Attitudes of Nurses in Turkey Toward Care of Dying Individual and the Associated Religious and Cultural Factors

Nurses' Attitudes Towards Death and Its Relationship With Anxiety Levels

This study examined nurses' attitudes towards death, anxiety levels, and socio-demographic characteristics affecting their attitudes towards death. Three hundred and eighty-four nurses participated in the study. A questionnaire form, the Death Attitude Profile-Revised (DAP-R), and the Penn State Worry Questionnaire were applied to the nurses. Nurses' attitudes towards death were positive and their level of fear of death was low. Approach acceptance was high in younger ones; the escape acceptance score was higher in single ones. The neutral acceptance score was higher in those who received training on death. A statistically significant positive correlation was found between nurses' anxiety level and escape acceptance score. There was a statistically significant positive correlation between the length of working years of nurses and the escape acceptance and approach acceptance. Nurses should be prepared for and supported on death with in-service training. It will be useful to provide these training programs to nursing students during their education process.

Clinical Simulation in Palliative Care for Undergraduate Nursing Students: A Randomized Clinical Trial and Complementary Qualitative Study

BACKGROUND

a lack of adequate training in palliative care leads to a greater emotional burden on nurses.

PURPOSE

to assess the effect of a simulation using standardized patients on self-efficacy in palliative care, ability to cope with death, and emotional intelligence among nursing students.

METHODS

a randomized clinical trial and qualitative study. A total of 264 nursing students in a palliative care module completed the Bugen, trait meta-mood, and self-efficacy in palliative care scales after active participation in the simulation (n = 51), watching the simulation (n = 113), and the control group (n = 100). An ANOVA with a multi-comparative analysis and McNemar's tests for paired samples were calculated. Active participants were interviewed, and a thematic analysis was conducted.

RESULTS

there was an improvement after the assessment in all three groups assessed for coping with death (p < 0.01), emotional intelligence (p < 0.01), and self-efficacy (p < 0.01). In addition, the active group improved more than the observer group and the control group in coping with death, attention, and repair. The students in the interviews identified sadness and an emotional lack of control.

CONCLUSIONS

the simulation improved nursing students' self-efficacy in palliative care. This effect was partially stronger in the active group.

Intensive Care Nurses' Experiences Related to Dying Patients: A Qualitative Study

OBJECTIVE

To describe intensive care nurses' experiences of caring for dying patients.

METHOD

This study was carried out between July 15, 2019, and September 15, 2019, in a university hospital's intensive care unit. We conducted in-depth semi-structured interviews with a purposive sample of 14 intensive care nurses to describe their experiences related to patient deaths. Qualitative thematic analysis was used to identify, analyse and report the identified themes.

RESULTS

Four themes were identified: (I) Emotions experienced the first time their patient passed away; (II) feelings and thoughts on impact of death; (III) difficulties encountered when providing care and (IV) coping methods with this situation.

CONCLUSION

Despite the passage of time, nurses are unable to forget their death experiences when they first encountered. They oftentimes use ineffective methods of coping and were negatively affected physically and emotionally.

General work stress and suicide cognitions in health-care workers: mediating effect of hopelessness and job satisfaction

Individuals with a satisfactory level of job satisfaction are much less likely to feel hopeless about their future and are more likely to perform efficiently in the workplace. General work stress (i.e., the work-related stress subjectively experienced) is a significant predictor of suicide cognitions. Furthermore, it has been posited that satisfaction and hope are fundamental to life from an existential perspective. We, therefore, tested a hypothetical model of general work stress, suicide cognitions, hopelessness, and job satisfaction. The data were collected from 416 health-care workers through a convenience sampling method. The mediation analysis results revealed significant negative and positive relationships among general work stress, suicide conceptions, hopelessness, and job satisfaction. The findings indicate that hopelessness and job satisfaction have a parallel mediating effect in the relationship between general work stress and suicide cognitions. The result of the study is of great importance, which suggests that interventions to alleviate hopelessness and work stress and to boost the job satisfaction of medical staff may help prevent suicide cognitions.

How do cultural factors influence the provision of end-of-life care? A narrative review

BACKGROUND

Culture influences the way in which patients, families and professionals provide care and undergo decision-making at the end of life.

