[논문]Effects of Awareness of Good Death and End-of-Life Care Attitudes on End-of-Life Care Performance in Long-Term Care Hospital Nurses

Kim, Sun-Hee; Kim, Eun-Young

doi:10.14475/jhpc.2021.24.1.26

Effects of Awareness of Good Death and End-of-Life Care Attitudes on End-of-Life Care Performance in Long-Term Care Hospital Nurses 원문보기

Journal of hospice and palliative care, v.24 no.1, 2021년, pp.26 - 35

Kim, Sun-Hee (College of Nursing, Dong-A University) , Kim, Eun-Young (College of Nursing, Dong-A University)

Abstract ▼ AI-Helper

Purpose: The purpose of this study was to determine the effects of awareness of good death and end-of-life care attitudes on end-of-life care performance in long-term care hospital nurses. Methods: This study used a cross-sectional study design. The participants were 147 nurses working at six long-term care hospitals with more than 200 beds in B city, South Korea. Data were collected using self-reported questionnaires, and analyzed with descriptive statistics, the t-test, analysis of variance, Pearson correlation coefficients, and multiple stepwise regression analysis using IBM/SPSS 26.0 for Windows. Results: The participants' awareness of good death, end-of-life care attitudes, and end-of-life care performance were positively correlated. The factors affecting end-of-life care performance were age, education level, awareness of good death, and end-of-life care attitudes; these variables explained 19.0% of end-of-life care performance. Conclusion: In order to improve long term care hospital nurses' end-of-life care performance, continuing education and training should be provided regarding awareness of good death and end-of-life care attitudes.

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문제 정의

The aim of this study was to determine the effects of awareness of good death and attitudes toward end-of-life care on end-of-life care performance. The specific aims were as follows:
To our best knowledge, no previous studies have investigated the relationships among these three variables in nurses in long-term care hospitals who frequently interact with elderly terminal patients at the end of their lives. Therefore, this study aimed to investigate the correlations of awareness of good death and end-of-life care attitudes with performance among nurses in long-term care hospitals and to gain an understanding of the factors that influence end-of-life care performance to provide formative materials necessary to develop an end-of-life care education program applicable to long-term care hospitals.
This study explored awareness of good death, attitudes toward end-of-life care, and performance of end-of-life care among nurses in long-term care hospitals and aimed to identify factors that influenced end-of-life care performance. In this study, the average score of awareness of good death among nurses in long-term care hospitals was 3.

제안 방법

1) The general characteristics of participants were analyzed using descriptive statistics including frequency, percentage, mean, and standard deviation.
The independent variables that were statistically significantly associated with end-of-life care performance in the univariate analysis, which were age, marital status, education level, work position, clinical experience, awareness of good death, and attitudes toward end-of-life care, were included in multiple regression analysis. Categorical variables, such as age, marital status, education level, work position, and clinical experience, were coded as dummy variables for analysis.
In order to identify factors that influenced end-of-life care performance among nurses in long-term care hospitals, multiple stepwise regression analysis was conducted. Tolerance and the variance inflation factor (VIF) were calculated by testing multicollinearity among independent variables.
Data collection took place from August 10 to 22, 2017. The researcher visited the selected hospitals to distribute the surveys and an informed consent form, which contained information on the content of the study, the purpose of the study, data privacy, and confidentiality. The informed consent form stated that the survey was to be completed voluntarily and that participants could discontinue their participation at any time.
This descriptive study was conducted to understand the level of awareness of good death, attitudes towards end-of-life care, and performance of end-of-life care among nurses employed at long-term care hospitals and to identify factors that influenced end-of-life care performance.

대상 데이터

Taking into account a possible dropout rate of 20%, 160 surveys were distributed, and 155 were returned. After excluding eight questionnaires with missing or inappropriate answers, 147 responses were used for the final data analysis.
The nursing department of the selected long-term care hospitals was called, the purpose and methods of the study were explained, and approval was sought. Data collection took place from August 10 to 22, 2017. The researcher visited the selected hospitals to distribute the surveys and an informed consent form, which contained information on the content of the study, the purpose of the study, data privacy, and confidentiality.
[11] for medical professionals that was translated by Jeong [17]. This scale is composed of 17 items, with subfactors of sense of closure (9 items), personal control (3 items), and clinical signs (5 items). To use the tool, the developer was contacted through email and gave approval after the use of the tool in this study was explained and a contract fee was paid.
for nurses. This scale is composed of 22 items with eight items in the physical subscale, eight items in the psychological subscale, and six items in the spiritual subscale. Each item was measured using a 4-point Likert scale from “not at all” (1 point) to “always” (4 points), and higher scores indicated greater end-of-life care performance.
by Cho and Kim [18]. This scale is composed of a total of 30 items with 20 items on attitudes toward terminal patients and 10 items on attitudes toward patients’ family members. Each item is measured on a 4-point scale from “not at all” (1 point) to “very much” (4 points), and negatively worded items are reverse-scored.

데이터처리

2) Differences in awareness of good death, attitudes toward end-of-life care, and performance of end-of-life care according to participants’ general characteristics were analyzed using the t-test and analysis of variance, as well as the Scheffé test for post-hoc testing.
4) Correlations among awareness of good death, attitudes toward end-of-life care, and performance of end-of-life care were analyzed using Pearson correlation coefficients.
Tests of residual assumptions demonstrated that linearity, normality of error terms, and the assumption of equal variance were also satisfied. The independent variables that were statistically significantly associated with end-of-life care performance in the univariate analysis, which were age, marital status, education level, work position, clinical experience, awareness of good death, and attitudes toward end-of-life care, were included in multiple regression analysis. Categorical variables, such as age, marital status, education level, work position, and clinical experience, were coded as dummy variables for analysis.

이론/모형

Attitudes toward end-of-life care were measured using the Frommelt Attitudes toward Nursing Care of the Dying scale developed by Frommelt [14] for nurses, which was later translated by Cho and Kim [18]. This scale is composed of a total of 30 items with 20 items on attitudes toward terminal patients and 10 items on attitudes toward patients’ family members.

성능/효과

3) Levels of awareness of good death, attitudes toward end-of-life care, and performance of end-of-life care were analyzed using mean and standard deviation.
60, showing no autocorrelation. Tests of residual assumptions demonstrated that linearity, normality of error terms, and the assumption of equal variance were also satisfied. The independent variables that were statistically significantly associated with end-of-life care performance in the univariate analysis, which were age, marital status, education level, work position, clinical experience, awareness of good death, and attitudes toward end-of-life care, were included in multiple regression analysis.
[11]. The results indicate that the nurses in long-term care hospitals placed the greatest importance on the psychosocial and spiritual aspects of helping patients and their family members experience a comfortable death by empathizing with them. Furthermore, there were meaningful differences in awareness of good death by age, religion, marital status, work position, clinical experience, and end-of-life care experience.

참고문헌 (28)

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