Correlates of perceived death competence: What role does meaning-in-life and quality-of-life play?

Death coping ability, death attitude, and professional quality of life among geriatric nurses: a multicentre cross-sectional study

BACKGROUND AND AIM

The ability of geriatric nurses to cope with death affects both their physical and mental health, as well as the quality of the hospice services they provide. The aim of this study was to investigate the death coping ability, death attitude, and professional quality of life of geriatric nurses, analyse the influencing factors of death coping ability, and explore the correlations among them.

DESIGN

A multicentre cross-sectional study design was used and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

METHODS

From October to November 2024, a convenience sampling method was used to survey 357 geriatric nurses from 9 hospitals in 8 provinces and cities, including Guangdong and Hubei, China, as the research subjects. The general information questionnaire, Coping With Death Scale (CDS), Death Attitude Profile-Revised (DAP-R), and Nurse Professional Quality of Life Scale were used for the investigation.

RESULTS

The death coping ability score of the geriatric nurses was 135.23 ± 33.04 points, the total death attitude score was 96.65 ± 21.04 points, and the total raw professional quality of life score was 90.00 ± 11.91 points. Pearson correlation analysis revealed that the death coping ability of geriatric nurses was positively correlated with death attitudes, negatively correlated with secondary trauma and occupational burnout, and positively correlated with compassion satisfaction. Regression analysis revealed that age, frequency of sharing experiences of caring for terminally ill patients with others, participation in death-related courses or training, attitude towards death, and professional quality of life were factors influencing geriatric nurses' ability to cope with death (P < 0.05).

CONCLUSION

The death coping ability of geriatric nurses is moderate and is related to death attitude and professional quality of life. Nursing managers are encouraged to enhance death education or training for geriatric nurses to help them develop a positive attitude towards death, pay attention to the quality of professional life of geriatric nurses and improve their ability to cope with death.

Latent class analysis of death coping ability among palliative care nurses and its association with their emotional labor

OBJECTIVE

Death coping ability is a critical professional skill for palliative care nurses. This study aimed to identify subgroups of death coping ability among Chinese palliative care nurses based on their assessments using the Death Coping Ability Scale, and to analyze the relationship between these subgroups and their emotional labor.

METHOD

Convenient sampling was employed to survey 868 palliative care nurses from medical institutions in Beijing, Jiangsu Province, Anhui Province, and Hunan Province. Data was collected using a general information questionnaire, the Chinese version of the Death Coping Ability Scale, and the Emotional Labor Scale. Latent profile analysis was conducted to categorize the nurses' death coping abilities, and differences in emotional labor among these categories were compared.

RESULTS

The death coping ability of palliative care nurses was categorized into three groups: "low death coping ability group" (11.5%), "medium death coping ability group" (52.0%), and "high death coping ability group" (36.5%). Factors influencing these categories included specialization in palliative care, opportunities for interaction with the bereaved, participation in grief counseling training, and personal bereavement experiences, all statistically significant (p < 0.05). Notably, there were significant differences in emotional labor scores among the three groups (F = 33.006, p < 0.001).

CONCLUSIONS

The death coping ability of palliative care nurses can be classified into three distinct categories, each associated with different levels of emotional labor. Nursing managers should recognize these differences and implement targeted, personalized interventions to enhance the death coping abilities of palliative care nurses.

Death competence profiles and influencing factors among novice oncology nurses: a latent profile analysis

BACKGROUND

Preparing novice oncology nurses to competently care for dying cancer patients is challenging, particularly in cultures where death and dying are taboo subjects. This study aims to explore the various profiles of death competence among novice oncology nurses through latent profile analysis, identifies distinguishing characteristics, and examines influential factors within these subgroups.

