Self-competence in death work among health and social care workers: a region-wide survey in Hong Kong

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.

Validating the self-competence in death work scale for end-of-life care volunteers

There is an increasing demand for end-of-life care (EoLC) volunteers in Hong Kong's aging population. However, there is no validated measure that assesses volunteers' self-competence in coping with death. This is essential to optimize their services, and ensure their psychological well-being. This study aimed to validate the existing Self-Competence in Death Work Scale (SC-DWS) for EoLC volunteers. This scale has been tested previously on health professionals providing end-of-life care, and was adapted for this study with words that fitted the volunteer context.A self-administered survey collected demographic information, personal experiences, the 16-item SC-DWS, 15-item Templer Death Anxiety Scale, and the 8-item Spiritual Wellbeing Scale to examine the internal consistency, concurrent validity, and discriminative validity of this scale among EoLC volunteers. The study sample consisted of all applicants who registered for the EoLC volunteer training programme between 2019 and 2021. Applicants first underwent a systematic screening and selection procedure. They completed an online registration form which included risk assessment, followed by structured individual interviews focusing on applicants' motivation and mental preparedness for their role. The content validity of the SC-DWS was determined using data from the 341 volunteers who were screened prior to training. Construct validity was tested using Exploratory Factor Analysis (EFA), which suggested that two-factors (subscales) offered the best combination of variables (Emotional and Existential Subscales). The new subscales and the component items differed slightly from those identified in health professional samples. Concurrent validity was demonstrated by strong correlations between the SC-DWS, and the Death Anxiety, and Spiritual Wellbeing scales. Discriminant validity was supported by strong relationships between the new subscales and participants' personal experiences. The SC-DWS was shown not only to be reliable and valid for EoLC volunteers, but it also highlighted the unique emotional challenges they faced.

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.

"I'm not an anxious person": end-of-life care workers constructing positive psychological states

BACKGROUND

Mental health is an issue of social and economic importance. Sociocultural and scholarly attention has largely focused on the negative aspects of mental health. That is, on mental disorders and illness and how they adversely impact our lives. In contrast, this paper forms part of a recent alternative empirical perspective in discourse-based research, by focusing on the positive aspects of mental health. In this article, we investigate how end-of-life care workers construct their positive psychological states.

METHODS

Our data are 38 audio-recorded and transcribed semi-structured interviews with end-of-life care workers from Hong Kong and the United Kingdom. We utilized thematic analysis to identify common categorial strands across the data and discourse analysis to identify the linguistic strategies that these interviewees used to talk about their mental health.

RESULTS

Our thematic analysis generated a superordinate theme across the interviews-namely, that of end-of-life care workers talking about their positive psychological states. We identify three generic ways that end-of-life care workers talked about these psychological states; by "foregrounding the positive," "reformulating the negative," and "dismissing the negative." Our analysis also explicates how interviewees connected social and organizational support to being a benefit to their psychological states.

CONCLUSIONS

Our work contributes to existing discourse-based and sociolinguistic research on mental health by turning their focus towards a consideration of its positive dimensions. We also identify recurrent linguistics strategies used by people to construct their mental health. Our analyses point to the importance of investigating mental health as a multidimensional concept that considers participants' own reflections on their mental health.

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.

Knowledge and attitude regarding organ donation among medical students in Hong Kong: a cross-sectional study

Objectives

The rate of organ donation in Hong Kong is among the lowest in developed regions. Since medical students will play an important role in counselling patients for organ donation and identifying potential donors in the future, their knowledge, attitudes and action for organ donation are important. This study aims to understand knowledge, attitudes and actions with regard to organ donation among medical students and investigate the factors determining the knowledge and attitudes.

Design

A cross-sectional study.

Setting and participants

Medical students in Hong Kong were invited to complete a questionnaire. 377 medical students participated in the study.

Methods

The questionnaire assessed their attitudes, knowledge, action of organ donation, belief and perception on organ donation, and other factors. Linear regression analyses and logistic regression were performed to analyse the effect of the variables on knowledge, attitudes and action for organ donation.

