Nurses' Attitudes Towards End of Life Care Research

pmabraham, BSN, RN · Jul 1, 2018

Hello:

"What area of nursing do you work in?" doesn't have an answer selection for Hospice and therefore I cannot complete the survey.

Thank you.

cardiacfreak, ADN · Jul 2, 2018

Posting this in the hospice forum will not show a good indicator of how nurses feel regarding care of patients at end of life. We are very comfortable taking care of dying patients or we wouldn't be doing hospice or palliative care.

Nascar nurse, ASN, RN · Jul 2, 2018

I put med-surg, although I'm a LTC nurse and former hospice nurse. This question of the survey needs expanded and I agree, this needs posted in the general forum

smf0903 · Jul 15, 2018

I started the survey but ended up not finishing because the questions are too vague for this topic. I found myself putting "neither agree nor disagree" for most because the situations/questions are too black-and-white. End-of-life has an infinite number of grey areas...family doesn't agree with patient's wishes, family is disruptive with care, patient and 98% of family want the same thing and the brother from five states over fights every move...I could go on and on.

Tboland88 · Nov 30, 2018

Thank you to everyone who participated in my survey! Below my thesis and results of survey!!

Thesis Proposal: What are the attitudes towards end of life care among registered nurses?

Trisha Boland, RN, BSN

Master's Thesis

In Partial Fulfillment of the Requirements

For the Degree of Masters of Science in Nursing

William Paterson University

Department of Nursing

Submitted to

Dr. Kem Louie, PhD., RN

Thesis Advisor

June 13, 2018

Abstract

The thesis presents how nurses feel about their role in end of life care, how competent they feel in caring for the dying and if they would like to be more involved in the decision-making process to transition a patient to end of life care. The purpose of the proposed study is to establish nurses' attitudes towards end of life care. A comprehensive literature review was completed and determined that the available literature on nurses' attitudes towards end of life care is scarce. The methodology used was a non-experimental, descriptive design. A survey that was developed by Frommelt (1991) titled The Frommelt Attitude Toward Care of Dying Scale (FATCOD) was distributed to participants to collect quantitative data to examine the attitudes of registered nurses towards death and dying. The survey was distributed through an online nursing blog. A convenience sample of 60 registered nurses were included. Data analysis shows attitudes towards end of life care scores ranged from 82 to 108, with a mean of 94.07. Overall, participants have moderate attitudes towards caring for patients who are near the end of their life. Recommendations for future practice are continuing education on end of life care to ensure registered nurses have positive attitudes when caring for terminally ill patients.

Keywords: nurses attitudes, end of life, decision-making

Table of Contents

Chapter I: Introduction.................................................................................................................... 5

Introduction to Problem..............................................................................5

Reason/Purpose for Study............................................................................5

Problem Statement/Research Question............................................................5

Conceptual and Operational Definitions of Variable.............................................6

Importance of the Study for Nursing...............................................................6

Chapter II: Review of the Literature............................................................................................... 8

Conceptual/Theoretical Framework ................................................................................... 9

Literature Review..............................................................................................................10

Summary of Literature Review..........................................................................................14

Chapter III: Methods and Approach.......................................................................15

Design................................................................................................15

Sample and Setting.................................................................................15

Protection of Human Subjects....................................................................15

Instrument............................................................................................16

Data Collection......................................................................................16

Data Analysis........................................................................................17

Chapter IV: Results..........................................................................................18

Results................................................................................................18

Chapter V: Discussion.......................................................................................25

Interpretation of Results............................................................................25

Relationship to Prior Literature...................................................................26

Chapter VI: Conclusion.....................................................................................27

Summary of Analysis and Discussion............................................................27

Implications for Practice and Future Research..................................................27

References......................................................................................................29

Appendices.................................................................................................................................... 31

Appendix A: The Frommelt Attitude Toward Care of the Dying Scale.....................31

Appendix B: WPU IRB.............................................................................34

Appendix C: Passive Informed Consent.........................................................36

Appendix D: Permission to use tool..............................................................38

Appendix E: Permission to post on allnurses...................................................39

Chapter I: Introduction

Introduction to the Problem

Death is unfortunately an inevitable process of life. "Numbers of deaths are expected to rise each year in the coming decades, most of them due to chronic disease such as cancer, heart disease, chronic respiratory disease and dementia" (Albers, Grancke, de Veer, Bilsen & Onwuteaka-Philipsen, 2013, p. 5). With the numbers of deaths increasing the profession of nursing is going to be involved with the care and comfort of these people. Nurses are at the frontline of bedside care and will be considered the first people families will confront regarding questions about the process of dying. Albers et al. (2013) states that "nurses often have closer and more frequent contact with patients than physicians" (p. 5).

Reason/Purpose for Study

Literature states that nurses may not feel comfortable discussing important issues with dying patients and families (Boyd, Merkh, Rutledge & Randall, 2013). This is significant to nursing because nurses should feel confident in discussing end of life with patients and families. The purpose of this study is to examine the attitudes of nurses towards end of life care. From identifying these attitudes, one can conclude that nurses' feelings towards death and dying can impact the care their patients receive at the end of their lives.

Problem Statement/Research Question

The research question is What are the attitudes towards end of life care among registered nurses? The hypothesis is attitudes of nurses caring for patients who are at the end of their life will directly affect the care provided to terminally ill patients.

Conceptual and Operational Definitions of Variable

Nurses' attitudes toward care of the dying is defined as views on various aspects of the dying process and palliative care that cause a person to react in a certain way when caring for the dying patient; may be comprised of cognitive, affective, and psychomotor elements (Frommelt, 2003). Attitudes will be operationalized using the instrument Frommelt Attitude Toward Care of the Dying Scale (FATCOD), developed by Katherine Frommelt. The purpose of this tool is to determine how nurses feel about certain situations in which they are involved with patients who are at the end of their lives (Frommelt, 1991).