OBJECTIVE

Therefore, our research questions were: How do cultural aspects influence the needs, perceptions, and experiences of patients and their families in end-of-life care? What implications does cultural diversity have for professionals who care for individuals at the end of life?

METHODS

A narrative review was conducted between June and July 2022. Articles published between 2017 and 2022 in peer-reviewed journals were included.

RESULTS

A total of 43 studies were included. Our findings were grouped into four themes: 1) places to die and preferences about healthcare interventions (e.g. parts of the immigrant population tend to receive more aggressive and invasive interventions); 2) advance care planning and verbalization of death (e.g. less use of ACP in some minority groups); 3) rituals and family involvement during healthcare; 4) professionals addressing multiculturalism in care at the end of life (e.g. lack of training in addressing the context of multiculturalism).

CONCLUSIONS

These findings could contribute to making professionals more aware of cultural aspects that influence the process of death and highlight the need for further training in the handling of such situations.

On Between Death and Life: Intensive Care Nurses

The aim of this study is to explore intensive care nurses' perceptions and experiences about death and dying patient. This study included 15 nurses from a university hospital's intensive care units (paediatric and internal medicine). Data were collected through face-to-face, in-depth and individual interviews using the "Nurse Information Form" and "Semi-Structured Interview Form". Six major themes and sixteen sub-themes were identified on the nurses' perceptions and experiences with death. After the nurses described their perceptions of death, their responses, approaches, coping mechanisms, and effects on the dead and dying patient in care and factors affecting perceptions of death were defined. Our findings suggest that nurses, particularly those working in intensive care, should be educated/trained on death, and dying patient care. Thus, orderly psychological support should be provided to nurses.

Association between hopelessness and job burnout among Chinese nurses during the COVID-19 epidemic: The mediating role of career calling and the moderating role of social isolation

Background

The COVID-19 pandemic has led to an increased workload and work pressure on nurses owing to the unpredictable changes during this challenging situation. Herein, we explored the relationship between hopelessness and job burnout in nurses working in China against the backdrop of the COVID-19 outbreak.

Method

This was a cross-sectional study involving 1216 nurses in two hospitals in Anhui Province. The data was collected using an online survey. The mediation and moderation model was constructed, and the data was analyzed using SPSS PROCESS macro software.

Results

Our results showed that the nurses had an average job burnout score of 1.75 ± 0.85. Further analysis revealed a negative correlation between hopelessness and career calling (r = -0.551, P < 0.01) and a positive correlation between hopelessness and job burnout (r = 0.133, P < 0.01). Additionally, a negative correlation was demonstrated between career calling and job burnout (r = -0.138, P < 0.01). Moreover, career calling strongly mediated (by 40.9%) the relationship between hopelessness and job burnout in the nurses. Finally, social isolation in the nurses was a moderating factor for the association between hopelessness and job burnout (β = 0.028, t = 2.851, P < 0.01).

Conclusion

Burnout severity in nurses increased during the COVID-19 pandemic. Career calling mediated the relationship between hopelessness and burnout, with greater burnout levels in nurses who experienced social isolation. Therefore, we suggest that job burnout in nurses can be improved by mitigating the effects of hopelessness and social isolation through psychological interventions and enhancing their sense of career calling through education to strengthen their professional identity.

Death attitudes and associated factors among health professional students in China

Background

China is entering an era of aging population with an increased mortality rate among this category of population. Health professional students' attitudes toward death directly affect their quality of palliative care in their future careers. It is thus important to understand their death attitudes and associated factors to guide future educational and training development.

Objectives

This study aimed to investigate death attitudes and analyze the associated factors among health professional students in China.

Methods

In this cross-sectional study, 1,044 health professional students were recruited from 14 medical colleges and universities. The Chinese version of the Death Attitude Profile-Revised (DAP-R) was used to evaluate their death attitudes. A multiple linear regression model was used to analyze the influencing factors of attitudes toward death.

Results

Health professional students tended to accept death more neutrally. Multivariate analysis showed that their negative death attitudes were associated with age (β = -0.31, p < 0.001) and religious belief (β = 2.76, p = 0.015), while positive death attitudes were associated with age (β = -0.42, p < 0.001), hearing of Advance Care Plan (ACP) (β = 2.21, p = 0.001), and attending funeral/memorial services (β = 2.69, p = 0.016).