Results

Almost all medical students (99.5%) held a positive attitude towards organ donation, but only 28.1% have signed up as organ donors. Determinants of knowledge of organ donation included belief in preservation of intact body after death (β = –0.14, 95% CI = –0.24 to –0.04) and perceived confidence and competence of organ donation discussion (β = –0.12, 95% CI = –0.22 to –0.02). Predictors of organ donor registration status included knowledge of organ donation (OR=1.03, 95% CI=1.00 to 1.06), perceived convenience of organ donation registration (OR=3.75, 95% CI=1.62 to 8.71), commitment to organ donation (OR=3.81, 95% CI=2.01 to 7.21) and exposure to organ donation (OR=4.28, 95% CI=2.37 to 7.74).

Conclusions

Knowledge is positively associated with organ donation action. The above determinants of organ donation could be emphasised in medical education.

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.

Effectiveness of Educational Programs on Palliative and End-of-life Care in Promoting Perceived Competence Among Health and Social Care Professionals

BACKGROUND

There is a growing need for palliative care for patients near the end of life and their caregivers. Palliative and end-of-life care (EoLC) education are recommended for all health care (e.g., physicians, nurses, and allied health practitioners) and social care professionals (e.g., social workers) to ensure the quality of services. However, less attention has been afforded to generic, in contrast to specialized, EoLC education. This study evaluated the effectiveness of a series of short-term generic EoLC educational programs for health and social care professionals.

METHOD

A pre-post survey design was adopted, focusing on different EoLC core competences.

RESULTS

Significant improvement was observed in all perceived competences after the educational programs, regardless of participants' occupation or EoLC experience. Perceived competence in self-care was rated significantly higher than all other competences prior to the programs. Healthcare professionals rated significantly higher on competence in symptom management than social workers. Scores on communication skill and self-care competences were significantly higher following longer (i.e., 16-24 hours) than shorter (i.e., 4-8 hours) programs.

CONCLUSION

Generalist palliative/EoLC educational programs may enable health and social care professionals to refresh and extend their knowledge and skills and enhance their perceived competence in providing EoLC. Further research on generalist palliative/EoLC education is needed to examine the impact of continuing training on professionals' actual practice in EoLC and palliative care.

Patient Navigator and Community Health Worker Attitudes Toward End-of-Life Care

Background: There are racial/ethnic disparities in hospice use and end-of-life (EOL) care outcomes in the United States. Although the use of community health workers (CHWs) and patient navigators (PNs) has been suggested as a means of reducing them, CHW/PNs' attitudes toward a palliative care philosophy remain unknown. The purpose of this study was to examine how personal attributes affect a CHW/PN's attitude toward EOL care. Methods: CHWs/PNs were recruited from two state-wide organizations and invited to complete an online survey. We collected information on demographics, attitudes toward the palliative care philosophy, and comfort with caring for patients at the EOL. Results: Of the 70 CHWs/PNs who responded to the survey, 82.5% identified as female, 56.4% identified as black, and 56.2% had a four-year college degree or higher. The mean score on a validated scale to assess attitudes toward EOL care was 33.5 (SD = 4.9; possible range, 8-40). Eighty percent strongly agreed or agreed with being open to discussing death with a dying patient. Higher self-efficacy scores were associated with more favorable attitudes toward hospice (r = 0.306, p = 0.016). Conclusions: CHWs/PNs have an overall favorable attitude toward the palliative care philosophy and may be inclined to providing EOL care.

Caregivers' psychological suffering and posttraumatic growth after patient death

PURPOSE

This study aimed to identify the association between caregivers' psychological suffering and posttraumatic growth (PTG) after patient death.

DESIGN AND METHODS

Participants were a total of 254 caregivers, including nurses, nursing assistants, social workers, and care workers.

FINDINGS

Higher psychological suffering, in terms of expanding self-consciousness, change of values, and spiritual sublimation, had a positive correlation with PTG. For nurses and nursing assistants, the change of values and spiritual sublimation had a positive correlation with PTG. For social workers, the higher self-consciousness was associated with greater PTG. For care workers, the expanded self-consciousness and lower helplessness had a positive correlation with PTG.

PRACTICE IMPLICATIONS

These findings will serve as a basis for the development of supportive programs to assist caregivers in improving PTG after patient death.

"Not Just Anybody Can Do It": A Qualitative Study of the Lived Experience of Inpatient Palliative Care Professionals in China's Mainland

Background: Over the past 5 years, China has invested substantially in palliative care programs to meet the rising demand for such services. In China's mainland, most palliative care programs are embedded within an established hospital unit, but a small subset of providers practice exclusively in a stand-alone inpatient palliative care department.

