Terminal Care Performance of Nurses Caring for COVID-19 Patients: A Cross-Sectional Descriptive Study

AIMS

To identify the effects of moral distress and terminal care stress on the terminal care performance of nurses who cared for COVID-19 patients.

DESIGN

This study was cross-sectional descriptive research.

METHODS

Using a convenience sampling method from June to October 2022, nurses who provided terminal care for COVID-19 patients in a Korean tertiary hospital within the last 6 months from the time of the study were selected as participants. Socio-demographic and work characteristics of the participants were collected, and COVID-19 moral distress, terminal care stress and terminal care performance were assessed. A total of 140 self-report questionnaires were distributed and returned (response rate: 100%).

RESULTS

In the terminal care performance, it was found that nurses performed relatively well in the physical area, but less well in the emotional and spiritual areas. Moral distress and terminal care stress were both positively correlated with terminal care performance for nurses who cared for COVID-19 patients. The predictors of terminal care performance were moral distress (β = 0.27, p = 0.003), gender (β = 0.20, p = 0.015) and experience in a dedicated COVID-19 unit (β = 0.22, p = 0.020).

CONCLUSIONS

The study identified moral distress as the most significant factor influencing terminal care performance among nurses caring for COVID-19 patients. To enhance terminal care performance, it is crucial to address moral distress and provide clear guidelines and support, especially in the emotional and spiritual care domains. Future research should explore additional factors that may influence terminal care performance in pandemic situations.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Stress-induced cortisol response predicts empathy for pain: The role of task-based connectivity between the insula and sensorimotor cortex during acute stress

Empathy for pain is a key driver of prosocial behavior and is influenced by acute psychosocial stress. However, the role of task-based brain connectivity during acute stress have been neglected. Hence, we aimed to explore the relationship between the magnitude of cortisol response to acute stress and empathy for pain, as well as the neural connectivity mechanisms involved. In this study, 80 healthy participants (37 women and 43 men) were exposed to the acute psychosocial stress paradigm (ScanSTRESS) and were scanned by functional magnetic resonance imaging. Saliva samples were collected to measure the magnitude of cortisol stress response. Subsequently, the participants took part in a pain-video task to assess their empathy for pain. Six participants were excluded because of physical discomfort or excessive head movement in all runs during the task-dependent fMRI scan. Therefore, 33 women and 41 men were included in data analysis. We found that empathy for pain was negatively correlated with the magnitude of cortisol stress response (r = -0.268, p = 0.018) and that the task-based connectivity between the salience network and sensorimotor network, including its sub-network and sub-region, was negatively correlated with the magnitude of cortisol stress response, and positively correlated with empathy for pain. Furthermore, task-based connectivity between the insula and the paracentral lobule mediates the effect of the stress-induced cortisol response on empathy for pain (indirect effect = -0.0152, 95% CI = [-0.036, -0.001], p = 0.036). Our research suggests that empathy is not only correlated with stress-induced glucocorticoids but also tied to the stress-induced reduced communication between basic and higher brain regions.

Factors Associated with Person-Centered Care among Hospice Nurses

Purpose

The purpose of this study was to examine person-centered care, nursing professionalism, the nursing work environment, and empathy capacity among hospice ward nurses and to identify the factors affecting person-centered care.

Methods

Data were collected using a self-report questionnaire completed by 120 nurses at 30 inpatient hospice institutions in South Korea from August 24, 2020 to September 8, 2020. The independent t-test, one-way analysis of variance, and Pearson correlation analysis were conducted using SPSS version 26.0.

Results

The scores were 3.76±0.45 for person-centered care, 3.58±0.47 for nursing professionalism, 3.24±0.57 for the nursing work environment, and 4.00±0.46 for empathy capacity. There were positive correlations between the variables. Factors that influenced the person-centered care of hospice nurses were being a manager (β=0.20, P=0.002), high nursing professionalism (β=0.20, P=0.012), a better nursing work environment (β=0.15, P=0.033), and high empathy capacity (β=0.51, P<0.001). The explanatory power was 65.3%.