Registered nurses are New Jersey state licensed individuals who provide care to improve a patient's health, promote healing, prevent illness and injury, alleviate suffering and advocate in the care of individuals families, groups, communities and populations (American Nurses Association, 2018).

Importance of the Study for Nursing

Death and dying is an issue that every nurse deal with at some point in his/her career. Knowing how one feels about death is significant to the nursing profession. The professional role of nurses means that they spend a lot of time at the bedside, and when a patient is terminally ill, nurses have to care for the patient's worsening condition as the patient approaches death (Lemobruni, Miniotti, Bovero, Zizzi, Castelli & Torta, 2014). Previous studies on nurses' attitudes to caring for terminally ill persons showed that dealing with death and dying evokes negative emotions, such as feelings of helplessness or surrender, and creates fears and anxieties that affect the quality of the care provided to patients (Lemobruni, Miniotti, Bovero, Zizzi, Castelli & Torta, 2014). Nurses having more positive attitudes towards death and dying will help one care properly for end of life patients.

Chapter II: Literature Review

Conceptual Framework

Katherine Kolcaba's Theory of Comfort is the conceptual framework for this study. Kolcaba believes that comfort is the product of holistic nursing. "Kolcaba described comfort existing in three forms: relief, ease, and transcendence. If specific comfort needs of a patient are met, the patient experiences comfort in the sense of relief" (Petiprin, 2016, p.1). Applying Kolcaba's Theory to the care of dying patients will make for a more comforting process. Additionally, nurses with positive attitudes towards end of life care can ease the patient's anxiety during the end of their life. Lastly, nurses can help patients achieve transcendence by helping them rise above the challenge of accepting a terminal diagnosis.

[TABLE=width: 100%]

[TR]

[TD]Attitudes on End-of Life Care

[/TD]

[/TR]

[/TABLE]

[TABLE=width: 100%]

[TR]

[TD]Nurses experience less fear and more confidence in caring for dying patients

[/TD]

[/TR]

[/TABLE]

[TABLE=width: 100%]

[TR]

[TD]Patients have better quality of life near the end of their lives

[/TD]

[/TR]

[/TABLE]

Figure 1. Conceptual Map

Literature Review

According to Yin, Xia, Yi & Chia (2007), caring for dying patients is a major part of nursing care, but previous studies showed that nurses feel uneasy and inadequate in dealing with dying patients and their families. Yin et al. (2007) states that "nurses have experienced a sense of helplessness when care for a dying patient" (p. 16). The study aimed to explore attitudes of nurses towards dying patients. The subjects were registered nurses who work on medical oncology and general surgical wards. The exclusion criteria were Nurse Managers and Nurse Case Coordinators. All 122 registered nurses from these floors were sent a questionnaire, which was untitled and developed by the authors of the study, to be completed and asked their views on nursing dying patients.

Ninety-six participants submitted questionnaires with 95 completed and one with missing data. The results showed that 58.4% of the staff in the general surgery ward felt exhausted taking care of dying patients, while 73.3% of the staff felt exhausted after caring for dying patients on in the medical oncology ward (Yin et al., 2007). The study also found that nurses working in the general surgical ward were 4.49 times more likely to feel frightened towards taking care of dying patients. It is apparent from these numbers that taking care of dying patients takes a toll on nurses and at some point, frightens them. According to the results of this study, Yin et al., (2007) discuses that a combination of education and clinical experience in the field of death and dying will prove more positive attitudes towards caring for end of life patients. The authors concluded that nurses should be educated about caring for dying patients to make the experience of the patients and their families a better one. The assumption is knowledge contributes to positive attitudes.

Boyd, Merkh, Rutledge & Randall (2011) suggest that nurses play an important role in the dying process because of the continuity of contact nurses have with their patients. Although this is true many nurses may not feel comfortable discussing important issues with patients and their families (Boyd et al., 2011). Most nurses in the acute care setting have little training and lack of knowledge regarding palliative care practices that are often appropriate for patients in end of life care (Boyd et al., 2011). The study performed was a descriptive, correlation survey study aimed to characterized oncology nurses' attitudes towards care at end of life. The purpose of the study was to characterize oncology nurses' attitude towards end of life care and their experience in caring for terminally ill patients, discussions about hospice with patients and their families, and the uses of palliative care practices. The subjects chosen were oncology nurses in inpatient and outpatient areas of a Magnet designated hospital in southern California. These nurses were sent the Caring for Terminally Ill Patients Nurse Survey which was developed researchers at Yale School of Medicine with the permission from Bradley who is the author of the instrument. Participants were asked to return the completed survey in two weeks' time.

Thirty-one nurses participated in the study, with a 47% response rate (Boyd et al., 2011). The results showed that most nurses reported having one or more patients with whom hospice care was not used and should have been. Boyd et al., (2011) discussed that nurses perceived both nurses and physicians having specific professional responsibilities related to hospice care and end of life decisions. Even with nurses believing they have responsibilities in end of life discussions, most nurses only felt they have mid-level skills related to caring for terminally ill patients and discussing hospice care. With this study Boyd et al., (2011) were able to support that education is needed for improving the capacity of nurses to deliver effective care to terminally ill patients. Current studies are needed to assess registered nurses' attitudes towards end of life care.

According to Albers, Grancke, de Veer, Bilsen & Onwuteaka-Philipsen (2013), responded physicians are responsible for end of life decisions, nurses are more likely to be involved in the decision-making process. "The contact between nursing staff and patients who are severely ill or dying is often informal and personal, and patients are therefore likely to speak to nurses about their hopes, wishes and concerns." (Albers et al., 2013, p.5). Nurses are an important information source for physicians when it comes to deciding about starting or stopping medical treatment. The subjects were nursing staff working in hospitals, home care, nursing homes or homes for the elderly in the Netherlands. The purpose of this study was to investigate nursing staff attitudes towards involvement and role in end of life decisions and the relationships with sociodemographic and work-related characteristics. 903 participants were sent a questionnaire which was developed by the authors of this study and remained untitled, regarding end of life decisions, with a total of 587 who completed the questionnaire.