Objective: To explore the lived experience of professionals at an independently operating palliative care hospital department in China's mainland.

Design: We used purposive sampling to select palliative care physicians and nurses. Semistructured in-depth interviews were conducted in person. Thematic analysis was used to elicit key themes that pertained to participants' lived experience.

Setting/Subjects: Ten palliative care physicians and seven nurses at the palliative medicine department in the West China Fourth Hospital of Sichuan University in Chengdu, Sichuan Province, participated in the interviews.

Results: Three themes related to participants' lived experience were (1) interactions with patients and families (e.g., frequent encounters with death, communication difficulties, witnessing family struggles, and developing mutually trusting relationships); (2) factors influencing their work life (e.g., supportive working environment, unmet training needs, policy restrictions, and lack of public awareness); and (3) perceived nature of work (e.g., complex and demanding, underappreciation, encroachment of work stress into personal life, deriving accomplishment from work, and personal growth).

Conclusion: This study helps fill the void in the palliative care literature regarding the lived experience of inpatient palliative care professionals in China's mainland. Our findings revealed factors influencing the well-being of palliative care professionals that are meaningful to policymakers.

Implementing Advance Care Planning in 'The Age of Deferred Death'- the Hong Kong Experience over 4 Years

OBJECTIVES

To plan, implement and evaluate a series of initiatives to improve patient centred quality of end of life care through raising public awareness, promoting the concept that all health and social care professionals should be engaged in this practice, and carrying out pilot of community care models.

DESIGN

Pilot studies of community models of care, training programs for health and social care professionals, public education programmes.

SETTING

Selected hospitals, residential care homes for the elderly, and community centres in Hong Kong.

PARTICIPANTS

Patients and their families at the end of life stage.

MEASUREMENTS

Combination of quantitative and qualitative studies according to different components of the initiative.

RESULTS

Effective training for professional staff occurred using training videos, role play, rather than lectures, and when concepts are integrated into daily practice and quality assurance programmes. Members of the public welcomed end of life care discussions and the implementation of advance care planning. The pilot community care program was found to reduce anxiety, depression, physical symptoms, improve communication within the family as well as promoting a feeling of peace among recipients of the service. It also reduced care giver strain and anxiety, as well as hospital visits and duration of stay. Similar findings were also observed among recipients of care in the residential care setting.

CONCLUSION

A sustainable model would require uptake by policy makers and chief executives of Social Welfare and Health Bureaus, supported by amendments of relevant legal ordinances, which is in progress after public consultation.

Hospice care self-efficacy among clinical medical staff working in the coronavirus disease 2019 (COVID-19) isolation wards of designated hospitals: a cross-sectional study

BACKGROUND

The COVID-19 pandemic has caused more than 462,417 deaths worldwide. A large number of patients with severe COVID-19 face death in hospital. Hospice care is truly a philosophy of care that delivers patient-centred care to the terminally ill and their families. Hospice care could provide many benefits for patients, families, and for hospice caregivers. The aim of this study is to investigate hospice care self-efficacy and identify its predictors among Chinese clinical medical staff in COVID-19 isolation wards of designated hospitals.

METHODS

A cross-sectional design was used. The Hospice Care Self-Efficacy, Self-Competence in Death Work Scale, Positive Aspects of Caregiving, and Simplified Coping Style Questionnaires were administered between February and April 2020. A total of 281 eligible medical staff responded to the questionnaires, with a response rate of ≥78.9%.

RESULTS

The mean score of hospice care self-efficacy was 47.04 (SD = 7.72). Self-efficacy was predicted by self-competence in death work (B = 0.433, P < 0.001), positive aspects of caregiving (B = 0.149, P = 0.027), positive coping (B = 0.219, P < 0.001), giving hospice care to dying or dead patients before fighting against COVID-19 (B = -1.487, P = 0.023), occupational exposure while fighting against COVID-19 (B = -5.244, P = 0.004), holding respect for life and professional sentiment as motivation in fighting against COVID-19 (B = 2.372, P = 0.031), and grade of hospital employment (B = -1.426, P = 0.024). The variables co-explained 58.7% variation of hospice care self-efficacy.

