The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students

doi:10.1016/S8755-7223(03)00094-2

Journal of Professional Nursing

Volume 19, Issue 5, September–October 2003, Pages 305-312

https://doi.org/10.1016/S8755-7223(03)00094-2 Get rights and content

Abstract

Nurse educators have identified that historically nurses have not been prepared to care for dying patients. Research also has identified that nursing students have anxieties about death, dying, and caring for dying patients. Several factors have been identified as affecting nurses’ and nursing students’ attitudes toward care of the dying. Factors addressed in this research were current and previous death education. This research incorporated experiential learning using a model of death education and transformative learning theory. The educational experiences were geared to help students understand the skills needed to care competently and compassionately for the dying. The use of the End of Life Nursing Education Consortium (ELNEC) education package along with experiences at the hospice, the funeral home, the anatomy laboratory, and role play helped facilitate transformative learning in the nursing students. The study examined the effects of an educational experience to determine if a one-time educational experience provides sufficient, lasting effects in a 6-week format. Results of this study indicate that education can have a positive effect on nursing students’ attitudes toward care of the dying. Nursing students in the intervention group had a significant positive increase in their attitudes toward care of the dying after the intervention. The attitude change increased slightly after a 4-week period.

Section snippets

The problem

Advances in technology over the past century have changed health care consumers’ attitudes and expectations about death (Callahan, 1993). Patients expect quality health care at the end of life. The media and the Internet provide a wealth of information. Patients are demanding palliative care when comfort and quality of life are the goals. Patients are making choices about when to stop intervention and how they will die.

Research shows that many nurses and nursing students have difficulty dealing

Purpose of study

The purpose of this research was to assess the impact of a palliative care educational component on the attitudes toward care of the dying in undergraduate nursing students from 2 different schools of nursing and the relationship of previous education on attitudes toward care of the dying.

Theoretical framework

The theoretical framework for this study is based on Quint’s (1967) theory developed from a symbolic interaction perspective and transformative learning theory. Through an educational process incorporating transformative learning, attitudes toward care of the dying can be changed from negative to positive. Figure 1 shows the use of transformative learning theory to change nursing students’ attitudes toward care of the dying. Quint’s theoretical model suggested that nursing students exposed to

Research question

The following research questions have come from the review of literature and theoretical framework: (1) Will there be a significant difference in attitudes toward care of the dying in nursing students who participated in didactic and experiential education and those who did not? (2) Will there be a change in attitudes toward care of the dying in nursing students who participate in a palliative care education component? (3) Is there a relationship between nursing students’ attitudes toward care

Research design

A quasiexperimental, longitudinal design was used with a pretest, intervention, and double posttest format. There was one intervention group and one control group. These groups were chosen from two different schools of nursing to provide an opportunity for sound research differentiation. Each group was asked to complete the Frommelt Attitude Toward Care of the Dying (FATCOD) scale and a demographics questionnaire. The intervention group then participated in an ELNEC education component

Sample

The population included junior undergraduate nursing students at two state universities in the Appalachian Mountains. Students were pretested during the first week of their nursing education experience. Before administering the instrument the researcher obtained written permission from the participating schools and informed consent from each participant. Written institutional review board approval was obtained from each school. The researcher personally administered the instruments to the two

Validity

To assess the validity of the FATCOD, a content validity index was computed at the time of the original study. Expert content judges were chosen who were identified as experts in the field. Requirements for judges were that they currently be licensed in nursing, active in practice, have a minimum of a bachelor’s of science in nursing degree and at least 4 years in the experience of hospice nursing. Two judges were given instructions and based on their findings an index of content validity was

Reliability

In the original FATCOD a test-retest procedure was used to assess reliability. Reliability was tested at three different times. The first two times that the reliability was measured were related to the previous research, which was conducted in 1988. The first time the sample was composed of 18 nurses from an oncology unit who were tested with the instrument and then again were retested using the same instrument 3 weeks later. The first test had a Pearson product-moment correlation coefficient

Results

A total of 104 participants were in the pretest group, and 95 were in the posttest group (Table 1). A significant (P < .05) difference was found between measures of attitude toward care of the dying on the FATCOD in the intervention group. The intervention pretest scores on the FATCOD ranged from 105 to 139, and the posttest scores ranged from 85 to 146. Using a paired t-test the investigator rejected the null hypothesis. For the paired sample t-test, the P value was .000. the intervention’s

Discussion

Death and dying are normal and natural parts of life and an integral component of the nursing profession. This study explored if an educational component on palliative care might affect attitudes toward care of the dying and if attitude changes remained over time. The study compared the intervention group with a control group.