Conclusion

To reinforce the person-centered care competency of hospice nurses, it is necessary to improve nursing professionalism, the nursing work environment, and empathy competency. Opportunities for nurses to practice independently must be expanded for nurses to develop nursing professionalism. Sufficient nursing personnel and material resources must be provided to nurses to cultivate a positive work environment. Empathy should be improved by implementing integrated education programs that include nursing practice situations.

Mediating Effect of Compassion Competence on the Relationship between Caring Behaviors and Quality of Nursing Services in South Korea

This study aimed to investigate the mediating effect of compassion competence on the relationship between caring behaviors and the quality of nursing services. Participants included nurses working in South Korean hospitals. Data collected from 1 November to 31 December 2020 were analyzed using a t-test, analysis of variance (ANOVA), Pearson’s correlation coefficients, and hierarchical multiple regression. We found that caring behavior had a positive correlation with the quality of nursing services and compassion competence. Moreover, there was a positive correlation between the quality of nursing services and compassion competence. Compassion competence had a significant mediating effect on the relationship between caring behaviors and quality of nursing services. This suggests that nurses’ caring behaviors can enable high-quality nursing services influenced by compassion. Therefore, in order to improve the quality of nursing services, repeated and continuous implementation of training programs including education that can improve compassion competence is necessary.

Factors Associated with Job Stress among Hospital Nurses: A Meta-Correlation Analysis

This study aims to investigate research trends concerning job stress among hospital nurses. Articles about job stress among hospital nurses published in English from 2008 to 2018 were searched. In the first search, 2673 articles were extracted from the MEDLINE, EMBASE, KoreaMed, KERIS, KISS, KISTI, and KMbase databases. Altogether, 154 articles were used in the systematic review and meta-analysis. Thirty-nine variables were explored regarding job stress. Among the major variables, insufficient job control, personal conflict, and burnout had a positive correlation. In contrast, intention to stay, job satisfaction, and personal accomplishment had a negative correlation. In the meta-analysis conducted in relation to a specific conceptual framework, the negative-outcome factors showed significant positive correlations with job stress, whereas the positive-outcome factors showed significant negative correlations with job stress. This study identified factors associated with job stress in nurses through a meta-correlation analysis, and the overall correlation coefficient was relatively high at 0.51. Job factors and moderators had significant meta-correlation coefficients. These results can be utilized in clinical practice and research to help develop intervention programs to relieve job stress among nurses.

The Relationships of End-of-life Care Stress with Compassionate Competence and Attitudes toward End-of-life Care among Pediatric Nurses

Purpose

This study aimed to provide basic data for developing interventions to relieve the end-of-life care stress experienced by pediatric nurses by examining the relationships of end-of-life care stress with compassionate competence and attitudes toward end-of-life care.

Methods

Data were collected via a survey that was conducted from September 10 to September 30, 2018 and administered to 113 nurses who had worked for more than 6 months in a pediatric unit at a tertiary hospital in Seoul, South Korea. The data were analyzed for frequency, percentage, mean, and standard deviation, and the independent t-test, one-way analysis of variance, and Pearson correlation analysis were conducted using SPSS version 25.0.

Results

End-of-life care stress among pediatric nurses had a weak positive correlation (r=0.216, P<0.05) with compassionate competence and had no significant correlation with attitudes toward end-of-life care. Among the sub-factors of end-of-life care stress, psychological difficulties had a weak positive correlation with sensitivity (r=0.309, P<0.01) and communication (r=0.230, P<0.05), which are aspects of compassionate competence. Lack of knowledge about end-of-life care had a weak positive correlation with communication (r=0.209, P<0.05) as an aspect of compassionate competence.

Conclusion

To improve the quality of end-of-life care provided by pediatric nurses, it is necessary to improve their compassionate competence and reduce their end-of-life care stress by developing education and support programs tailored to the characteristics of children and specific communication methods.