The response rate was 66%. According the Albers et al. (2013), 64% of participants agreed that patients would rather talk to nurses about end of life decisions than to a physician and 33% agreed that nurses are in a better position to assess patients' end of life wishes than a physician. One quarter of nurses surveyed found themselves in a subordinate position that makes communication with physicians difficult (Albers et al., 2013). Nurses feel an innate responsibility to be involved in the decision-making process for their patients facing end of life. The study recommends that nursing staff should be involved in developing guidelines and standards on end of life decisions in order to improve communication between patients, nurses and physicians regarding end of life (Albers et al., 2013). Nurses attitudes towards caring for end of life patients are more positive when they are involved in decision to withdraw care will ultimately increase the satisfaction of the dying patient.

According to Latour, Fulbrook & Albarran (2009), "end of life care should be based on collaborative arrangements between the patient, family, and health care professionals but the involvement and participation of ICU nurses in decision-making lacks consistency" (p. 111). Nurses report wanting more involvement in end of life decisions because they feel their engagement in these discussions would increase job satisfaction (Latour et al., 2009). Nurses feel that their involvement in end of life decisions is important for effective communication between the physicians and the family (Latour et al., 2009). The authors of this article believe that there should be a standardized end of life practice.

The purpose of this study was to investigate the attitudes of intensive care nurses regarding end of life care. A convenient sample was drawn from a pool of 419 intensive care nurses who attended the European critical care nursing congress. The authors developed a questionnaire regarding attitudes towards end of life decisions and end of life care and sent them to the nurses who attended the congress (Latour et al., 2009).

The total number of questionnaires, developed by the authors from relevant literature and untitled, returned was 164 (39.1%). The results showed that the majority of the nurses who responded stated that involvement in the decision making of end of life care, positively influenced their job satisfaction (Latour et al., 2009). The study also showed that "there is some disparity over the interpretation of withholding and withdrawing life-sustaining treatment among nurses in the ICU" (Latour et al., 2009, p. 116). The study concluded that further education in the area of end of life among intensive care nurses is needed to have a better understanding of and increase their confidence during end of life discussions. Having better education in end of life care will coincide with positive attitudes towards caring for terminally ill patients.

Matsui & Braun (2010) state that although patients prefer to die at home, most die in facilities. Therefore, nurses and other health care professionals are the ones who are at the forefront of their care during the end of these patients lives. Knowing how nurses feel about caring for end of life patients will determine how well the patients experience a peaceful death. The authors of this study examined the attitudes of nurses towards death (Death Attitude Profile) and attitudes towards caring for dying older people (The Frommelt Attitude Toward Care of Dying Scale). This study was conducted in Japan at two hospitals, three nursing home and seven group homes. A total of 464 nurses were sent the Frommelt Attitude Towards Care of the Dying Scale and The Death Attitude Profile. The participants were given 3 months to complete and return the questionnaires (Matsui & Braun, 2010).

The total number of questionnaires returned was 388 (83.6%). Results from demographics showed that 80% of the sample were female, the mean age was 38 years and the mean years of work experience was 9.5 years. The results showed that 70% of the sample were experienced in with caring for dying patients (Matsui & Braun, 2010). Approximately one third of the subjects attended training or a seminar on end of life care. The results also show that nurses who have attended seminars on end of life care were more likely to have better attitudes toward caring for dying patients as measured by the FATCOD (Matsui & Braun, 2010). As supported in this study, staff education is important for maintaining and improving standards in end of life care. There is a need to examine registered nurses' attitudes in the United States.

Summary of Literature Review

The literature shows nurses have varied attitudes towards end of life care. Nurses feel a sense of fear when caring for dying patients, feel a personal closeness to dying patients, feel under educated regarding care of dying patients and feel that they should be involved in end of life decisions. Research has concluded that giving nurses more education and more of a say in end of life care will improve their attitudes towards caring for the dying. This study will further examine the attitudes and care toward end of life care.

Chapter III: Methods and Approach

Design

A non-experimental, descriptive design was used. A survey that was developed by Frommelt (1991) titled The Frommelt Attitude Toward Care of Dying Scale (FATCOD) was distributed to participants to collect quantitative data to examine the attitudes of registered nurses towards death and dying (Appendix A). The survey was completed electronically by registered nurses in a nursing blog.

Sample and Setting

A convenience sample of 60 registered nurses were included. The sample size was determined based on limitations on time while making sure an accurate representation of the target population was used. All participants are registered nurses subscribed to the blog, titled All Nurses. All Nurses are the leading social-networking site for nurses. The purpose of the blog is to allow registered nurses from all over the world to communicate about nursing, jobs, school and careers. There are over one million members to date. Requirements needed to be met to post survey on the blog are as follows: a registered member, post minimum of 20 topics prior to submitting research request, submit the research request to the Academic Nursing Research Participation, share research findings, post summary of final research and give credit to blog (Appendix E). Inclusion criteria are as follows: registered nurses with current license of one year of experience, ages 18 and above who are subscribed to the blog. All participants must be capable of reading, comprehending, and speaking English. Exclusion criteria included surveys that are incomplete.

Protection of Human Subjects

William Patterson University IRB was sought (Appendix B). Participation in the study was voluntary and passive consent was used. Introduction to the study and passive consent was listed on the blog site before starting the survey (Appendix C). There were no physical or legal risks to the participants. Psychological risks may include feelings of fear or sadness when thinking about death and dying. The seriousness of these psychological risks is rare. The survey was designed to be anonymous, the email address, content of responses and time/date of response will not be available to participants. The benefits of participating in the study is nurses will be able to realize their attitudes towards death and dying. The completed surveys will be deleted after five years.

