus of their care when the patient’s condition is diagnosed as irreversible. They also need to be well equipped to maintain a balance, thereby preparing themselves for the patient’s forthcoming death.     

Nurses' and care workers' attitudes toward death and caring for dying older adults in Japan

Registered nurses (RNs) and care workers (CWs) have important roles in providing end-of-life care to older adults, but little is known about the attitudes of RNs and CWs in Japan. In this study, 464 RNs and CWs working in facilities in Japan were asked to complete a self-administered questionnaire that included the Frommelt Attitude Toward Care of the Dying Scale, Form B, Japanese version (FATCOD-Form B-J) and the Death Attitude Profile (DAP), Japanese version. A total of 388 (83.6%) questionnaires were returned, and 367 (79.1%) were fully completed. The final sample included 190 RNs and 177 CWs. Multiple regression analysis showed that better attitudes toward caring for the dying were positively associated with seminar attendance and negatively associated with fear of death.     

Integration of End‐of‐Life Education into a Community Health Nursing Course

Student nurses and novice nurses report that they received little in their nursing education to adequately prepare them for the death of a patient. The American Association of Colleges of Nursing's (AACN) competencies for end‐of‐life care assert the need for competent nursing care at the time of death. To prepare students to care for dying patients and their families, a hospice clinical experience in a community health nursing course was designed to facilitate the development of competence in caring for adults and children at the end of life. At the end of the semester, the students were able to demonstrate principles of pain and symptom management and to communicate the goals and philosophy of hospice care to dying patients and their families. The students also demonstrated the ability to advocate for individuals at the end of life through the provision of information about hospice care, especially the benefits for timely referral to hospice and palliative care. The incorporation of a clinical experience into a community health nursing course that focuses on end‐of‐life care is an effective approach to teaching both community health concepts and care of dying patients. Such an approach incorporates essential content without adding to already extensive nursing curricula.     

Student nurses' attitudes towards working with older patients

BACKGROUND: The ageing of the United Kingdom (UK) population means that the care of older people will become an increasingly important part of nurses' remit. However, employment statistics suggest that this is an unpopular nursing specialism. This may be due to a number of factors, one of which may be nurses' negative attitudes towards working with older people. This constitutes a potential problem, especially if such attitudes have an impact on the quality of care provided. AIM: To examine the attitudes held by student nurses towards working with older patients. METHODS: Questionnaires incorporating Likert-type scales, two vignettes and demographic questions were designed using the theory of planned behaviour. These were distributed to 172 student nurses undertaking preregistration nursing courses in the UK during the academic session 2000-2001. RESULTS: Student nurses displayed positive intentions towards working with older patients. These were based on their own attitudes and beliefs about what others would wish them to do. Participants believed that their behaviour towards older patients was to a large extent under volitional control. Analysis of the beliefs underlying student nurses' views showed that they differentiated between those participants who had a relatively positive approach to their work with older patients and those with a less positive approach. In addition, the results offered mixed support for the view that more knowledgeable or experienced nurses hold more positive views towards older people. CONCLUSIONS: The findings offer some support for previous studies that have looked at the more general issue of attitudes towards older people. However, the results also indicate that a more rigorous and more highly focused approach to the study of such attitudes is required if the research is to be relevant to the issue of working with older patients. The theoretical, methodological and practical implications of the findings are discussed.     

Nurses'' behavioural intentions towards self-poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables

BACKGROUND: The incidence of self-poisoning is on the increase. Most patients who self-poison are dealt with initially in the general hospital. Therefore, the type and quality of care self-poisoning patients receive will depend, in part, on how they are viewed by nursing staff within the general hospital setting. A knowledge and understanding of the attitudes held by nurses towards self-poisoning patients is therefore important to those involved in the planning and delivery of care towards this client group. Previous studies have examined health care professionals' attitudes towards people who self-poison. Usually, however, these have not focused specifically on nurses' attitudes, and they have ignored the relationship between the attitudes expressed by staff and their intentions to engage in subsequent caring behaviour of one sort or another. It is hence unclear how the findings of such studies are relevant or applicable to nursing policy and practice. AIMS: The present study aims to address these limitations using a methodology informed by the theory of reasoned action. The study aims to separate out the distinctive roles played by nurses' own attitudes, and the social pressures represented by other people's attitudes, in determining the types of caring behaviour in which nurses intend to engage when dealing with self-poisoning patients. DESIGN/METHODS: The study adopts a questionnaire-based approach incorporating two specially designed vignettes. RESULTS: The results show that nurses' own attitudes, and what they believe about the attitudes of others, predict their behavioural intentions towards self-poisoning patients. The study also shows that nurses with a more positive orientation towards self-poisoning patients differ in behavioural and normative beliefs from nurses who have a less positive orientation. CONCLUSIONS: The implications for future attempts to explore the relationship between nurses' attitudes and subsequent caring behaviour are considered, along with implications for nursing policy and practice.     

Attitudes of Asian and American graduate nursing students towards death and dying

This study compared the difference in attitudes towards death and dying between 17 Asian and 11 American graduate nursing students. Asian and American students did not significantly differ in attitudes related to fear of death, of self, or others, but Asian students were significantly more afraid than American students of their own process of dying. Asian students were more averse than American students to interacting and discussing death with dying patients. Talking about death with dying patients was the most difficult aspect of care for both groups. However, Asian students gained more personal satisfaction than American students in caring for dying patients. The findings provoke discussion regarding differences in nursing practice by Asian and American graduate nursing students.     

Nurses' perspectives on whether medical aid in dying should be accessible to incompetent patients with dementia: findings from a survey conducted in Quebec,Canada

We conducted a survey in a random sample of 514 Quebec nurses caring for the elderly to assess their attitudes towards extending medical aid in dying to incompetent patients and to explore associated factors. Attitudes were measured using clinical vignettes featuring a hypothetical patient with Alzheimer disease. Vignettes varied according to the stage of the disease (advanced or terminal) and the presence or absence of a written request. Of the 291 respondents, 83.5% agreed with the current legislation that allows physicians to administer aid in dying to competent patients who are at the end of life and suffer unbearably. A similar proportion (83%, p?=?0.871) were in favor of extending medical aid in dying to incompetent patients who are at the terminal stage of Alzheimer disease, show signs of distress, and have made a written request before losing capacity.     

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.