ARE BACKGROUND AND PALLIATIVE EDUCATION AND TRAINING VARIABLES ASSOCIATED WITH NURSES’ ATTITUDES TOWARD DEATH?

Julie Dudash RN-BC, MS, CNML, NE-BC

University of South Florida Ph.D. Candidate

Why this topic?• Past experience teaching• Nurses and their reaction• Reluctance to share• Lack of educational materials• Lack of exposure

Importance in our Society• Over 65 will double in number from 2000 to 2030• (Admin. On Aging)• Oldest of the old group growing

Importance in our Culture• Importance of youth• Changes in exposure to death• Ways people die• Where people die• Technology can save us all

Palliative Care versus Hospice Care

Lack of training• 2009 study 50% of 2300 nurses polled• 50 textbooks only 2% content

Nurse as Advocate• Only get one chance to get this right• Wishes and plans are supported

Primary Purpose• Describe nurses’ attitudes toward death and the extent of

education and training in palliative care• Complementary goal: determine whether nurses’ attitudes

are associated with background and extent of palliative education and training

Research Questions• 1. What is the nurses’ profile of attitudes toward death

(anxiety, escape, neutrality)?• 2. What is the extent of nurses’ education and training on

palliative care?• 3. What background (age, gender, years of experience,

nursing area, ethnicity, state of residency) and educational and training variables have impacts on nurses’ attitudes toward death (anxiety, escape, neutrality)?

• 4. What is the best set of background and educatin and training variables explaining attitudes toward death (anxiety, escape, neutrality)?

Attitudes• “The way a person views something or tends to behave

towards it” (Dictionary.com, 2014).• 1970’s: Kubler-Ross:

Denial, Anger, Bargaining, Depression and Acceptance

What about the emotional toll?

Emotional Labor• Being present• False bravado• Stress, psychological and physiological harm

Limitations• Online survey• May be comfortable with subject• Others may not respond

Literature Review

Aging population

Growth of those over 85: 5.8 million (2010) to 19 million by 2050

(Russakoff, 2010)

Chronic diseases

Public Attitude• Age• Ethnicity• Life experience with death• Terror Management Theory

Nursing Workforce & Attitudes• Age of Registered Nurses• Shortage of nurses• Percentage in end-of-life areas• Higher death anxiety• Understanding end-of-life care• Self awareness• Demanding and emotional task

Current Practices/Nurses’ Experiences

• ICU: weak communication• Lack of knowledge• More experience = more positive attitude• Fear of patriarchal system• Exposure to death

Conceptual Framework• Emotional Labor Hochschild 1983• Stewardesses: smile and be friendly• Fear, disgust, boredom• Issues of well being• Good and bad patients• Emotional jugglers

Methods• Research Questions

Research Design• Non-experimental• Survey strategies

Target Population• Registered Nurses• United States• Survey via Email

Variables & Instrumentation

Variables= attitudes toward death, extent of palliative education and training, background characteristics

Attitudes toward death• DAP-R: Death Attitude Profile-Revised survey by• Wong, Reker & Gesser 1994.• 32 questions 5 subsets• Good/Very good reliability• Fear of death & death avoidance = anxiety toward death• Approach & Escape Acceptance = Escape Acceptance• Neutral Acceptance• Likert Scale• Higher score = higher identified with that category

Extent of education & training• Complementary survey• 12 items Palliative Care Education Needs Assessment

Survey• Nurses’ education/training background • Level of confidence in performing tasks

Background Variables• 6 related items• Age, gender, ethnicity, years of nursing practice, area of

nursing work, formal educational level, state of residence

Open-ended questions• How would you describe your attitudes toward death?• How prepared do you feel you are in meeting patients’

end-of-life needs?

Focus Group After Survey is Complete

• Verify and gather further insight on attitudes toward death and views on palliative preparation.

• Getting reactions to results

Data collection• Email Survey• Goal = 100-200 responses• 4 sections of the Survey

Analysis• Questions 1 & 2:• Descriptive statistics (mean, standard deviation)• Open ended questions Survey Monkey’s Text Analysis

• Questions 3 & 4:• Dependent variables• Independent variables• Simultaneous regression: recommended when there is no prior

evidence of causal priority• Multiple regression SPSS software• Question 3: Beta weights• Question 4: R-square results

• Focus group data

Limitations/Ethics• Registered Nurse• English only• Anonymous

• Anonymous: no names• Confidentiality• IRB process