Instrument

The FATCOD scale is a 30-item scale that measures attitudes towards caring for dying patients and their families (Appendix A). The scale has an equal number of positively and negatively worded items, which are rated on a five-point Likert scale, strongly disagree to strongly agree. (Matsui & Braun, 2010). Scores range from 30 to 150, with higher scores indicating more positive attitudes. Demographics information includes the following: sex, age, years of experience, area of specialty, and if participants attended an end of life care education program. Matsui & Braun (2010) found its internal reliability to be high, at 0.85. Matsui et al., (2010) also found that FATCOD I, which related to positive attitudes towards caring for the dying patient had a Cronbach alpha of 0.73 and FATCOD II which related to perceptions of patient and family centered care had a Cronbach alpha of 0.65. At the time of her original study, Frommelt (1991) computed a content validity index of 1.00. Permission to use to tool and added demographics were obtained through Sage Productions who published Katherine Frommelts' research (Appendix D).

Data Collection

After William Patterson University IRB approval, the researcher posted a minimum of 20 posts to the blog All Nurses prior to getting approval from the Administration Office of the blog to post the survey. A post with an introduction to the study with the survey was sent to the blog requesting participation (Appendix C). The software used to post the survey was Survey Monkey, a web-based survey company. The company was used to distribute and collect data. The survey took 20 min to complete. Participants were informed not to put an identifying information on the survey. Upon completion, Survey Monkey will analyze the results. No emails/identifying information was sent to the researcher.

Data Analysis

Descriptive data was evaluated using descriptive statistics. The correlation between attitudes and death and dying was measured using Oneway ANOVA and t-test. All data was analyzed using SPSS.

Chapter IV: Results

Results

Descriptive Statistics.

Data analysis began after 75 surveys were received. One survey was incomplete and removed from data analysis. 89.3% of participants were females (n=67). 10.7% of participants were males (n=8). Ages of participants ranged from 18 years to 60 or above. Age range 18-20 years has less than two answers each and therefor suppressed. The mean age of participants was 34. 26.7% of participants were between the ages of 21-29 (n=20). 37.3% of participants were between the age of 30-39 (n=28). 9.3% of participants were between the age 40-49 (n=7). 22.7% of participants were between the age 50-59 (n=17). 2.7% of participants were between the ages 60 and above (n=2). Nursing experienced ranged from 1 year to 11 years and above. 37.3% of participants have 1-5 years of nursing experience (n= 28). 32% of participants have 6-10 years of experience (n=24). 30.7% of participants have 11 or above years of experience (n=23). Level of degree ranged from some college to graduate degree. 5.3% of participants have some college experience (n=4). 10.7% of participants have an associates degree (n=8). 52% of participants have a bachelors degree (n=39). 32% of participants have graduate degrees (n=24). Area of care of participants ranged from Medical/Surgical, Operating Room (OR), Intensive Care Unit (ICU), and Oncology. The area of care, OR, had less than two answers each and therefore suppressed. 69.3% of participants work in a Medical/Surgical unit (n=52). 14.7% of participants work in the ICU (n=11). 10.7% of participants work on an oncology unit (n=8) (See Table 1).

Participants were also asked if they have ever attended an end of life education program. A limited number of participants, 34.7% (n=26) responded "yes" they have attended an end of life educational program. An overwhelmingly majority, 65.3% (n=49), responded "no" they have never attended an end of life educational program.

Table 1:

Demographics

[TABLE=width: 0]

[TR]

[TD=colspan: 6]SEX

[/TD]

[/TR]

[TR]

[TD=colspan: 2]

[/TD]

[TD]Frequency

[/TD]

[TD]Percent

[/TD]

[TD]Valid Percent

[/TD]

[TD]Cumulative Percent

[/TD]

[/TR]

[TR]

[TD]Valid

[/TD]

[TD]Female

[/TD]

[TD]67

[/TD]

[TD]89.3

[/TD]

[TD]89.3

[/TD]

[TD]89.3

[/TD]

[/TR]

[TR]

[TD]Male

[/TD]

[TD]8

[/TD]

[TD]10.7

[/TD]

[TD]10.7

[/TD]

[TD]100.0

[/TD]

[/TR]

[TR]

[TD]Total

[/TD]

[TD]75

[/TD]

[TD]100.0

[/TD]

[TD]100.0

[/TD]

[TD]

[/TD]

[/TR]

[/TABLE]

[TABLE=width: 0]

[TR]

[TD=colspan: 6]AGE

[/TD]

[/TR]

[TR]

[TD=colspan: 2]

[/TD]

[TD]Frequency

[/TD]

[TD]Percent

[/TD]

[TD]Valid Percent

[/TD]

[TD]Cumulative Percent

[/TD]

[/TR]

[TR]

[TD]Valid

[/TD]

[TD]18-20

[/TD]

[TD]1

[/TD]

[TD]1.3

[/TD]

[TD]1.3

[/TD]

[TD]1.3

[/TD]

[/TR]

[TR]

[TD]21-29

[/TD]

[TD]20

[/TD]

[TD]26.7

[/TD]

[TD]26.7

[/TD]

[TD]28.0

[/TD]

[/TR]

[TR]

[TD]30-39

[/TD]

[TD]28

[/TD]

[TD]37.3

[/TD]

[TD]37.3

[/TD]

[TD]65.3

[/TD]

[/TR]

[TR]

[TD]40-49

[/TD]

[TD]7

[/TD]

[TD]9.3

[/TD]

[TD]9.3

[/TD]

[TD]74.7

[/TD]

[/TR]

[TR]

[TD]50-59

[/TD]

[TD]17

[/TD]

[TD]22.7

[/TD]

[TD]22.7

[/TD]

[TD]97.3

[/TD]