Conclusion

Our study stresses the importance of including death and palliative care education in healthcare courses among health professional students in China. Incorporation of ACP education along with experiences of funeral/memorial services may help promote health professional students' positive attitudes toward death and improve the quality of palliative care in their future careers.

The Meaning of Death for Nursing Students and Their Attitudes Toward Dignified Death Principles

This study aims to determine the meaning of death for nursing students and their attitudes toward dignified death principles. The descriptive study was conducted with nursing students studying at a state university in Turkey. The data were collected using the Personal Information Form, the Personal Meanings of Death Scale (PMDS), and the Assessment Scale of Attitudes toward the Principles of Dying with Dignity (ASAPDD). A positive and low-level significant relationship was determined between the students' age and the scores for the PMDS subdimensions and the ASAPDD. It was found that the students had positive perceptions of death and adopted the principles of a dignified death. It was determined that an increase in the students' perceptions of death positively affected their adoption of the principles of a dignified death.

When cultural values meets professional values: a qualitative study of chinese nurses' attitudes and experiences concerning death

Background

In China, there is a culture of death-avoidance and death-denying. Influenced by this distinctive socio-cultural views surrounding death, nurses often find it challenging to handle death and care for dying patients. This study explores the nurses’ attitudes and coping strategies concerning death and caring for dying patients in a cultural context of death taboo.

Methods

This research is a qualitative study that employs in-depth, semi-structured interviews with nurses from two major hospitals in Guangzhou, China. Overall, 28 nurses from four departments with high patient death rate were recruited and interviewed. All of the interviews were analyzed thematically.

Results

The nurses who participated in this study expressed attitudes toward death and caring for dying patients from both a personal dimension and a professional dimension. The personal dimension is influenced by traditional culture and societal attitudes towards death and dying, while their professional dimension is congruent with the nursing and palliative care values concerning death and dying. With an obvious discrepancy between these two dimensions, Chinese nurses adopt three strategies in their practice to solve this tension: boundary-drawing to separate their personal and professional life, complying with the existing cultural values at work, and constructing positive meanings for end-of-life care.

Conclusion

In a society that traditionally avoids making any reference to death, it is useful to reduce cultural taboo and construct positive meanings in end-of-life care, death education and the development of palliative care. Meanwhile, nurses also need institutional support, education and training to transition smoothly from a novice to a mature professional when handling patient death.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01067-3.

Analysis of Nurses' Attitudes toward Patient Death

(1) The aim of the study was to analyze nurses' attitudes toward a patient's death, taking into account the emotions they experience and the general perception of death. (2) The study involved 516 nurses from the West Pomeranian Voivodeship in Poland. The research was carried out using the diagnostic survey method using The Death Attitudes Profile Revisited (DAP-R-PL), the Scale of Fear and Fascination with Death, and a demographic questionnaire. (3) Research has shown that nurses accept the phenomenon of death as a natural process of human life; however, they adopt the attitude of fear of death. Most of the respondents experienced: sadness (73.4%), helplessness (58.5%), and regret (43.6%) due to the patient's death. (4) Both age, sex, marital status, and place of residence significantly influenced the attitudes of nurses toward the patient's death. Therefore, it is important to provide psychological support or special education in the case of dealing with the fear of death.

Perceived barriers and motivators of undergraduate nursing students in end-of-life care: A qualitative study based on lived experiences

PURPOSE

The aim of this study is to determine which barriers and motivators undergraduate nursing students perceived during their experience of providing end-of-life (EoL) care.

DESIGN AND METHODS

Qualitative phenomenological study leans on focus groups. The study was carried out with Zoom, a Web-based mobile video-conferencing application. Students were recruited from two universities in Turkey. Semistructured focus group interviews were conducted with 28 nursing students. The Heidegger phenomenological approach was adopted in this study.

FINDINGS

Three thematic categories and nine subcategories were determined. While the students stated that insufficient clinical experience, lack of knowledge, the inadequacy of communication techniques, and the insecurity of patients, relatives, and healthcare teams were barriers in EoL care, they stated they were motivated by witnessing the effect of nursing care on patients, integrating their theoretical knowledge into care, applying different communication techniques, and being positive role models of nurses in clinics.

