The use of multidimensional scales for assessing fear of death among nursing students can assist in teaching and evaluating the effectiveness of targeted training in thanatology. Research has demonstrated good psychometric characteristics of the Czech version of the Collett–Lester Fear of Death Scale (CL-FODS). It was applied to nursing students (N = 256), who reported as their biggest fear the process of their own dying. Greater fear of death and dying was found in students who had no experience of the dying and death of a loved one. Good internal consistency was achieved for the four subscales of the Czech CL-FODS.
Background: Little is known about how certain educational interventions may improve informed code status discussions by physician assistant (PA) and nurse practitioner students.
Methods: This is a prospective, prospective, single academic center pilot study utilizing a short case-based PowerPoint that reviewed the differences between code status choices and the likelihood of survival to hospital discharge of attempted resuscitation after a cardiac arrest. Training occurred between September 1, 2017, and May 31, 2018. The study population included PA and adult gerontology acute care nurse practitioner (AGACNP) students during their inpatient internal medicine rotation (n = 9) and preclinical PA students (n = 5).
Results: After training, there was a significant increase in knowledge in the likelihood of survival to hospital discharge (P = .01) and comfort level in having an informed code status discussion (3.36 ± 0.81 vs 4.10 ± 0.80, P = .02). For questions related to identification of the correct code status, there were no significant differences before and after the intervention.
Conclusion: A short case-based PowerPoint viewed by PA and AGACNP students increased the knowledge about the likelihood of survival to hospital discharge of attempted resuscitation after a cardiac arrest and increased the comfort level of having code status discussions with patients by PA and AGACNP students.
BACKGROUND AND PURPOSE: This study aimed to examine the psychometric properties of the Revised Death Attitude Profile (DAP-R) in a sample of Greek nurses and nursing students.
METHODS: A convenience sample (n = 934) was used from six National Health System hospitals, and two University Schools of Nursing in central and northern Greece completed the Greek version of the DAP-R (Gr-DAP-R).
RESULTS: Principal component analysis with varimax rotation revealed a six-factor solution, including approach acceptance, death avoidance, escape acceptance, neutral acceptance, fear of death, and after death concerns. The internal consistency for each of the subscales ranged from 0.64 to 0.88. Intercorrelations between the Gr-DAP-R subscales supported the relative independence of death attitudes dimensions.
CONCLUSIONS: The Gr-DAP-R can be used as a research and clinical tool in assessing death attitudes among Greek nurses.
Background: Recognising dying is a key clinical skill for doctors, yet there is little training.
Aim: To assess the effectiveness of an online training resource designed to enhance medical students’ ability to recognise dying.
Design: online multicentre double-blind randomised controlled trial (NCT03360812). The training resource for the intervention group was developed from a group of expert palliative care doctors’ weightings of various signs/symptoms to recognise dying. The control group received no training.
Setting/participants: Participants were senior UK medical students. They reviewed 92 patient summaries and provided a probability of death within 72 hours (0% certain survival – 100% certain death) pre, post, and 2 weeks after the training. Primary outcome: (1) Mean Absolute Difference (MAD) score between participants’ and the experts’ scores, immediately post intervention. Secondary outcomes: (2) weight attributed to each factor, (3) learning effect and (4) level of expertise (Cochran–Weiss–Shanteau (CWS)).
Results: Out of 168 participants, 135 completed the trial (80%); 66 received the intervention (49%). After using the training resource, the intervention group had better agreement with the experts in their survival estimates (dMAD = -3.43, 95% CI -0.11 to -0.34, p = <0.001) and weighting of clinical factors. There was no learning effect of the MAD scores at the 2-week time point (dMAD = 1.50, 95% CI -0.87 to 3.86, p = 0.21). At the 2-week time point, the intervention group was statistically more expert in their decision-making versus controls (intervention CWS = 146.04 (SD 140.21), control CWS = 110.75 (SD 104.05); p = 0.01).
Conclusion: The online training resource proved effective in altering the decision-making of medical students to agree more with expert decision-making.
Background: Advance directives have been established as a legal document that ensures patients' wishes are followed if/when they cannot make medical decisions for themselves. The concept, advance directive, is rooted in the ethical principle of patient's autonomy. New York State recognizes three types of advance directives: New York State Health Care Proxy, Living Wills, and Do Not Resuscitate (DNR) order. A common misnomer in healthcare is the idea that advance directives are for the elderly or patients with terminal illness. As per New York State statutes, everyone older than 18-years-old should have an advance directive to avoid conflicts in times of crisis. It has been shown that most patients believe it is their physician's responsibility to initiate an advance directive discussion and residents are at the forefront of most health facilities.