[/TR]

[TR]

[TD]60 and up

[/TD]

[TD]2

[/TD]

[TD]2.7

[/TD]

[TD]2.7

[/TD]

[TD]100.0

[/TD]

[/TR]

[TR]

[TD]Total

[/TD]

[TD]75

[/TD]

[TD]100.0

[/TD]

[TD]100.0

[/TD]

[TD]

[/TD]

[/TR]

[/TABLE]

[TABLE=width: 0]

[TR]

[TD=colspan: 6]DEGREE

[/TD]

[/TR]

[TR]

[TD=colspan: 2]

[/TD]

[TD]Frequency

[/TD]

[TD]Percent

[/TD]

[TD]Valid Percent

[/TD]

[TD]Cumulative Percent

[/TD]

[/TR]

[TR]

[TD]Valid

[/TD]

[TD]Some College

[/TD]

[TD]4

[/TD]

[TD]5.3

[/TD]

[TD]5.3

[/TD]

[TD]5.3

[/TD]

[/TR]

[TR]

[TD]Associates

[/TD]

[TD]8

[/TD]

[TD]10.7

[/TD]

[TD]10.7

[/TD]

[TD]16.0

[/TD]

[/TR]

[TR]

[TD]Bachelors

[/TD]

[TD]39

[/TD]

[TD]52.0

[/TD]

[TD]52.0

[/TD]

[TD]68.0

[/TD]

[/TR]

[TR]

[TD]Graduate

[/TD]

[TD]24

[/TD]

[TD]32.0

[/TD]

[TD]32.0

[/TD]

[TD]100.0

[/TD]

[/TR]

[TR]

[TD]Total

[/TD]

[TD]75

[/TD]

[TD]100.0

[/TD]

[TD]100.0

[/TD]

[TD]

[/TD]

[/TR]

[/TABLE]

[TABLE=width: 0]

[TR]

[TD=colspan: 6]YRSEXP

[/TD]

[/TR]

[TR]

[TD=colspan: 2]

[/TD]

[TD]Frequency

[/TD]

[TD]Percent

[/TD]

[TD]Valid Percent

[/TD]

[TD]Cumulative Percent

[/TD]

[/TR]

[TR]

[TD]Valid

[/TD]

[TD]1-5

[/TD]

[TD]28

[/TD]

[TD]37.3

[/TD]

[TD]37.3

[/TD]

[TD]37.3

[/TD]

[/TR]

[TR]

[TD]6-10

[/TD]

[TD]24

[/TD]

[TD]32.0

[/TD]

[TD]32.0

[/TD]

[TD]69.3

[/TD]

[/TR]

[TR]

[TD]11 and up

[/TD]

[TD]23

[/TD]

[TD]30.7

[/TD]

[TD]30.7

[/TD]

[TD]100.0

[/TD]

[/TR]

[TR]

[TD]Total

[/TD]

[TD]75

[/TD]

[TD]100.0

[/TD]

[TD]100.0

[/TD]

[TD]

[/TD]

[/TR]

[/TABLE]

[TABLE=width: 0]

[TR]

[TD=colspan: 6]CAREAREA

[/TD]

[/TR]

[TR]

[TD=colspan: 2]

[/TD]

[TD]Frequency

[/TD]

[TD]Percent

[/TD]

[TD]Valid Percent

[/TD]

[TD]Cumulative Percent

[/TD]

[/TR]

[TR]

[TD]Valid

[/TD]

[TD]MedSurg

[/TD]

[TD]52

[/TD]

[TD]69.3

[/TD]

[TD]71.2

[/TD]

[TD]71.2

[/TD]

[/TR]

[TR]

[TD]OR

[/TD]

[TD]2

[/TD]

[TD]2.7

[/TD]

[TD]2.7

[/TD]

[TD]74.0

[/TD]

[/TR]

[TR]

[TD]ICU

[/TD]

[TD]11

[/TD]

[TD]14.7

[/TD]

[TD]15.1

[/TD]

[TD]89.0

[/TD]

[/TR]

[TR]

[TD]Oncology

[/TD]

[TD]8

[/TD]

[TD]10.7

[/TD]

[TD]11.0

[/TD]

[TD]100.0

[/TD]

[/TR]

[TR]

[TD]Total

[/TD]

[TD]73

[/TD]

[TD]97.3

[/TD]

[TD]100.0

[/TD]

[TD]

[/TD]

[/TR]

[TR]

[TD]Missing

[/TD]

[TD]System

[/TD]

[TD]2

[/TD]

[TD]2.7

[/TD]

[TD]

[/TD]

[TD]

[/TD]

[/TR]

[TR]

[TD=colspan: 2]Total

[/TD]

[TD]75

[/TD]

[TD]100.0

[/TD]

[TD]

[/TD]

[TD]

[/TD]

[/TR]

[/TABLE]

[TABLE=width: 0]

[TR]

[TD=colspan: 6]EOLPROG

[/TD]

[/TR]

[TR]

[TD=colspan: 2]

[/TD]

[TD]Frequency

[/TD]

[TD]Percent

[/TD]

[TD]Valid Percent

[/TD]

[TD]Cumulative Percent

[/TD]

[/TR]

[TR]

[TD]Valid

[/TD]

[TD]yes

[/TD]

[TD]26

[/TD]

[TD]34.7

[/TD]

[TD]34.7

[/TD]

[TD]34.7

[/TD]

[/TR]

[TR]

[TD]no

[/TD]

[TD]49

[/TD]

[TD]65.3

[/TD]

[TD]65.3

[/TD]

[TD]100.0

[/TD]

[/TR]

[TR]

[TD]Total

[/TD]

[TD]75

[/TD]

[TD]100.0

[/TD]

[TD]100.0

[/TD]

[TD]

[/TD]

[/TR]

[/TABLE]

Inferential statistics.