Quint’s (1967) theoretical model suggested that nursing students exposed to dying patients but lacking education in how to care for the dying experienced death anxiety and

Confounding factors and limitations

It is important to note two events that occurred that could have had an effect on nursing students’ attitudes toward care of the dying that were outside the control of the researcher. The first event that occurred was the terrorist attacks on September 11, 2001. Students at both the intervention school and the control school were devastated, bewildered, frightened, shocked, and spent much time grieving over these events. Both universities took great efforts to meet students’ needs to grieve,

Implications

Research has shown that many nurses and nursing students have difficulty dealing with death (Payne et al 1998, Servaty et al 1996, Waltman and Zimmerman 1992; Thompson, 1985; Brockopp et al., 1991). Attitudes can be created and changed through education and experience. This study explored how experiences and education relating to death and dying affected nursing students’ attitudes toward care of the dying. Recent trends in nursing education in the United States have nursing schools exploring

Recommendations

Based on the findings of this study and previous research, it is recommended that end-of-life education for nursing students have a combination of both clinical experiences and didactic education in care for the dying.

A palliative care elective course should be considered to allow the content to be expanded to a full-semester course. By expanding the didactic experience, students would be able to assimilate more of the content and implement what has been learned in the clinical setting before a

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Se analizaron variables sociodemográficas, formación en CP, necesidades de formación mediante cuestionario online de Google Forms e Instrumento INCUE. Se realizaron análisis descriptivos y se compararon los resultados mediante test de simetría exacto y test de Mann-Whitney.
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La formación enfermera en CP en atención primaria continúa siendo deficitaria sobre todo en su aplicación práctica, siendo necesaria formación dirigida para que repercuta en el cuidado de las personas con necesidades paliativas y sus familias.
Asses training, perception of readiness and training needs in palliative care (PC) theoretical and practical of primary care nurses in Spain, through descriptive cross-sectional study.
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Primary care nurses in Spain with online access.
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82,6% women, with an average age of 45.5 years. 86.1% of the nurses had training in PC, been basic in the 45.4%. Only 40.5% feel quite or very prepared to take care for palliative patients. Nurses demanded more training in psycho-emotional and grief and coping with losses. 83.76% passed the theoretical block compared to 43.36% of the practical, detecting higher training needs in the last (P < .001). The passed rates varied depending on the educational level.
Nursing training in PC in primary care continues to be deficient, especially in practical application. Targeted training is necessary to have an impact on the care of people with palliative needs and their families.
Effectiveness of end-of-life educational interventions at improving nurses and nursing students' attitude toward death and care of dying patients: A systematic review and meta-analysis
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Citation Excerpt :
It reported a statistically non-significant small effect favoring the intervention group at 5–6 months follow-up (Henoch et al., 2013). Mallory (2003) conducted follow-up assessment of attitude toward care of dying patients for the intervention group only. Nursing students from the intervention group reported a statistically non-significant higher mean score compared to their immediate post-intervention score at 1 month follow-up (Mallory, 2003).
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A meta-analysis was conducted using the random-effect model. Standardized mean differences with 95% confidence intervals were used as the effect measure under the inverse-variance method. Heterogeneity was assessed using the I² statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool conducted quality appraisal at the study level while the Grades of Recommendation, Assessment, Development, and Evaluation approach conducted quality appraisal at the outcome level.
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A total of 13/18 (72%) educational institutions completed the survey. All integrate palliative and end of life care in their teaching with an identified coordinator at 12 (92%) institutions. Between 1 and 10 h of formal teaching is provided at 11 (85%) institutions where lectures and tutorials are most comon. Clinical placements with specialist palliative care providers are scarce and limited to senior students as elective placements. Assessment of student learning in palliative and end of life care is carried out at seven (54%) institutions, and formally evaluated at 12 (92%). Lack of teaching time and clinical placements with palliative care providers are barriers to increased learning opportunities in palliative and end of life care.
This article provides comprehensive information about palliative and end of life care teaching in undergraduate nurse education in New Zealand. Teaching on this subject is not a mandatory requirement so there are inconsistencies in the teaching provided between educational institutions, and significant barriers to development. Mandatory competencies need to be introduced to ensure graduates have the knowledge, skills and attitudes required to provide optimal care for people near the end of life.
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Original articleThe impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students

Abstract

Section snippets

The problem

Purpose of study

Theoretical framework

Research question

Research design

Sample

Validity

Reliability

Results

Discussion

Confounding factors and limitations

Implications

Recommendations

The contribution of death-related experiences to health care providers’ attitudes toward dying patientsI. Graduate and undergraduate nursing students

OMEGA

The dying patientA comparative study of nurse caregiver characteristics

Death Studies

The troubled dream of life

Understanding and promoting transformative learningA guide for educators of adults

The effect of an undergraduate nursing course in palliative care on death anxiety and attitudes to care of the dying in nursing students

Dissertion Abstract International

Critical nursing behaviors in care for the dying

Cancer Nursing

The impact of death education

Death Studies

Dignity in dying

Nursing Management

Analysis of end-of-life content in nursing textbooks

Oncology Nursing Forum

The effects of death education on nurses’ attitudes toward caring for terminally ill persons and their families

The American Journal of Hospice and Palliative Care

Educational researchAn introduction

End-of-life careEvolution of the nurse’s role

Oncology Nursing Forum

Basic principles of nursing care

Original article
The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students