Objective: To assess the knowledge and attitude of internal medicine residents towards advance directive and to improve residents' skills and confidence on advance directive discussion.
Design: We carried out a prospective study to assess the knowledge and attitude of the internal medicine residents towards advance directive to validate the need to implement didactic sessions and simulations. Results: Fifty out of the 75 internal medicine residents of Harlem Hospital Center participated in the study. Most of the responders indicated that they lacked sufficient knowledge in advance directive discussion and indicated that they were interested in didactic sessions and simulations related to how to help patients with advance directives.
Conclusion: Our study showed that most of the residents lacked sufficient knowledge in advance directives discussions and the importance of its incorporation into residency training education.
BACKGROUND: Undergraduate nursing students encounter patients at the end of life during their clinical training. They need to confront dying and death under supportive circumstances in order to be prepared for similar situations in their future career.
AIM: To explore undergraduate nursing students' descriptions of caring situations with patients at the end of life during supervised clinical training.
METHODS: A qualitative study using the critical incident technique was chosen. A total of 85 students wrote a short text about their experiences of caring for patients at the end of life during their clinical training. These critical incident reports were then analysed using deductive and inductive content analysis.
FINDINGS: The theme 'students' transformational learning towards becoming a professional nurse during clinical training' summarises how students relate to patients and relatives, interpret the transition from life to death, feel when caring for a dead body and learn end-of-life caring actions from their supervisors.
IMPLICATIONS: As a preparation for their future profession, students undergoing clinical training need to confront death and dying while supported by trained supervisors and must learn how to communicate about end-of-life issues and cope with emotional stress and grief.
BACKGROUND: Recommendations of the European Association for Palliative Care have been proposed to strengthen the provision of palliative care and it is clear that people with dementia can benefit from palliative care, but no research so far addresses the beliefs of university students and professionals in the social, medical and other science fields in South East Europe regarding the need from palliative care. The objective of this study is to explore when students and professionals consider a person with dementia in need of palliative care and to compare their opinions in three South East European countries.
SUBJECTS AND METHODS: An anonymized questionnaire was used based on van Riet Paap et al. (2015) case-vignette. A sample of 1287 participants (student nurses, professional nurses, psychology students, professional psychologists, student doctors, professional doctors, and students and professionals from other non-relevant to medical and social care sciences) was examined in Greece, Bulgaria and Romania.
RESULTS: The open responses to the "when" question revealed the categories: after her diagnosis/after the first symptoms; when she and her family cannot cope; at the advance of symptoms; all the time; when she behaves aggressively; I am not sure/there is no specific point. Unexpectedly, age, professional status and field of studies were not found to be significant predictors, but only the country of origin was found to contribute to the differences in the participants' answers regarding the start of palliative care.
CONCLUSION: Although professional-student status and relevancy of subject did not predict opinions, the country of origin predicted controversies for the proposed time point of considering a person with dementia in need of palliative care.
This paper presents a study that examines the potential value of a new and innovative inter-professional education (IPE) experience for final year midwifery and children's nursing students focused on improving awareness of end-of-life care for infants in conjunction with the support of their families. The study uses an action research approach to examine midwifery and children's nursing student experiences of an IPE initiative in developing knowledge regarding perinatal/neonatal palliative care.
The setting is a Higher Education Institute in the South of England that included final year midwifery students (n = 39) and children's nursing students (n = 34) taking part in the study. Qualitative and quantitative data indicated that the IPE intervention had proven worth in developing knowledge and confidence in the students as both student groupings felt they lacked knowledge and confidence about perinatal/neonatal palliative care before attending the study day.
Students felt that learning with, from and about the other profession represented was important in generating their knowledge. Educators should explore innovative ways to enable the further development of the fledgling speciality of perinatal/neonatal palliative care through education on an interprofessional platform.
