Psychometric properties of the Korean version of the Palliative Care Nursing Self-Competence scale for infant use

BACKGROUND

Despite the significant advances in neonatal treatment and care over the past 30 years, palliative care in the neonatal intensive care unit has not been fully provided in South Korea. Neonatal nurses are essential professionals in palliative care as they are directly involved in the care, but there is little information on their palliative care competency because no assessment instrument is available in Korea.

OBJECTIVES

The aim of this study was to develop and test the validity and reliability of the Korean version of the Palliative Care Nursing Self-Competence scale for neonatal palliative care.

METHODS

This scale for infant care was developed through parallel translation techniques and revised based on cognitive interviews. Survey data were then collected from 220 neonatal nurses who worked in 13 neonatal intensive care units in Korea. Internal consistency reliability, construct validity based on exploratory factor analysis, and criterion-related validity were tested.

RESULTS

The final version of the scale included 40 items in five domains that explained 53.4% of the variance. Criterion-related validity was confirmed based on a positive correlation with the Korean version of the attitudes towards neonatal palliative care measurement tool. The Cronbach's alpha for the scale was 0.95.

CONCLUSIONS

The Korean version of the Palliative Care Nursing Self-Competence scale for infant care has satisfactory construct validity and reliability to measure palliative care self-competence of neonatal nurses in Korea and evaluate an education program in future studies.

Development of a Palliative Care Education Program in Rural Long-Term Care Facilities

In North America, people 85 years and older are the fastest growing age cohort and long-term care homes are increasingly becoming the place of end-of-life care. This is especially true in rural communities where services are lacking. Staff in long-term care homes lack education about palliative care, but in rural areas, accessing education and the lack of relevant curricula are barriers. The focus of this paper is to describe an approach to developing and delivering a research-based palliative care education curriculum in rural long-term care homes. The approach included conducting a detailed assessment of staffs’ educational needs and preferred educational formats; developing a 15-hour interprofessional curriculum tailored to the identified needs; and delivering the curriculum on site in rural long-term care homes. Staff confidence and participation in delivering palliative care increased. Based on work in northwestern Ontario, Canada, this approach can serve as a model for palliative care education in other rural areas.

Can Addressing Death Anxiety Reduce Health Care Workers’ Burnout and Improve Patient Care?

Death anxiety may interfere with health care workers’ (HCWs) relationships with patients and patients’ families and increase HCWs’ levels of burn-out. This study shows the impact of a six-day course for HCWs that provided training in communication, in offering emotional and spiritual support to patients, and in personal introspection on death anxiety. The HCWs were given questionnaires to evaluate their level of burnout, personal well-being, and death anxiety as well as the quality of their relationships with patients before the course and four months after it. There were 150 study participants, all HCWs involved in caring for dying patients (85 in palliative care units and 65 in other settings). There was a control group of 26 HCWs who cared for the dying in settings other than palliative care units. The results show that the course appeared to lead to a significant reduction in levels of burnout and death anxiety; they also indicated an increase in personal well-being and professional fulfillment, and participants perceived an improvement in the quality of their relationships with patients and patients’ families.

Secondary Traumatization and Proneness to Dissociation Among Palliative Care Workers: A Cross-Sectional Study

CONTEXT

Exposure to dying patients can contribute to secondary traumatic stress (STS) among palliative care workers. Peritraumatic dissociation (PETD), an individual's personal proneness to dissociation during exposure to a stressful event, is the strongest predictor of post-traumatic stress, but existing research on its relationship to STS is limited.

OBJECTIVE

To compare the level of STS among palliative workers with clinical levels of PETD compared with those without clinical levels of PETD.

METHODS

A cross-sectional self-report survey.

SETTING/PARTICIPANTS

These include about 420 physicians and nurses working in hospital-based and/or home-based palliative care units.

INCLUSION CRITERIA

two years' experience with at least 10 hours/week of direct care for terminally ill patients.

RESULTS

About 144 participants returned completed questionnaires (response rate 35%). Sixty percent reported a nonclinical level of dissociation. Workers with a clinical level of dissociation had significantly higher levels of STS compared with workers who did not. Awareness of an interaction effect between PETD and fear of dying progression can advance our understanding of how the development of PETD during exposure to dying can have an impact that is beyond the main effect on STS.

CONCLUSIONS

The clinical level of PETD correlates significantly with STS. Further research is needed to understand whether STS is related to the individual's own vulnerability, as reflected by their personal proneness to dissociation, during exposure to death and dying.