METHODS

A multisite cross-sectional study was conducted from August 2021 to July 2022, involving 506 novice oncology nurses from six tertiary cancer hospitals and centers across mainland China. Participants completed a questionnaire that included the Chinese version of the Coping with Death Scale, the Big Five Personality Traits Scale, and general demographic information. Latent profile analysis, univariate analysis, and multinomial logistic regression were utilized to identify death competence profiles and interindividual variability.

RESULTS

Three latent profiles were identified: 'Low Death Competence with Attitude Change toward Living' group (21.5%, Profile 1), 'Moderate Death Competence' group (52.0%, Profile 2), and 'High Death Competence with No Attitude Change toward Living' group (26.5%, Profile 3). Specifically, for Profile 2, being male and having a conscientious personality were facilitating factors for death competence. Conversely, an agreeable personality and frequent exposure to patient death emerged as hindering factors. In Profile 3, working in Intensive Care Units and Palliative Care Units, along with personality traits of conscientiousness, openness, or extraversion, were associated with higher death competence, although frequent exposure to patient death was identified as a potential hindering factor even for this highly competent group.

CONCLUSION

Significant variability in death competence exists among the three groups of novice oncology nurses, reflecting the complexity of their experiences. These findings underscore the necessity for tailored, culturally sensitive death education and training programs. This study also provides vital insights for developing such programs, customized to meet the unique characteristics and needs of different subgroups of novice oncology nurses, ultimately enhancing their death competence and improving end-of-life cancer care.

Mediating effect of meaning in life on death anxiety and attitude toward palliative care among undergraduate nursing students

BACKGROUND

This study investigates the mediating effect of meaning in life between death anxiety and attitude toward palliative care among nursing students.

METHODS

We enrolled 363 undergraduate nursing students using a convenience sampling method as the respondents and conducted a survey using general information about nursing students, the Chinese version of the FATCOD-B Scale, the Chinese version of the Death Anxiety Scale, and the Chinese version of the Meaning in Life Questionnaire. The SPSS25.0 statistical software was used to analyze the mediating effect.

RESULTS

The mean total attitude score toward palliative care was (104.72 ± 10.62). Death anxiety had a significant negative predictive effect on the attitude toward palliative care (β = -0.520, P < 0.01). When the mediating variable of the presence of meaning in life was included, the negative predictive effect of death anxiety on attitude toward palliative care remained significant (β = -0.379, P = 0.036); the mediating effect (-0.141) accounted for 27.12% of the total impact (-0.520).

CONCLUSIONS

The presence of meaning in life mediates the relationship between death anxiety and attitude toward palliative care. This implies that nursing educators, through their role in educating nursing students about the meaning of life, can significantly influence the development of a positive attitude toward palliative care.

Level of professional quality of life and coping with death competence in healthcare professionals exposed to perinatal loss: A cross-sectional study

Perinatal loss is a traumatic and stressful experience with a significant emotional toll on the physical and psychological wellbeing of the healthcare professionals. We included 216 healthcare professionals working in an obstetrics-gynecology service or neonatal intensive care unit in a cross-sectional study and aimed to analyze the possible association between the healthcare professionals' level of professional quality of life, their coping with death competence, and their personal and work-related characteristics. Compassion fatigue and burnout did not correlate significantly with healthcare professionals' personal and work-related characteristics. Formal training was strongly associated with high levels of compassion satisfaction and coping with death competence. A low level of coping with death competence was found in women and in younger healthcare professionals, those who are single, and with little professional experience. Self-care activities and hospital support systems can be effective resources in coping with death.

The mediating effects of attitude toward death and meaning of life on the relationship between perception of death and coping with death competence among Chinese nurses: a cross-sectional study

Background

It is important to understand how the perception of death affects the competence to cope with death.

Objectives

To explore whether the perception of death has an indirect effect on competence to cope with death through the mediation of attitude toward death and meaning of life.

Methods

A total of 786 nurses from Hunan Province, China, selected by random sampling method and asked to complete an online electronic questionnaire between October and November 2021 were included in the study.