CONCLUSION

Clinical nurses and physicians fighting COVID-19 reported a moderate level of hospice care self-efficacy during this pandemic. Exploring the traditional Chinese philosophy of life to learn from its strengths and make up for its weaknesses and applying it to hospice care may provide a new framework for facing death and dying during the COVID-19 pandemic. Continuous hospice care education to improve self-competence in death work, taking effective measures to mobilize positive psychological resources, and providing safer practice environments to avoid occupational exposure are also essential for the improvement of the hospice care self-efficacy of clinical nurses and physicians. These measures help caregivers deal effectively with death and dying while fighting against the COVID-19 pandemic.

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.

Professional quality of life, depression, and meaning in life among helping professionals: The moderating role of self-competence in death work

We examined the moderating role of self-competence in death work, and the relationships of professional quality of life with personal well-being and self-competence in death work. Two hundred helping professionals (mean age = 40.43, 85.5% female) completed a questionnaire. Better professional quality of life (i.e., a higher level of compassion satisfaction and lower levels of burnout and secondary traumatic stress) was associated with better personal well-being and self-competence in death work. Self-competence in death work moderated the negative impact of a lower level of compassion satisfaction on depression. Implications on self-care of helping professionals doing death work are discussed.

Barriers to advance care planning: a qualitative study of seriously ill Chinese patients and their families

BACKGROUND

Advance care planning (ACP) facilitates identification and documentation of patients' treatment preferences. Its goal aligns with that of palliative care - optimizing quality of life of seriously ill patients. However, concepts of ACP and palliative care remain poorly recognized in Chinese population. This study aims at exploring barriers to ACP from perspective of seriously ill patients and their family caregivers.

METHODS

This is a qualitative study conducted in a Palliative Day Care Centre of Hong Kong between October 2016 and July 2017. We carried out focus groups and individual interviews for the seriously ill patients and their family caregivers. A semi-structured interview guide was used to explore participants' experiences and attitudes about ACP. Qualitative content analysis was adopted to analyze both manifest content and latent content.

RESULTS

A total of 17 patients and 13 family caregivers participated in our study. The qualitative analysis identified four barriers to ACP: 1) limited patients' participation in autonomous decision making, 2) cognitive and emotional barriers to discussion, 3) lack of readiness and awareness of early discussion, and 4) unprepared healthcare professionals and healthcare system.

CONCLUSIONS

Participations of seriously ill patients, family caregivers and healthcare workers in ACP initiation are lacking respectively. A series of interventions are necessary to resolve the barriers.

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.

Moderating effects of meaning in life on the relationship between depression and self-competence in death work among helping professionals

This study aims to examine the relationships of self-competence in death work (SC-DW) with meaning in life (MIL) and depression, particularly the moderating effects of MIL on the relationship between depression and SC-DW. A total of 151 helping professionals completed a questionnaire. SC-DW showed negative and positive significant associations with depression and MIL, respectively. MIL was the moderator between depression and SC-DW. At the same depression level, helping professionals who experienced a higher level of MIL indicated a higher level of SC-DW, and particularly a higher level of emotional competence in death work. Implications on supporting helping professionals are discussed.

Resilience in inpatient palliative care nursing: a qualitative systematic review

Background

Nurses in inpatient palliative care are frequently exposed to death and dying in addition to common stressors found in other nursing practice. Resilience may mitigate against stress but remains ill-defined and under-researched in the specialist palliative care setting.

Objective

The aim of this systematic review was to understand resilience from the perspectives of inpatient palliative care nurses.

Design

A thematic synthesis of qualitative studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources

Academic Search Ultimate, Cumulative Index to Nursing and Allied Health Literature, Medline Complete, PsycINFO and Scopus.

Review methods

The review stages were searching for relevant literature, selecting relevant papers, data extraction, critical appraisal and thematic synthesis.

Results

Eight studies revealed 10 subthemes, 3 descriptive themes and 1 analytical theme: resilience occurs when nurses incorporate stressful aspects of their personal or professional lives into a coherent narrative that enhances their ability to cope with the demands of their role.

Conclusion

Palliative care nursing is more stressful if patients or situations remind nurses of personal experiences. Nurses cope better with adequate support; however, coping does not necessarily imply increased resilience. Resilience occurs when nurses cognitively process their experiences, articulate their thoughts and feelings into a coherent narrative, and construct a sense of meaning or purpose. Future research could explore how nurses understand resilience and how it could be enhanced in the palliative care inpatient setting. With resilience, nurses may remain in the profession longer and improve the quality of care when they do.