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Attitudes towards the dying and death anxiety in acute care nurses – can a workshop make any difference? A mixed-methods evaluation

Published online by Cambridge University Press:  06 August 2019

Chin Yee Cheong Open the ORCID record for Chin Yee Cheong [Opens in a new window] ,
Ngoc Huong Lien Ha ,
Laurence Lean Chin Tan  and
James A. Low
Chin Yee Cheong*
Affiliation:
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore 90 Yishun Central, S768828 Geriatric Education and Research Institute, Singapore 2 Yishun Central 2, S768024
Ngoc Huong Lien Ha
Affiliation:
Geriatric Education and Research Institute, Singapore 2 Yishun Central 2, S768024
Laurence Lean Chin Tan
Affiliation:
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore 90 Yishun Central, S768828 Geriatric Education and Research Institute, Singapore 2 Yishun Central 2, S768024
James A. Low
Affiliation:
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore 90 Yishun Central, S768828 Geriatric Education and Research Institute, Singapore 2 Yishun Central 2, S768024
*
Corresponding Author: Dr. Chin Yee Cheong Department of Geriatric Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore. Email: cheong.chin.yee@ktph.com.sg
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Abstract

Objectives

In Singapore, the core curriculum for end-of-life (EOL) care used in nurse training courses is limited. Only 45% of nurses indicated familiarity with inpatient palliative care. Nurses who lack skills in palliative care may develop anxiety and negative attitudes towards caring for dying patients. We explored whether a two-day, multimodal EOL care workshop could reduce nurses’ death anxiety and improve nurses’ skills, knowledge, and attitude towards palliative care.

Methods

Forty-five nurses participated in the workshop. At baseline before and at six weeks after, a 20-item knowledge-based questionnaire and the Death Attitude Profile-Revised (DAP-R) were administered. Six weeks post-workshop, in-depth interviews were conducted. We employed descriptive statistics, student paired samples t-test and inductive thematic analysis.

Results

There was a significant improvement in nurses’ knowledge score (p < 0.01) and reduction in their death anxiety score (p < 0.01). Fear of Death (p = 0.025) and Death Avoidance (p = 0.047) sub-scores decreased significantly. However, the remaining domains such as Neutral Acceptance, Approach Acceptance, and Escape Acceptance did not show any significant difference, although Escape Acceptance showed a trend towards a reduced score (p = 0.063). After the workshop, more nurses adopted the Neutral Acceptance stance (76.2%), and none of them fell into the Fear of Death subdomain. Most nurses interviewed reported a positive change in their knowledge, attitudes, and practice even after the workshop.

Significance of results

The multimodal palliative care workshop was useful in improving nurses’ EOL knowledge and reducing their anxiety towards death. The positive change in nurses’ attitudes and practices were noted to be sustained for at least six weeks after the intervention.

Keywords

death anxietyacute care nursesend-of-lifeworkshop
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 2 , April 2020 , pp. 164 - 169
Copyright
Copyright © Cambridge University Press 2019

