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Attitudes towards the dying and death anxiety in acute care nurses – can a workshop make any difference? A mixed-methods evaluation

Published online by Cambridge University Press:  06 August 2019

Chin Yee Cheong Open the ORCID record for Chin Yee Cheong [Opens in a new window] ,
Ngoc Huong Lien Ha ,
Laurence Lean Chin Tan  and
James A. Low
Chin Yee Cheong*
Affiliation:
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore 90 Yishun Central, S768828 Geriatric Education and Research Institute, Singapore 2 Yishun Central 2, S768024
Ngoc Huong Lien Ha
Affiliation:
Geriatric Education and Research Institute, Singapore 2 Yishun Central 2, S768024
Laurence Lean Chin Tan
Affiliation:
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore 90 Yishun Central, S768828 Geriatric Education and Research Institute, Singapore 2 Yishun Central 2, S768024
James A. Low
Affiliation:
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore 90 Yishun Central, S768828 Geriatric Education and Research Institute, Singapore 2 Yishun Central 2, S768024
*
Corresponding Author: Dr. Chin Yee Cheong Department of Geriatric Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore. Email: [email protected]
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Abstract

Objectives

In Singapore, the core curriculum for end-of-life (EOL) care used in nurse training courses is limited. Only 45% of nurses indicated familiarity with inpatient palliative care. Nurses who lack skills in palliative care may develop anxiety and negative attitudes towards caring for dying patients. We explored whether a two-day, multimodal EOL care workshop could reduce nurses’ death anxiety and improve nurses’ skills, knowledge, and attitude towards palliative care.

Methods

Forty-five nurses participated in the workshop. At baseline before and at six weeks after, a 20-item knowledge-based questionnaire and the Death Attitude Profile-Revised (DAP-R) were administered. Six weeks post-workshop, in-depth interviews were conducted. We employed descriptive statistics, student paired samples t-test and inductive thematic analysis.

Results

There was a significant improvement in nurses’ knowledge score (p < 0.01) and reduction in their death anxiety score (p < 0.01). Fear of Death (p = 0.025) and Death Avoidance (p = 0.047) sub-scores decreased significantly. However, the remaining domains such as Neutral Acceptance, Approach Acceptance, and Escape Acceptance did not show any significant difference, although Escape Acceptance showed a trend towards a reduced score (p = 0.063). After the workshop, more nurses adopted the Neutral Acceptance stance (76.2%), and none of them fell into the Fear of Death subdomain. Most nurses interviewed reported a positive change in their knowledge, attitudes, and practice even after the workshop.

Significance of results

The multimodal palliative care workshop was useful in improving nurses’ EOL knowledge and reducing their anxiety towards death. The positive change in nurses’ attitudes and practices were noted to be sustained for at least six weeks after the intervention.

Keywords

death anxietyacute care nursesend-of-lifeworkshop
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 2 , April 2020 , pp. 164 - 169
Copyright
Copyright © Cambridge University Press 2019

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