End-of-life care is an important nursing competency and must be incorporated into the baccalaureate nursing curriculum. The purpose of this research was to examine the outcomes of an actual hospice compared with a simulated hospice clinical experience. This pretest and posttest nonequivalent 2-group design consisted of a sample of 65 undergraduate nursing students enrolled in a community health course. All students enrolled in the community health course have 1 day for hospice experience and a 2-hour orientation from the nurse educator at a local hospice agency. Students enrolled in the first 7 weeks were paired with a hospice nurse and conducted home visits. Students enrolled in the second 7-week session participated in 2 simulated hospice clinical experiences on campus. Thirty-two students were in the simulated hospice group and 33 were in the home hospice group. Attitudes toward end-of-life care were measured before and after the intervention with the Frommelt Attitudes Toward Care of the Dying. The findings indicated positive attitude changes toward end-of-life care. After the hospice clinical experience, both groups seemed to show increases in their mean Frommelt Attitudes Toward Care of the Dying scores, possibly indicating a greater comfort with caring for dying patients.
Background: Many nursing students are not prepared to encounter death and care for patients who are at the end of life as newly educated nurses. The Frommelt Attitude Toward Care of Dying Scale (FATCOD) has been used to assess nursing students' attitudes during their education and changes have been noted.
Objective: To examine nursing students' attitudes towards care of dying patients before and after a course in palliative care.
Design: A descriptive study with a pre and post design.
Settings & participants: Nursing students (n = 73) enrolled in a mandatory palliative course in the nursing programme at a Swedish university.
Methods: Data were collected before and after a palliative care course using FATCOD and qualitative open-ended questions. Data from FATCOD were analysed using descriptive and analytical statistics. The open-ended questions were analysed with qualitative content analysis.
Results: The students' mean scores showed a statistically significant change toward a more positive attitude toward care of dying. Students with the lowest pre-course scores showed the highest mean change. The qualitative analysis showed that the students had gained additional knowledge, deepened understanding, and increased feelings of security through the course.
Conclusions: A course in palliative care could help to change nursing students' attitudes towards care of patients who are dying and their relatives, in a positive direction. A course in palliative care is suggested to be mandatory in nursing education, and in addition to theoretical lectures include learning activities such as reflection in small groups, simulation training and taking care of the dead body.
Introduction: Do not resuscitate (DNR) is a medical procedure for patients who are suffering from critical, untreatable, and irreversible disease where the patient's life is predicted to end. DNR is considered a sensitive decision for patients and their relatives, as well as physicians.
Aim: This study is aimed to assess the knowledge and attitude of medical students and interns toward the DNR order and the factors affecting their attitude at the King Abdulaziz University Hospital (KAUH) in Jeddah.
Methods: Nonintervention cross-sectional study was conducted among 429 medical students (preclinical and clinical years) and interns who were given an online questionnaire between May and June in 2016 at KAUH in 18 Kingdom of Saudi Arabia.
Results: Our study indicates that most of the participants (73.2%) were familiar with DNR order; however, more than half of them (58.3%) did not take any lecture or session on DNR. Large proportion of medical students had the opinion that attending a lecture or session on DNR would help them discuss it more skillfully with the patients and their relatives. More than half of the participants (55%) believed that there is a Fatwa that regulates DNR on the Islamic level.
Conclusion: Participants, who were interns, were more familiar with the term DNR, whereas the 2nd-year medical students were less familiar with DNR. Considering the variation in the knowledge of participants about DNR, we conclude that additional lectures and sessions about DNR should be added to the medical school curriculum to make the students more confident and able in handling the DNR discussions.
As the national demand for donated organs continues to rise, the rate of registered donors within the United States has remained stagnant, creating a shortage of viable, transferrable organs. Lack of registered donors can be partially attributed to misconceptions about organ donation, which has led to a population less willing to register as organ donors. The utilization of educational interventions can begin to address common misconceptions and change attitudes to favor organ donation. A quantitative pretest, posttest survey design was utilized in order to assess effectiveness of an educational intervention within the college-aged population. Results suggest that educational interventions are effective in creating positive attitudes about organ donation in college-aged students.
BACKGROUND: Palliative simulation is a beneficial bridge between theory and practice; however, it can be emotionally laden. Often overlooked during a debrief session of a palliative simulation is ensuring that participants have the skills to process the feelings they may experience.
METHOD: The purpose of this mixed-methods concurrent triangulation study was to understand the perceived value and usefulness of debriefing in palliative simulation process feelings and emotions.
RESULTS: The simulation modality affects the intensity of feelings. A debriefer who is skilled in both debriefing simulation and coping with emotionally stressful situations allowed students to feel prepared to cope with their own feelings about palliative care. Having other students talk about their feelings in debriefing helped students to normalize their feelings.
CONCLUSION: The debriefing in palliative-based simulations requires additional considerations regarding modality and the skill set of the debriefer to adequately assist students to process feelings and emotions.