Results

The nurses’ scored 125.39 ± 23.88 on the competence to cope with death. There was a positive correlation among perception of death, competence to cope with death, the meaning of life, and attitude toward death. There were three mediating pathways: the separate mediating effect of natural acceptance and meaning of life, and the chain mediating effect of natural acceptance and meaning of life.

Conclusion

The nurses’ competence to cope with death was moderate. Perception of death could indirectly and positively predict nurses’ competence to cope with death by enhancing natural acceptance or sense of meaning in life. In addition, perception of death could improve natural acceptance and then enhance the sense of meaning in life to positively predict nurses’ competence to cope with death.

Perceptions of healthcare professional about the "PACE Steps to Success" palliative care program for long-term care: A qualitative study in Switzerland

AIM

This study aimed to examine the healthcare professionals' perceptions after implementing the "PACE Steps to Success" program in the French-speaking part of Switzerland.

DESIGN

A qualitative descriptive study.

METHODS

Thematic analysis of semi-structured face-to-face and group interviews with health professionals, PACE coordinators, and managers purposely invited in the four long-term home facilities that had previously participated in the PACE cluster randomized clinical trial intervention group.

RESULTS

The PACE program implementation has improved communication with residents regarding end-of-life issues and helped identify patients' needs. The introduction of codified tools can complete internal tools and support decision-making. In addition, the training has promoted inter-professional collaboration, particularly in the case of care assistants, by defining each profession's specific responsibilities in providing care for older adults.

Relationship between Death Coping and Death Cognition and Meaning in Life among Nurses: A Cross-Sectional Study

To explore nurses' ability to cope with death and its relationship with death cognition and meaning in life in the context of Chinese traditional culture. 1146 nurses from six tertiary hospitals were recruited. Participants completed the Coping with Death Scale, the Meaning in Life Questionnaire, and the self-made Death Cognition Questionnaire. Multiple regression analysis revealed that the search for meaning, the understanding of "good death", receiving education related to life-and-death, cultural aspect, the presence of meaning, and the number of patient deaths experienced in career explained 20.3% of the variance in the ability to cope with death. Lacking a correct understanding of death, nurses are not sufficiently prepared to deal with death and their ability to cope with death is influenced by the unique cognition of death and the sense of the meaning in life in the context of Chinese traditional culture.

The contribution of perceived death competence in determining the professional quality of life of novice oncology nurses: A multicentre study

PURPOSE

Novice nurses find it challenging to cope with patient dying and death, especially in a death taboo cultural context, such as mainland China. By taking the example of Chinese novice oncology nurses, this study aimed to explore the contribution of their perceived death competence in determining their professional quality of life.

METHOD

A multicentre, cross-sectional study was conducted in six tertiary cancer hospitals in mainland China involving 506 novice oncology nurses. Measurements were the Coping with Death Scale-Chinese version, the Professional Quality of Life Questionnaire, and the Coping Style Questionnaire. Hierarchical multiple regression analyses were used to analyse the data.

RESULTS

Death competence was significantly associated with compassion satisfaction (r = 0.509, P < 0.001), burnout (r = -0.441, P < 0.001) and secondary traumatic stress (r = -0.154, P < 0.001) which are the three dimensions of professional quality of life. The results of hierarchical multiple regression analyses demonstrated that death competence positively predicted compassion satisfaction and negatively predicted burnout (P < 0.01), but had no significant impact on secondary traumatic stress after coping style was entered into the model (P > 0.05).

CONCLUSIONS

Novice oncology nurses who perceive themselves to be incompetent in dealing with patient dying and death are more likely to experience poor professional quality of life in the death taboo cultural context. Cultural-sensitive interventions and a supportive work environment are important to enhance these nurses' death competence, increasing their professional quality of life and ultimately contributing to better end-of-life cancer care management.