Further analysis was completed to evaluate the attitudes of nurses towards end of life by comparing areas of care, if participants attended an end of life program and age. Oneway ANOVA was performed to compare the areas of care and participants score on the instrument analyzing attitudes towards end of life (See Table 2). Post hoc test results found no significant statistics regarding areas of care and positive attitudes towards end of life care (F= 2.169, p=.122).

Table 2:

EOLIndex vs Care area

[TABLE=width: 0]

[TR]

[TD=colspan: 6]

[/TD]

[/TR]

[TR]

[TD=colspan: 6]EOLIndex

[/TD]

[/TR]

[TR]

[TD]

[/TD]

[TD]Sum of Squares

[/TD]

[TD]df

[/TD]

[TD]Mean Square

[/TD]

[TD]F

[/TD]

[TD]Sig.

[/TD]

[/TR]

[TR]

[TD]Between Groups

[/TD]

[TD]187.115

[/TD]

[TD]2

[/TD]

[TD]93.558

[/TD]

[TD]2.169

[/TD]

[TD].122

[/TD]

[/TR]

[TR]

[TD]Within Groups

[/TD]

[TD]2890.085

[/TD]

[TD]67

[/TD]

[TD]43.136

[/TD]

[TD]

[/TD]

[TD]

[/TD]

[/TR]

[TR]

[TD]Total

[/TD]

[TD]3077.200

[/TD]

[TD]69

[/TD]

[TD]

[/TD]

[TD]

[/TD]

[TD]

[/TD]

[/TR]

[/TABLE]

[TABLE=width: 0]

[TR]

[TD=colspan: 7]

[/TD]

[/TR]

[TR]

[TD=colspan: 7]Dependent Variable: EOLIndex

[/TD]

[/TR]

[TR]

[TD=colspan: 7]Tukey HSD

[/TD]

[/TR]

[TR]

[TD](I) CAREAREA

[/TD]

[TD](J) CAREAREA

[/TD]

[TD]Mean Difference (I-J)

[/TD]

[TD]Std. Error

[/TD]

[TD]Sig.

[/TD]

[TD=colspan: 2]95% Confidence Interval

[/TD]

[/TR]

[TR]

[TD]Lower Bound

[/TD]

[TD]Upper Bound

[/TD]

[/TR]

[TR]

[TD]MedSurg

[/TD]

[TD]ICU

[/TD]

[TD]3.832

[/TD]

[TD]2.183

[/TD]

[TD].193

[/TD]

[TD]-1.40

[/TD]

[TD]9.07

[/TD]

[/TR]

[TR]

[TD]Oncology

[/TD]

[TD]3.446

[/TD]

[TD]2.498

[/TD]

[TD].357

[/TD]

[TD]-2.54

[/TD]

[TD]9.43

[/TD]

[/TR]

[TR]

[TD]ICU

[/TD]

[TD]MedSurg

[/TD]

[TD]-3.832

[/TD]

[TD]2.183

[/TD]

[TD].193

[/TD]

[TD]-9.07

[/TD]

[TD]1.40

[/TD]

[/TR]

[TR]

[TD]Oncology

[/TD]

[TD]-.386

[/TD]

[TD]3.052

[/TD]

[TD].991

[/TD]

[TD]-7.70

[/TD]

[TD]6.93

[/TD]

[/TR]

[TR]

[TD]Oncology

[/TD]

[TD]MedSurg

[/TD]

[TD]-3.446

[/TD]

[TD]2.498

[/TD]

[TD].357

[/TD]

[TD]-9.43

[/TD]

[TD]2.54

[/TD]

[/TR]

[TR]

[TD]ICU

[/TD]

[TD].386

[/TD]

[TD]3.052

[/TD]

[TD].991

[/TD]

[TD]-6.93

[/TD]

[TD]7.70

[/TD]

[/TR]

[/TABLE]

Attitudes towards end of life care and participants ever attending an end of life educational program was measured using independent t-test. Resulted found participants who answered "no" to attending an end of life education program had a higher mean score, 96.2, for the survey. Those participants who answered "yes" to attending and end of life education program has a mean score of 89.9 for the survey. Results found no significant statistic result a in a more positive attitude towards end of life care in participants who did attended and end of life education program (t=-4.356, p=.0.310) as listed in Table 3.

Table 3:

EOLIndex vs EOLProgram

[TABLE=width: 0]

[TR]

[TD=colspan: 11]

[/TD]

[/TR]

[TR]

[TD=colspan: 2]

[/TD]

[TD=colspan: 2]

[/TD]

[TD=colspan: 7]t-test for Equality of Means

[/TD]

[/TR]

[TR]

[TD]F

[/TD]

[TD]Sig.

[/TD]

[TD]t

[/TD]

[TD]df

[/TD]

[TD]Sig. (2-tailed)

[/TD]

[TD]Mean Difference

[/TD]

[TD]Std. Error Difference

[/TD]

[TD=colspan: 2]95% Confidence Interval of the Difference

[/TD]

[/TR]

[TR]

[TD]Lower

[/TD]

[TD]Upper

[/TD]

[/TR]

[TR]

[TD]EOLIndex

[/TD]

[TD]Equal variances assumed

[/TD]

[TD]1.046

[/TD]

[TD].310

[/TD]

[TD]-4.356

[/TD]

[TD]72

[/TD]

[TD].000

[/TD]

[TD]-6.324

[/TD]

[TD]1.452

[/TD]

[TD]-9.218

[/TD]

[TD]-3.430

[/TD]

[/TR]

[TR]

[TD]Equal variances not assumed

[/TD]

[TD]

[/TD]

[TD]

[/TD]

[TD]-4.534

[/TD]

[TD]54.016

[/TD]

[TD].000

[/TD]

[TD]-6.324

[/TD]

[TD]1.395

[/TD]

[TD]-9.121

[/TD]

[TD]-3.528

[/TD]

[/TR]

[/TABLE]

Attitudes towards end of life care and age was measured using Oneway ANOVA. Result found that participants in the age bracket 30-39 produced higher scores on the survey, 96.4%. Results found a statistic significance in participants who are between the ages 30-39 have more positive attitudes towards caring for patients at the end of their life (F= 5.756, p=.001), as shown in Table 4.