Understanding Nurses' Experiences and Perceptions of End-of-Life Care for Cancer Patients in Korea: A Scoping Review

BACKGROUND

Quality end-of-life care for cancer patients is a global health priority, and nurses are instrumental in providing this care. However, little is known about nurses' experiences and perceptions in end-of-life care settings in Korea. Aims: This scoping review examined Korean nurses' end-of-life care experiences and assessed the state of research in this area.

METHODS

Systematic searches were conducted using 7 electronic databases (PubMed, CINAHL, Scopus, Embase, WPRIM, KCI, and RISS), and 17 studies were selected for review.

FINDINGS

Most studies were limited to cross-sectional, descriptive designs. Outcomes regarding end-of-life care measured in the studies were categorized into cognitive variables, emotional variables, participation/performance, and educational needs. Study results suggested low nurse knowledge and self-efficacy with regard to provision of end-of-life care. Perceived barriers to quality end of life care included difficulties in meeting family members' needs. In addition, emotional outcomes associated with end-of-life care included high levels of nurse stress and burnout. Predictors of elevated stress included inability to provide adequate pain control, inability to reconcile patient requests with physician orders, and heavy workload. Although most nurses had end-of-life care experience, fewer than half reported receiving related education. The lack of knowledge and skill related to end of life care was a primary contributor to stress.

CONCLUSIONS

Korean nurses providing end-of-life care for cancer patients need additional education and support to help them manage high stress levels. Further study is needed to identify strategies for meeting nurses' end-of-life care education needs and of improving their overall performance in such practice.

Validation of the Nurses' Involvement in Dying Patients and Family Care-Korean Version

Purpose

The purpose of this study was to test the validity of the Korean version of the Nurses' Involvement in Dying Patients and Family Care (NIDPFC) instrument.

Methods

Data were collected from 410 registered nurses at a university hospital, general hospitals, and a convalescent hospital. Data were collected from June 23 to July 17, 2020. Internal consistency reliability, construct validity, and criterion validity were examined using the SPSS and AMOS software.

Results

Of the 35 preliminary items of the instrument, 24 items were finally selected after evaluating the content validity, analyzing the items, and assessing construct validity. The following four factors were derived "burden" (seven items), "deep involvement" (eight items), "resilience" (five items), and "empathy" (four items), with a cumulative explanatory variance of 55.2%. For criterion validity, a significant positive relationship was found between the NIDPFC and attitudes toward caring for the dying. For internal consistency reliability, the Cronbach's α was 0.82.

Conclusion

The validity and reliability of the NIDPFC were verified. Therefore, the NIDPFC is an effective instrument to use in further studies.

The Relationship of Perceptions of Hospice and Palliative Care With Emotional Intelligence and Cognitive Empathy in Nursing Students

This study aimed to identify the relationships of perception of hospice and palliative care with emotional intelligence and cognitive empathy in nursing students. The participants were 458 nursing students. Data were collected using structured questionnaires and analyzed with Pearson correlation coefficients, independent-samples t test, and binary logistic regression. Perception of hospice and palliative care was significantly and positively correlated with emotional intelligence (r = 0.224, P < .001) and cognitive empathy (r = 0.311, P < .001). Mean score differences of perception of hospice and palliative care by emotional intelligence and cognitive empathy were statistically significant (t = -3.973, P < .001; t = -4.109, P < .001, respectively). Logistic regression yielded an odds ratio of 1.860 (P < .001; 95% confidence interval, 1.283-2.698) between the perception of hospice and palliative care and emotional intelligence and an odds ratio of 2.028 (P < .001; 95% confidence interval, 1.394-2.951) between the perception of hospice and palliative care and cognitive empathy. Emotional intelligence and cognitive empathy should be cultivated to raise nursing students' perception of hospice and palliative care and must be included when developing related curricula and extracurricular programs.