The study examined the influence of training on first-year nursing department students’ attitudes on death and caring for dying patients. Utilizing the experimental model, the study sample consisted of 81 first-year students attending the nursing department of a university. Death Attitude Profile-Revised and Frommelt Attitude toward Care of the Dying Scale were used for data collection. Data analysis included means, standard deviation, and t test for related samples. Student attitudes toward death were measured as 146.43 (16.741) and 152.75 (15.132) for pre- and posttraining, respectively. Student attitudes toward caring for dying patients were established to be 103.02 (7.655) during pretraining period and 111.02 (10.359) at posttraining period. The difference between pre- and posttests for mean attitudes toward death and caring for the dying patient was statistically significant. Study results determined that training was effective in forming positive student attitudes toward death and caring for dying patients.
Les situations de soins palliatifs ou de fin de vie peuvent être difficiles à gérer pour les étudiants en soins infirmiers.
L'évolution de la formation infirmière a permis la mise en place d'enseignements de soins palliatifs et des moyens d'accompagner les étudiants dans leur apprentissage de ces situations.
Le suivi pédagogique des étudiants et l'analyse de pratiques professionnelles pourraient être des moyens de gérer les situations de soins palliatifs et de fin de vie, en développant la pratique réflexive et les compétences des futurs professionnels.
Des étudiants ont participé à cette recherche, les résultats ont permis d'ouvrir la réflexion et d'élargir l'hypothèse.
La professionnalisation en serait-elle la clé ?
The Frommelt Attitude Toward Care of the Dying Scale (FATCOD) is designed to assess the attitudes of professionals and trainees toward caring for the dying patient and their family members. In this study the main aim is to adapt the FATCOD to a Spanish context (FATCOD-S). In addition, the relations between FATCOD-S, sociodemographic variables, emotional intelligence, and death attitudes have been analyzed. A sample of 669 Spanish nursing students from four Universities responded to a questionnaire. The exploratory factor analysis (EFA) concludes a structure composed of two significant factors. A confirmatory factor analysis (CFA) was carried out. The CFA supported a two-factor model. Students with past experience of death and those who had received training in palliative care scored significantly higher on both factors of the FATCOD-S (p < 0.01). The FATCOD-S is an effective and valid tool for measuring the attitudes of Spanish nursing students toward caring for patients at the end of life.
Death metaphors are a meaningful way to understand personal perceptions of death, an important construct affecting how people live. This study collected death metaphor data among 100 university students in Hong Kong in 2016 and compared the findings with another study reported in 2004. Interpersonally oriented death metaphors were still popular among students a decade later. There was a general decrease in positive perception of death and an increase in negative perception of death from 2004 to 2016. Death metaphors are useful tools in death education programs, especially in cultures where death is a taboo topic.
This study examines the experiences and beliefs of university students which affect attitudes toward palliative care. A total of 322 students responded to a survey on palliative care and end-of-life attitudes. Almost 40% of the students reported not having enough knowledge about options at the end of life. Results of multiple regression indicate students who have more negative attitudes toward palliative care did not believe in end-of-life care planning. Female students and those who had a family member or friend who used palliative care had more positive attitudes toward palliative care. Understanding student perceptions of palliative care allows for developing curriculum sensitive to learners' needs and addressing misconceptions.
Background: The World Health Organization estimates that around 6 million people need palliative care in India but not even 1% of the patients have access to it.
Objective: To find the prevalence of knowledge on palliative care and compare the effectiveness of different methods of health education on attitude regarding palliative care among urban college students in southern India.
Subjects: A pre-post intervention study was conducted in three different arts, science and commerce colleges in urban Pondicherry in August 2017.
Methods: Data regarding attitude change towards palliative care by three different modes of intervention in the three colleges: health talk (Group A), health talk with video (Group B) and health talk and interaction with a patient's caregiver (Group C) - before and after intervention - were collected using a predesigned pretested structured questionnaire.
Results: Among the 65, 75 and 67 participants in Groups A, B and C, respectively - the majority belonged to urban nuclear families; the mean age was 19.5 (0.9) years and Group C had only female students. The prevalence of knowledge about palliative care was found to be 9.2%. There was a difference in attitude scores among the three groups (p = 0.02) with Group C having the highest change of a score with a median of 2 (-1,5). Conclusion: Awareness about palliative care is very low among non-medical undergraduate college students of urban Pondicherry. The best method of health education in changing the attitude towards palliative care was interaction with patient's caregiver.