Table 4:

EOLIndex vs Age

[TABLE=width: 0]

[TR]

[TD=colspan: 6]ANOVA

[/TD]

[/TR]

[TR]

[TD=colspan: 6]EOLIndex

[/TD]

[/TR]

[TR]

[TD]

[/TD]

[TD]Sum of Squares

[/TD]

[TD]df

[/TD]

[TD]Mean Square

[/TD]

[TD]F

[/TD]

[TD]Sig.

[/TD]

[/TR]

[TR]

[TD]Between Groups

[/TD]

[TD]599.513

[/TD]

[TD]3

[/TD]

[TD]199.838

[/TD]

[TD]5.756

[/TD]

[TD].001

[/TD]

[/TR]

[TR]

[TD]Within Groups

[/TD]

[TD]2326.262

[/TD]

[TD]67

[/TD]

[TD]34.720

[/TD]

[TD]

[/TD]

[TD]

[/TD]

[/TR]

[TR]

[TD]Total

[/TD]

[TD]2925.775

[/TD]

[TD]70

[/TD]

[TD]

[/TD]

[TD]

[/TD]

[TD]

[/TD]

[/TR]

[/TABLE]

[TABLE=width: 0]

[TR]

[TD=colspan: 7]Multiple Comparisons

[/TD]

[/TR]

[TR]

[TD=colspan: 7]Dependent Variable: EOLIndex

[/TD]

[/TR]

[TR]

[TD=colspan: 7]Tukey HSD

[/TD]

[/TR]

[TR]

[TD](I) AGE

[/TD]

[TD](J) AGE

[/TD]

[TD]Mean Difference (I-J)

[/TD]

[TD]Std. Error

[/TD]

[TD]Sig.

[/TD]

[TD=colspan: 2]95% Confidence Interval

[/TD]

[/TR]

[TR]

[TD]Lower Bound

[/TD]

[TD]Upper Bound

[/TD]

[/TR]

[TR]

[TD]21-29

[/TD]

[TD]30-39

[/TD]

[TD]-1.257

[/TD]

[TD]1.738

[/TD]

[TD].887

[/TD]

[TD]-5.84

[/TD]

[TD]3.32

[/TD]

[/TR]

[TR]

[TD]40-49

[/TD]

[TD]2.436

[/TD]

[TD]2.588

[/TD]

[TD].783

[/TD]

[TD]-4.38

[/TD]

[TD]9.25

[/TD]

[/TR]

[TR]

[TD]50-59

[/TD]

[TD]6.032^*

[/TD]

[TD]1.944

[/TD]

[TD].015

[/TD]

[TD].91

[/TD]

[TD]11.15

[/TD]

[/TR]

[TR]

[TD]30-39

[/TD]

[TD]21-29

[/TD]

[TD]1.257

[/TD]

[TD]1.738

[/TD]

[TD].887

[/TD]

[TD]-3.32

[/TD]

[TD]5.84

[/TD]

[/TR]

[TR]

[TD]40-49

[/TD]

[TD]3.693

[/TD]

[TD]2.499

[/TD]

[TD].457

[/TD]

[TD]-2.89

[/TD]

[TD]10.28

[/TD]

[/TR]

[TR]

[TD]50-59

[/TD]

[TD]7.290^*

[/TD]

[TD]1.824

[/TD]

[TD].001

[/TD]

[TD]2.48

[/TD]

[TD]12.10

[/TD]

[/TR]

[TR]

[TD]40-49

[/TD]

[TD]21-29

[/TD]

[TD]-2.436

[/TD]

[TD]2.588

[/TD]

[TD].783

[/TD]

[TD]-9.25

[/TD]

[TD]4.38

[/TD]

[/TR]

[TR]

[TD]30-39

[/TD]

[TD]-3.693

[/TD]

[TD]2.499

[/TD]

[TD].457

[/TD]

[TD]-10.28

[/TD]

[TD]2.89

[/TD]

[/TR]

[TR]

[TD]50-59

[/TD]

[TD]3.597

[/TD]

[TD]2.646

[/TD]

[TD].529

[/TD]

[TD]-3.38

[/TD]

[TD]10.57

[/TD]

[/TR]

[TR]

[TD]50-59

[/TD]

[TD]21-29

[/TD]

[TD]-6.032^*

[/TD]

[TD]1.944

[/TD]

[TD].015

[/TD]

[TD]-11.15

[/TD]

[TD]-.91

[/TD]

[/TR]

[TR]

[TD]30-39

[/TD]

[TD]-7.290^*

[/TD]

[TD]1.824

[/TD]

[TD].001

[/TD]

[TD]-12.10

[/TD]

[TD]-2.48

[/TD]

[/TR]

[TR]

[TD]40-49

[/TD]

[TD]-3.597

[/TD]

[TD]2.646

[/TD]

[TD].529

[/TD]

[TD]-10.57

[/TD]

[TD]3.38

[/TD]

[/TR]

[TR]

[TD=colspan: 7]*. The mean difference is significant at the 0.05 level.

[/TD]

[/TR]

[/TABLE]

Hypothesis. Data analysis was focused on attitudes towards end of life care scores. Attitudes towards end of life care scores ranged from 82 to 108, with a mean of 94.07 (SD=6.595), as shown in Figure. According to Matsui & Braun (2010), possible scores range from 30 to 150, with higher scores indicating more positive attitudes. Overall, participants have moderate attitudes towards caring for patients who are near the end of their life.