PRACTICE IMPLICATIONS

As students were not adequately prepared to cope with clinical practices in EoL care, the nursing core curriculum needs revision in this regard. Providing adequate theoretical and clinical training in EoL care will help nursing students manage their emotions and provide high-quality care to patients and their families.

Nurses' Perceptions on Good Death and Their Attitudes Towards the Care of Dying Individuals

This study was conducted to determine the good death perceptions of intensive care and oncology inpatient unit nurses, their attitudes toward care of the dying and the correlation between them. The sample of this study consisted of 134 intensive care and oncology inpatient unit nurses. The data were collected using the Frommelt Attitudes Toward Care of the Dying Scale and the Good Death Scale. As the results of the study, the nurses had high good death perceptions. They had moderately positive attitudes toward care of the dying patients. As their good death perceptions increased, their positive attitudes toward care of the dying individual also increased. It is recommended to organize programs to raise awareness of nurses about good death and attitudes toward the dying patients and to strengthen their communication and coping methods.

The relationship between death attitude and professional identity in nursing students from mainland China

BACKGROUND

Professional identity reduces the risk of job burnout in nurses, and attitudes towards death might be a factor affecting nurses' professional identity. Little research has been conducted to directly investigate the relationship between professional identity and death attitudes in nursing students. In addition, there are cultural differences in the formation of death attitudes. It is necessary to explore attitudes towards death in Chinese nursing students and investigate the relationship between death attitudes and professional identity.

OBJECTIVES

To investigate the relationship between professional identity and death attitudes in nursing students in mainland China.

DESIGN

A cross-sectional study.

PARTICIPANTS

A total of 2119 nursing students from mainland China were included in this survey.

METHODS

The survey was conducted online. The questionnaire included the Chinese version of the Professional Identification Scale and the Chinese version of the Death Attitude Profile - Revised to measure the nursing students' professional identity and attitudes towards death. The survey also collected the participants' age, gender, institution type, place of residence and self-assessed health state.

RESULTS

The professional identity of the nursing students (average scores: 33.68 ± 5.12) from mainland China was above an intermediate level, and their attitudes towards death were positive overall (escape acceptance: 3.37 ± 0.96, approach acceptance: 3.36 ± 0.79, fear of death: 2.88 ± 0.77, death avoidance: 2.74 ± 0.84, neutral acceptance: 2.29 ± 0.77). Among the nursing students, professional identity was correlated with attitudes towards death. Specifically, professional identity was positively correlated with approach acceptance (p < 0.001), escape acceptance (p < 0.001) and neutral acceptance (p < 0.001) but negatively correlated with fear of death (p < 0.001) and death avoidance (p < 0.001). The nursing students with relatively low professional identity showed stronger death anxiety than those with relatively high professional identity (p < 0.001).

CONCLUSION

The outcome of this study suggests that education on life and death and internship experience in palliative care contribute to the development of a high level of professional identity in nursing work.

An Exploratory Study on Death Anxiety and Its Impact on Community Palliative Nurses in Singapore

Nurses working in palliative care settings encounter death and dying regularly and face a greater risk of developing death anxiety and negative attitudes than their counterparts. Such distress and apprehension can cause care fatigue and affect patients' quality of life. Death anxiety remains an underresearched area in Asia, where death and dying are still considered taboo. This study explored death anxiety and its impact on community palliative nurses in Singapore and was conducted at a community hospital in Singapore from January to June 2018. Purposive sampling was used to recruit 16 nurses of different job grades for the face-to-face interviews, which were transcribed verbatim and analyzed using the data analytical approach of Miles et al. Four overarching themes were generated: (1) intrinsic factors influencing death anxiety, (2) extrinsic factors influencing death anxiety, (3) emotional struggles and coping, and (4) need for death education and psychological support. Gaps in palliative care education and death education need to be contextualized to increase the community palliative nurses' awareness and acceptance of death and enhance their death literacy in a multicultural setting.