Death-coping self-efficacy and its influencing factors among Chinese nurses: A cross-sectional study

Background

Nurses are the main caregivers of dying patients. Facing or dealing with death-related events is inevitable. Death-coping self-efficacy (DCS) is very important, as it can reduce the risk of nursing staff to adverse emotional distress, help them participate in end-of-life care and improve the quality of care of patients.

Methods

Using the convenient sampling method, this study included a total of 572 nurses from a tertiary hospital in Hangzhou, China. The status and influencing factors of the DCS of nurses were explored using a general information questionnaire and DCS scale.

Results

The scores of each parameter, ranging from low to high, were in the order of coping with grief, preparation for death and hospice care. Factors influencing nurses’ DCS included attendance in hospice care education courses within the previous year, experience of accompanying the family members of the deceased and attitude towards death.

Conclusions

The overall self-efficacy of nurses in palliative care was at a medium level. Moreover, their self-efficacy in coping with grief and preparation for death should be strengthened. Managers of medical institutions can assess the death-coping ability of nurses, which helps provide corresponding support and training for nurses at an early stage. Nurses should receive guidance in grief adjustment and emotion regulation. Medical units should provide nurses with a platform for continuous training and education, use of death-related theoretical models and frameworks to guide nurses in dealing with death-related events, reduce nurses’ negative mood and jointly promote their mental health.

Integrating Nurse Practitioners Into Long-term Care: A Call for Action

The coronavirus disease 2019 pandemic exposed the devastating effects of inadequate primary care in long-term care (LTC) settings, both nationally and internationally. Deaths in LTC were compounded by the global shortage of physicians and limitations in existing funding models for these facilities. Nurse practitioners (NPs) can provide similar services as general practice physicians in LTC while meeting residents’ needs in a more timely, cost-effective manner. It is critical that NPs be integrated into LTC, particularly in the wake of the coronavirus disease 2019 pandemic. This article provides relevant literature and evidence to substantiate the effectiveness of integrating NPs into the Canadian LTC and highlights the urgent need for improved funding models and policy reform.

New graduate nurses' coping with death and the relationship with death self-efficacy and death anxiety: A multicentre cross-sectional study

AIMS

To examine new graduate nurses' perceptions of competency on coping with dying and death and the relationship with death self-efficacy and death anxiety.

DESIGN

A multicentre, cross-sectional study.

METHODS

Three hundred and forty new graduate nurses from five metropolitan hospitals were recruited between August-November 2018. Participants completed the Coping with Death Scale, Death Self-efficacy Scale, and Death Anxiety Scale.

RESULTS

Two hundred and ninety-eight new graduate nurses responded to the survey. The mean score of coping with death and death self-efficacy was 120.11 (SD 24.59), 259.11 (SD 57.70) respectively. 88.9% feared a painful death, 81.5% were particularly afraid of getting cancer, and 80.2% were afraid of death. There was a positive relationship between coping with death and death self-efficacy, a negative relationship between coping with death and death anxiety and a negative correlation between death self-efficacy and death anxiety. Five variables, including death self-efficacy, three dimensions of death anxiety including emotion, cognition with life and death and stress and distress and religion in total accounted for 46.9% of the variance of coping with death.

CONCLUSION

New graduate nurses are at a disadvantage in terms of death self-efficacy, less well prepared in coping with death and are more anxious about death.

IMPACT

It is imperative for educational institutions to support new graduate nurses with pre-licensure learning related to patient death issues and care. Organizations are also strongly advised to support new graduate nurses to cope with patient death through development of culturally sensitive interventions and guidelines, which may in turn assist with decreasing new graduate nurses' risk of burnout and increasing their longevity in the profession.

Development and psychometric validation of a comprehensive end-of-life care competence scale: A study based on three-year surveys of health and social care professionals in Hong Kong

OBJECTIVE

This study aimed to develop an assessment tool measuring comprehensive interdisciplinary competence in end-of-life care (EoLC) and investigate its content, construct validity, reliability, and their correlates.

