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