Personal and Emotional Factors of Nursing Professionals Related to Coping with End-of-Life Care: A Cross-Sectional Study

The death of a patient can be a traumatic event, causing emotional and psychological distress in professional nurses and potentially hampering the quality of their care. Optimal self-perceived coping with death involves valuing these difficult situations as challenges and actively coping with work-related stress during the care of the dying patient. Thus, the aim of this study was to assess Spanish nurses’ self-perceived competence with patient death and investigate its relationship with their personality traits, anxiety and fear of death. A cross-sectional study based on a web-based survey was conducted. A sample of 534 Spanish nurses provided socio-demographic information and answered validated questionnaires. Most participants perceived their coping with death as optimal. Men and nurses older than 31 years coped better with death. Professionals with an optimal self-perception showed significantly lower scores on all personality dimensions evaluated, while a higher level of the anxiety trait predicted worse coping. Although with medium explanatory power, psychoticism, anxiety, and fear of death were the main predictors of the development of optimal coping with death among Spanish nurses. These characteristics together with information from the work environment and evidence-based practice could help to develop better routines and contexts of care for nurses working in end-of-life care.

Psychometric Properties of Grief Traits and State Scale for Nurses to Measure Levels of Grief

Frequent exposure to patient deaths prompts nurses to experience grief. Unresolved grief leads to harmful consequences of nurses' mental health and quality of nursing care. A cross-sectional study using an online survey was conducted to determine the psychometric properties of the Grief traits and State Scale for Nurses. Exploratory factor analysis revealed two factors measuring the level of nurses' grief traits (Cronbach's alpha: 0.84) and two factors in grief state (Cronbach's alpha: 0.86). Nurses' feelings of unable to provide good care were associated with a higher risk of grief (odds ratio (OR): 4.30, 95% confidence interval (CI): 1.45-12.75), uncomfortable feeling toward deaths (OR: 11.29, 95%CI: 1.48-85.91), and emotional exhaustion (OR: 7.12, 95%CI: 1.63-30.99). Results indicated that the scale was reliable in determining the levels of their grief. Nurse managers can use the scale to identify their nurses' levels of grief, creating opportunities to influence the resolution of the grief experiences.

The Relationship Between the Stress Perceived by the Intensive Care Patient's Relatives with Their Religious Attitudes and Behaviors: Turkey Sample

This study was carried out in a university hospital located in the southeastern region of Turkey to determine the relationship between the perceived stress with the religious attitude and behavior of the intensive care patient's relatives; 150 patient's relatives participated in this descriptive and relation-seeking study between the dates of January and April 2019. The Personal Data Form, Perceived Stress Scale, and Religious Attitude and Behavior Inventory that were designed by their own researchers as a result of the literature review were used in this study. As a result of this study, it was found that there was a statistically significant relationship between religious attitude and behavior and perceived stress levels of the patient's relatives with sociodemographic features such as age, gender, marital status, and educational level. It was determined that the participants mostly prefer to pray as a method for stress management (65.3%). In terms of educational level, it was identified that 42% of the participants are elementary school graduates; besides, the stress level of this group was significantly lower than the others, and their religious attitude and behaviors were higher (p = 0.004). In consideration of these results, in terms of holistic care, it is recommended that nurses should make arrangements toward their strategy for stress management considering the religious attitudes and behaviors of patients' relatives.

The Relationship Between Nurses' Ethical Sensitivity Levels and Their Attitudes Toward Principles About Die with Dignity

This study was conducted to determine the relationship between nurses' ethical sensitivity levels and their attitudes toward principles about die with dignity. The study was descriptive and correlational in design. The data were obtained from 226 nurses. The results of the correlation analysis conducted to determine whether there is a relationship between the nurses' ethical sensitivity level and their attitudes toward principles about die with dignity are among the autonomy, meaning and relation showed a significant, negative and low-level relationship between. As a result of the research, it was found that there was a negatively, significant and low-level relationship between autonomy, meaning and relation and attitudes toward respectable principles of death.

Attitudes of Front-Line Nurses Toward Hospice Care During the COVID-19 Pandemic

OBJECTIVE

The aim of this study was to understand the attitudes of front-line clinical nurses toward hospice care in the fight against the COVID-19 pandemic, to provide a source of reference for hospice care education and training in hospitals treating patients with COVID-19.