Figure 1:

EOLIndex

With the mean score of 94.07 on the survey, the results show participants having moderate attitudes towards end of life care. This result did answer my research question of What are the attitudes towards end of life care among registered nurses? The answer is that registered nurses have moderated attitudes towards caring for terminally ill patients.

Chapter V: Discussion

Interpretation of Results

A majority of registered nurses, do not have a positive attitude towards caring for patients at the end of their life. The mean attitude score obtained from the sample was 94.07, below the score of 150 set by Frommelt (2003) as positive attitudes towards death and dying. Eight four percent of participants had bachelor's degrees or higher (n=63) and 34.7 % of participants had attended an end of life educational program (n=26). Nursing experience widely varied ranging from 1 to 11 years or above. A total of 52 participants has between 1 and 10 years' experience (69.3%), with 23 participants with greater than 11 years' experience (30.7%). The hypothesis was rejected as a statistically significant relationship was not found between positive attitudes towards death and dying and the care given to terminally ill patients (F=1.107, p=.336). Positive attitudes towards end of life will result in positive care provided to terminally ill patients. Overall, the results of this study showed that generally nurses' do not have positive attitudes towards death and dying. In addition, the relationship found between a positive attitude with end of life care and those attending an end of life educational program was not statistically significant.

Further analysis investigated the relationship between the attitudes of nurses towards end of life by comparing areas of care, whether participants attended an end of life program and age. A statistically significant relationship between survey score and age (p=.001) was found, but survey score and attending an end of life program (p=.310) was not statistically significant. A small number of participants attended an end of life educational program (n=49).

It was found that registered nurses in the age bracket of 30-39 (n=28) have more positive attitudes towards end of life care as opposed to older registered nurses. The mean score of the survey was 94.07, below the set score of 150 indicating more positive attitudes. This is relevant to report as it demonstrated the need for all registered nurses to have more positive attitudes towards death and dying to make the terminally ill patients experience better.

Relationship to Prior Literature

Findings in this study are not comparable to the results presented by Matsui & Braun (2010) in which the same instrument was used. The average years of nursing experience was 9.5 years among the study's 388 participants (Matsui & Braun, 2010). 70% of the participants were experienced with caring for dying patients and one third of the participants attended training or seminar on end of life care in this study. Matsui & Braun (2010) found that nurses who have attended an end of life seminar were more likely to have better attitudes towards caring for dying patients as measured by the FATCOD. This study found that participants who have never attended an end of life seminar have better attitudes towards caring for dying patients as measured by the FATCOD. I believe this is so because of the methodology and convenience sampling that caused these results.

Chapter VI: Conclusion and Implications

Summary of Analysis and Discussion

Attitudes towards caring for the dying were found to be negative among registered nurses in the convenience sample. No relationship was found between level of attitudes and area of care among registered nurses. A relationship was found between a more positive attitude for caring for terminally ill patients and attending an end of life seminar and age. Although this study found a more positive attitude in participants who did not attended an end of life seminar, the total score was still below the highest score possible, which still indicates a less than positive attitude towards end of life care.

There were no similar findings between this study and previous studies. A lack of sufficient education among registered nurses was prevalent as well as negative attitudes towards end of life care. Registered nurses need a more positive attitudes towards caring for terminally ill patients to make the end of patients' life more fulfilling.

Limitations to this study are as follows: time constraint, small sample size, uneven distribution between areas of care and no evidence of participants who stated attendance to an end of life seminar. For future studies regarding this area, there should be a pre and post FATCOD where an end of life seminar is given in between to see if end of life education can affect a more positive attitude.

Implications for Practice and Future Research

There is a need for registered nurses in every area of care to be educated in end of life care, in order to obtain positive attitudes towards caring for terminally ill patients. Practice implications should include policies and procedures related to implementing practice changes for caring for end of life patients.

References

Albers, G., Francke, A., de Veer, A., Bilsen, J., & Onwuteaka-Philipsen, B. (2013). Attitudes

of nursing staff towards involvement in medical end-of-life decisions: A national survey

study. Patient Education and Counceling. 94(2014). 4-9. http://dx/doi.org/10.1016/j.

pec.2013.09.018

American Nurses Association. (2018). What is a Registered Nurse?. Retrieved from

What is Nursing & What do nurses do? | ANA Enterprise

Boyd, D., Merkh, K., Rutledge, D., & Randall, V. (2011). Nurses' perceptions and experiences

with end-of-life communication and care. Oncology Nursing Forum. 38(3). 229-239.

doi: 10.1188/11.ONF.E229-E239

Frommelt, K. (2003). Attitudes toward care of the terminally ill: An educational intervention.

American Journal of Hospice and Palliative Medicine. 20(1).

SAGE Journals: Your gateway to world-class journal research

Latour, J., Fulbrook, P. & Albarran, J. (2009). EfCCNa survey: European intensive care nurses'

Attitudes and beliefs towards end-of-life care. British Association of Critical Care

Nurses, Nursing in Critical Care. 14(3). 110-121.

Leombruni, P., Miniotti, M., Bovero, A., Zizzi, F., Castelli, L. & Torta, R. (2014). Attitdues

toward caring for duing patients: An overview among Italian nursing students and preliminary psychometrics of the FATCOD-B scale. Journal of Nursing Education and Practice. 4(3). 188-196

Matsui, M. & Braun, K. (2010). Nurses' and care workers' attitudes toward death and caring for

dying older adults in Japan. International Journal of Palliative Nursing. 16(12). 593-598.

Petiprin, A. (2016). Kolcaba's Theory of Comfort. Nursing Theory. Retrieved from

Kolcaba's Theory of Comfort - Nursing Theory

Yin, O., Xia, Z., Yi, X., & Chia, D. (2007). Nurses' perceptions towards caring for dying patients

in oncology ward and general surgical ward. Singapore Nursing Journal. 34(3). 16-20

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