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References

Banerjee, SC, Manna, R, Coyle, N, Shen, MJ, Pehrson, C, Zaider, T, Hammonds, S, Krueger, CA, Parker, PA and Bylund, CL (2016) Oncology nurses’ communication challenges with patients and families: a qualitative study. Nurse Education in Practice 16(1), 193–201.CrossRefGoogle ScholarPubMed
Bassett, JF (2007) Psychological defenses against death anxiety: integrating terror management theory and firestone's separation theory. Death Studies 31(8), 727–50.CrossRefGoogle ScholarPubMed
Black, K (2007) Health care professionals’ death attitudes, experiences, and advance directive communication behavior. Death Studies 31(6), 563–72.CrossRefGoogle ScholarPubMed
Braun, M, Gordon, D and Uziely, B (2010) Associations between oncology nurses’ attitudes toward death and caring for dying patients. Oncology Nursing Forum 37(1), E43–49.CrossRefGoogle ScholarPubMed
Braun, V and Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2), 77–101.CrossRefGoogle Scholar
Brosche, TA (2003) Death, dying, and the ICU nurse. Dimensions of Critical Care Nursing: DCCN 22(4), 173–79.CrossRefGoogle ScholarPubMed
Buller, H, Virani, R, Malloy, P and Paice, P (2019) End-of-life nursing and education consortium communication curriculum for nurses. Journal of Hospice & Palliative Nursing 21(2), E5–12.CrossRefGoogle ScholarPubMed
Dunn, KS, Otten, C and Stephens, E (2005) Nursing experience and the care of dying patients. Oncology Nursing Forum 32(1), 97–104.CrossRefGoogle ScholarPubMed
Firestone, RW (1993) Individual defenses against death anxiety. Death Studies 17(6), 497–515.CrossRefGoogle Scholar
Friedenberg, AS, Levy, MM, Ross, S and Evans, LE (2012) Barriers to end-of-life care in the intensive care unit: perceptions vary by level of training, discipline, and institution. Journal of Palliative Medicine 15(4), 404–11.CrossRefGoogle ScholarPubMed
Gan, GL (2016) Palliative care overview. The Singapore Family Physician 42(3), 24–30.Google Scholar
Hagelin, CL, Melin-Johansson, C, Henoch, I, Bergh, I, Ek, K, Hammarlund, K, Prahl, C, Strang, S, Westin, L, Österlind, J and Browall, M (2016) Factors influencing attitude toward care of dying patients in first-year nursing students. International Journal of Palliative Nursing 22(1), 28–36.CrossRefGoogle ScholarPubMed
Hegedus, K, Zana, Á and Szabó, G (2008) Effect of end of life education on medical students’ and health care workers’ death attitude. Palliative Medicine 22(3), 264–69.CrossRefGoogle ScholarPubMed
Henoch, I, Melin-Johansson, C, Bergh, I, Strang, S, Ek, K, Hammarlund, K, Hagelin, CL, Westin, L, Österlind, J and Browall, M (2017) Undergraduate nursing students’ attitudes and preparedness toward caring for dying persons - a longitudinal study. Nurse Education in Practice 26, 12–20.CrossRefGoogle ScholarPubMed
Jo, KH and An, GJ (2015) Effect of end-of-life care education using humanistic approach in korea. Collegian 22(1), 91–97.CrossRefGoogle ScholarPubMed
Kirkpatrick, DL (1994) Evaluating Training Programs: The Four Levels. San Francisco: Berrett-Koehler.Google Scholar
Kolb, DA (1984) Experimental Learning. Experience as Source of Learning and Development. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Lee, VL and King, AH (2014) Exploring death anxiety and burnout among staff members who work in outpatient hemodialysis units. Nephrology Nursing Journal 41(5), 479–85, 518.Google ScholarPubMed
Lien Foundation 2014 Doctors and Nurses Report Inadequacies in Medical & Nursing Education, Training, Communication and Healthcare System Support for the Terminally Ill in Singapore. http://lienfoundation.org/sites/default/files/Lien Fdn Survey of Death Attitudes - Doctors n Nurses Final 18 June_0.pdf (accessed 6 August 2017).Google Scholar
Lloyd-Williams, M and Macleod, RDM (2004) A systematic review of teaching and learning in palliative care within the medical undergraduate curriculum. Medical Teacher 26(8), 683–90.CrossRefGoogle ScholarPubMed
Mallory, JL (2003) The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students. Journal of Professional Nursing 19(5), 305–12.CrossRefGoogle ScholarPubMed
Malloy, P, Takenouchi, S, Kim, H, Lu, Y and Ferrell, B (2018) Providing palliative care education: showcasing efforts of asian nurses. Asia-Pacific Journal of Oncology Nursing 5(1), 15–20.Google ScholarPubMed
McKinlay, E, McBain, L, Stanley, J, Taylor, EJ and Robertson, G (2011) Does a multi component palliative care education programme help medical students talk with patients at end-of-life? Medical Teacher 33(10), 864.Google ScholarPubMed
Mok, E and Chiu, PC (2004) Nurse-patient relationships in palliative care. Journal of Advanced Nursing 48(5), 475–83.CrossRefGoogle ScholarPubMed
Peters, L, Cant, R, Payne, S, O'Connor, M, McDermott, F, Hood, K, Morphet, J and Shimoinaba, K 2013 How death anxiety impacts nurses’ caring for patients at the end of life: a review of literature. The Open Nursing Journal 7, 14–21.CrossRefGoogle ScholarPubMed
Peters, L, Cant, R, Payne, S, O'Connor, M, McDermott, F, Hood, K, Morphet, J and Shimoinaba, K (2013) Emergency and palliative care nurses’ levels of anxiety about death and coping with death: a questionnaire survey. Australasian Emergency Nursing Journal 16(4), 152–59.CrossRefGoogle ScholarPubMed
Routledge, C, Ostafin, B, Juhl, J, Sedikides, C, Cathey, C and Liao, J (2010) Adjusting to death: the effects of mortality salience and self-esteem on psychological well-being, growth motivation, and maladaptive behavior. Journal of Personality and Social Psychology 99(6), 897–916.CrossRefGoogle ScholarPubMed
Schlairet, MC (2009) End-of-life nursing care: statewide survey of nurses’ education needs and effects of education. Journal of Professional Nursing 25(3), 170–77.CrossRefGoogle ScholarPubMed
Wang, L, Chen, J, Du, Y, Wang, Z, Li, Z and Dong, Z (2017) Factors influencing Chinese nursing students’ attitudes toward the care of dying patients. Journal of Hospice & Palliative Nursing 19(4), 343–50.CrossRefGoogle Scholar
Weil, A, Weldon, SM, Kronfli, M, Watkins, B, Kneebone, R, Bello, F and Cox, S (2018) A new approach to multi-professional end-of-life care training using a sequential simulation (SQS Simulation™) design: a mixed-methods study. Nurse Education Today 71, 26–33.CrossRefGoogle ScholarPubMed
Wong, PTP, Reker, GT and Gesser, G (1994) Death Anxiety Handbook: Research, Instrumentation, and Application - Google Books. Washington, DC, USA: Taylor & Francis.Google Scholar
Zyga, S, Malliarou, M, Lavdaniti, M, Athanasopoulou, M and Sarafis, P (2011) Greek renal nurses’ attitudes towards death. Journal of Renal Care 37(2), 101–7.CrossRefGoogle ScholarPubMed
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