Attitude of Palestinian Nursing Students Toward Caring for Dying Patients

Death is a natural process that occurs each day. Some nursing students may encounter the experience of taking care of a dying patient while others do not. Therefore, their attitude toward death and caring for dying patients may vary. The purpose of this study was to assess Palestinian student nurses’ attitudes toward death and caring for dying patients and their families. In a cross-sectional, descriptive study, all fourth-year students at the College of Nursing, Islamic University of Gaza, Palestine, were invited to participate in this study. A total of 141 students completed the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B). Results revealed that the mean score on the FATCOD-B was (96.96 ± 8.30). Overall, nursing students in the sample demonstrated a relatively low attitude toward caring for dying patients and their families. No statistically significant differences of students’ attitudes toward caring for dying patients were found between male and female students nor between students who attended death cases and those who did not. The results suggest that theoretical nursing education should place more emphasis on palliative care to improve the quality of care at the end of life.

Is work stress in palliative care nurses a cause for concern? A literature review

Palliative care nurses are at risk of work stress because their role involves exposure to frequent deaths and family grieving. Little is known about their degree of stress or whether they suffer stress or burnout more than nurses in other disciplines.

AIM

The aim of this paper is to critically examine the current literature concerning stress and burnout in palliative care nurses.

RESULTS

Sixteen papers were included in the review. Although work demands were a common cause of stress in the studies reported, there was no strong evidence that palliative care or hospice nurses experienced higher levels of stress than nurses in other disciplines. Common causes of stress were the work environment, role conflict, and issues with patients and their families. Constructive coping styles appeared to help nurses to manage stress.

CONCLUSION

Managers have a key role in providing education and training for palliative care nurses to support their personal development and to help reduce vulnerability to and the impact of stress in the workplace.

Providing direction for change: assessing Canadian nursing students learning needs

AIM

To examine the current curriculum content and learning needs of graduating nursing students related to end-of-life care (EOLC).

DESIGN

A survey method was employed.

SAMPLE

A purposive sample of 58 Anglophone and Francophone students completed the Palliative Care Quiz for Nursing (PCQN) and Frommelt's Attitudes Toward Care of the Dying Scale (FATCOD). Students responded to open-ended questions regarding perceptions of preparedness to care for terminally ill patients, and provided suggestions for changes to the curriculum. Key informant educators identified opportunities to include EOLC content in courses and clinical placements.

RESULTS

Results indicated that students held positive attitudes towards caring for dying patients, had modest knowledge levels, and that one third did not feel adequately prepared to care for dying patients. Although EOLC education tends to be threaded throughout the program, the emphasis is dependent upon the commitment of individual professors and clinical instructors with experience and/or expertise in this area.

CONCLUSION

Students and educators agreed more emphasis on EOLC was needed. Recommendations include development of teaching strategies and experiential learning in EOLC throughout the curriculum.

Caring for patients with terminal delirium: palliative care unit and home care nurses’ experiences

AIM

To explore palliative care unit and home care nurses' experiences of caring for patients with terminal delirium.

DESIGN

A qualitative exploratory design using individual interviews.

SAMPLE

Participants included five nurses working in an interdisciplinary palliative care unit located in a large Canadian city hospital, and four nurses from a palliative home care nursing team located in the same city.

RESULTS

Nurses in both sites experienced multiple challenges caring for delirious patients. Additional education on delirium and collaborative teamwork were viewed as key factors in enhancing their ability to care for and support this patient and family population. Four core themes reflected the participants' perceptions and experiences: experiencing distress; the importance of presence; valuing the team; and the need to know more.

CONCLUSION

Findings suggest the need for interdisciplinary educational initiatives focused on the identification and management of terminal delirium, and targeted to the specific context in which nurses practise.

Identifying educational needs in end-of-life care for staff and families of residents in care facilities

AIM

the purpose of this article is to describe educational needs in end-of-life (EoL) care for staff and families of residents in long-term care (LTC) facilities in the province of Ontario, Canada. Barriers to providing end-of-life care education in LTC facilities are also identified.

DESIGN, SETTING AND PARTICIPANTS

cross-sectional survey of directors of care in all licensed LTC facilities in the province of Ontario, Canada.

RESULTS

directors of care from 426 (76.9% response rate) licensed LTC facilities completed a postal-survey questionnaire. Topics identified as very important for staff education included pain and symptom management and communication with family members about EoL care. Priorities for family education included respecting the residents' expressed wishes for care and communication about EoL care. Having sufficient institutional resources was identified as a major barrier to providing continuing education to both staff and families.

CONCLUSION

through examining educational needs in EoL care this study identified an environment of inadequate staffing and over-burdened care providers. The importance of increased staffing concomitant with education is a priority for LTC facilities.