METHOD

Items of the Comprehensive End-of-Life Care Competence Scale (CECCS) were developed according to a comprehensive core competence framework in EoLC and refined by a multi-disciplinary panel of experts. The psychometric properties were further tested through region-wide surveys of self-administered questionnaires completed by health and social care professionals in Hong Kong.

RESULTS

Participants comprised social workers, nurses, physicians, and allied health care professionals (445 participants in 2016, 410 in 2017, and 523 in 2018). Factor analysis validated the construct of the questionnaire which encompassed 26 items describing EoLC core competences in seven domains with satisfactory internal reliability (confirmatory factor analysis: χ2/df = 3.12, GFI = 0.85, TLI = 0.93, CFI = 0.94, RMSEA = 0.07; Cronbach's alphas ranged from 0.89 to 0.97): overarching value & knowledge, communication skills, symptom management, psychosocial and community care, end-of-life decision-making, bereavement care, and self-care. Higher perceived levels in these competences were correlated with a higher level of job meaningfulness and satisfaction (r ranged from 0.17 to 0.39, p < 0.01) and correlated with lower perceived stress (r ranged from -0.11 to -0.28, p < 0.05). Regression analysis found that age and work involvement in EoLC were positively associated with the perceived competences in all domains; professionals working in hospices reported higher levels of competence than workers in other settings; social workers showed lower perceived competences in symptom management, but higher levels in bereavement care than other health care professionals.

SIGNIFICANCE OF RESULTS

The validity and internal reliability of CECCS were demonstrated. The levels of perceived competences working in EoLC were significantly associated with professionals' job-related well-being. Practically, there is still room for improvement in comprehensive competences among health and social care workers in Hong Kong.

Death Self-efficacy, Attitudes Toward Death and Burnout Among Oncology Nurses: A Multicenter Cross-sectional Study

BACKGROUND

To effectively care for dying patients, nurses need to possess death self-efficacy-the state of having both a range of skills and capabilities to provide care to dying patients and confidence in one's ability to do so. A paucity of death self-efficacy may lead to burnout.

OBJECTIVES

The aims of this study are to clarify oncology nurses' death self-efficacy and to explore its relationships with attitudes toward death and burnout.

METHODS

A cross-sectional study was performed in 7 cancer hospitals across mainland China between June and July 2019. Oncology nurses completed an online survey consisting of the Death Self-efficacy Scale, Death Attitude Profile-Revised Scale, and Maslach Burnout Inventory.

RESULTS

The 755 oncology nurses completing the survey reported low death self-efficacy and high levels of burnout. Those who had more years of clinical experience, had the highest professional rank, talked death quite often, and have received palliative care trainings, doing no shift work, scored higher on death self-efficacy. Death self-efficacy was positively correlated with positive attitudes toward death and negatively correlated with levels of burnout. The multiple regression analysis showed that death self-efficacy and attitudes toward death were independent, significant predictors of oncology nurses' burnout.

CONCLUSIONS

Chinese oncology nurses are not well prepared to care for dying cancer patients and cope with death-related issues.

IMPLICATIONS FOR PRACTICE

Improvement in death self-efficacy among oncology nurses is necessary, especially for those who are young, are unmarried, are doing shift work, and never received palliative care training. Enhanced death self-efficacy may be realized through self-reflective practice and palliative care education.

Alcance de la calidad de vida en atención médica

La expresión calidad de vida tiene un uso cada vez más generalizado en la práctica biomédica, sobre todo en situaciones de final de la vida. La experiencia demuestra que, muchas veces, esa expresión se emplea con alcances muy diversos, en ocasiones contrapuestos. En el presente artículo se exponen los resultados de una revisión bibliográfica que muestra tlas diferentes posturas y se propone una delimitación del tema. El análisis compara los términos “calidad de vida”, “dignidad humana” y “valor de la vida humana”.