METHOD

Front-line nurses from a designated COVID-19 hospital in Wuhan, China, participated. Participants completed the Chinese versions of the General Information Questionnaire, the Frommelt Attitudes Toward Care of the Dying Scale, the Jefferson Scale of Empathy, and the General Self-Efficacy Scale.

RESULTS

A total of 149 questionnaires were included in the analysis. The median total hospice care attitudes score was median 102.00(interquartile range, 95.5-120.50). The nurses' attitudes toward hospice care were significantly associated with their age, knowledge of hospice care, level of empathy, and self-efficacy.

CONCLUSION

The attitudes of front-line nurses toward hospice care need to be improved. Hospital departments should establish an effective public health emergency strategy, provide training to increase front-line nurses' knowledge and practical experience of hospice care, cultivate nurses' empathy, and enhance their sense of self-efficacy, in order to improve the quality of hospice care for patients and their families.

Hospital Nurses' Perception of Death and Self-Reported Performance of End-of-Life Care: Mediating Role of Attitude towards End-of-Life Care

Few studies have explored how nurses in acute care hospitals perceive and perform end-of-life care in Korea. Therefore, this study aimed to evaluate the influence of nurses' perceptions of death on end-of-life care performance and analyze the mediating role of attitude towards end-of-life care among hospital nurses. This cross-sectional study included a total of 250 nurses who have had experience with end-of-life care from four general hospitals in Korea. We used the Korean validated tools with the View of Life and Death Scale, the Frommelt Attitudes Toward Care of the Dying (FATCOD) scale, and the performance of end-of-life care. Hierarchical linear regression and mediation analysis, applying the bootstrapping method. The results of hierarchical linear regression showed that nurses' positive perceptions of death and attitude towards end-of-life care were significantly associated with their performance of end-of-life care. A mediation analysis further revealed that nurses' attitude towards end-of-life care mediates the relationship between the perceptions of death and performance of end-of-life care. Our findings suggest that supportive and practical death educational programs should be designed, based on nurses' professional experience and work environment, which will enable them to provide better end-of-life care.

Simulação realística como ferramenta de ensino na comunicação de situação crítica em cuidados paliativos

RESUMO Objetivo Identificar a percepção, habilidades e competências dos estudantes de enfermagem frente à comunicação da situação crítica em cuidados paliativos por meio da simulação realística. Método Estudo descritivo quali-quantitativo, desenvolvido com 41 estudantes do Curso de Graduação em Enfermagem de uma universidade do sul do Brasil. Pesquisa realizada no laboratório de práticas simuladas, entre março e maio de 2019. Resultados A média de idade dos estudantes era 23,4 anos. Quanto à percepção deles sobre comunicação da situação crítica: 39% pontuam como difícil; 75,6% nunca participaram de uma comunicação em situações críticas e; 36,60% se sentem bastante estressados nesse contexto. Da análise dos dados qualitativos, emergiram duas categorias: Sentimentos e dificuldades do estudante frente à comunicação de situações críticas em cuidados paliativos e; Principais competências adquiridas por meio da ferramenta de ensino-simulação. Conclusão e implicações para a prática da enfermagem A simulação clínica é importante ferramenta no processo ensino-aprendizagem, faz emergir a observação e torna os estudantes confiantes na habilidade de manter diálogos interprofissionais e com a família. Implica, desta maneira, na prática profissional no tocante às tomadas de decisão, na comunicação de más notícias.

Relationship Between Death Anxiety of Turkish Nurses and Their Attitudes Toward the Dying Patients

This study aims to investigate the relationship between death anxiety of the Turkish nurses and their attitudes toward the dying patient. This study involved 203 nurses who were working at a university hospital. The data were collected using "Nurse Information Form" (which was prepared by the authors of this research), "Thorson-Powell Death Anxiety Scale," and "Attitude Scale about Euthanasia, Death, and Dying Patient." There was a positive correlation between death anxiety and dying patient avoidance behavior and euthanasia score (p < .05). The findings showed that nurses, death anxiety, and death scores were high in the loss of a close relatives (p < .05). Our findings suggest that the situation of the dying patients and their families and also nurses should be improved. Thus, special psychological education/training should be given to the nurses to deal with death anxiety and their attitude to the dying patient.