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Abstract
Purpose
The aims of the study were to investigate relationships among intensive care unit (ICU) nurses' attitude, role perception, and nursing stress related to life sustaining treatment (LST), and secondly, to identify factors influencing nursing stress about LST.
Methods
Participants were 202 conveniently sampled ICU nurses from general hospitals in Korea with over 300 beds. From December 1, 2015 to January 31, 2016, data were collected using structured questionnaires. The questionnaire was designed to measure nursing stress related to LST. Content validity and reliability was established for the instrument.
Results
Relationships were found between attitude and role perception, and between role perception and nursing stress about LST. Participants' role perception, gender, education level, and the experience of dealing with family members of patients receiving LST accounted for 13% of variance in nursing stress about LST.
Conclusion
Results confirmed that ICU nurses' role perception affects nursing stress about LST. Accordingly, the nursing education programs related to LST should aim to enhance role perception of nurses, and strategies to reduce the nursing stress about LST of the nurses in ICU need to be further developed.
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Table 1.
Attitude, Role Perception, and Nursing Stress on Life Sustaining Treatment based on Nurses' General Characteristics (N=202)
| Variables | Categories | n (%) or M± SD | Attitude | Role perception | Nursing stress | |||
|---|---|---|---|---|---|---|---|---|
| M± SD | t or F (p) | M± SD | t or F (p) | M± SD | t or F (p) | |||
| Gender | Male | 16(7.9) | 3.43±0.51 | 0.92 | 3.73±0.59 | -1.74 | 3.40±0.63 | -2.77 |
| Female | 186(92.1) | 3.32±0.46 | (.358) | 3.95±0.49 | (.084) | 3.76±0.48 | (.006) | |
| Age (year) | ≤25 a | 57(28.2) | 3.21±0.42 | 2.25 | 3.83±0.46 | 3.90 | 3.73±0.37 | 2.14 |
| 26~30 b | 71(35.1) | 3.38±0.46 | (.084) | 3.86±0.55 | (.010) | 3.64±0.57 | (.096) | |
| 31~35 c | 26(12.9) | 3.27±0.41 | 3.99±0.48 | a, b＜ d | 3.70±0.46 | |||
| ≥36 d | 48(23.8) | 3.42±0.52 | 4.12±0.43 | 3.88±0.54 | ||||
| 30.69±7.04 | ||||||||
| Marital status | Single | 147(72.8) | 3.29±0.46 | -1.95 | 3.89±0.49 | -2.03 | 3.71±0.51 | -1.01 |
| Married | 55(27.2) | 3.43±0.46 | (.053) | 4.05±0.51 | (.044) | 3.79±0.48 | (.316) | |
| Religion | Catholic | 38(18.8) | 3.46±0.39 | 1.88 | 4.01±0.43 | 1.44 | 3.79±0.48 | 0.39 |
| Christian | 23(11.4) | 3.42±0.55 | (.134) | 4.03±0.51 | (.232) | 3.66±0.50 | (.762) | |
| Buddhism | 21(10.4) | 3.29±0.49 | 4.03±0.40 | 3.70±0.44 | ||||
| None | 120(59.4) | 3.28±0.46 | 3.87±0.53 | 3.73±0.53 | ||||
| Education level completed | College | 89(44.1) | 3.36±0.43 | 0.90 | 3.84±0.55 | -2.43 | 3.60±0.51 | -3.30 |
| ≥ Bachelor | 113(55.9) | 3.30±0.49 | (.370) | 4.01±0.44 | (.016) | 3.83±0.48 | (.001) | |
| Job position | Staff nurse | 182(90.1) | 3.32±0.47 | 1.34 | 3.91±0.50 | 1.25 | 3.71±0.50 | 1.51 |
| Charge nurse | 12(5.9) | 3.54±0.37 | (.265) | 4.12±0.46 | (.290) | 3.95±0.52 | (.223) | |
| Head nurse | 8(4.0) | 3.30±0.48 | 4.06±0.32 | 3.85±0.54 | ||||
| Working experience as a nurse (month) | ≤24 a | 50(24.7) | 3.18±0.45 | 3.65 | 3.92±0.41 | 6.67 | 3.72±0.43 | 3.11 |
| 25~60 b | 57(28.2) | 3.28±0.45 | (.014) | 3.73±0.56 | (＜.001) | 3.62±0.50 | (.028) | |
| 61~120 c | 46(22.8) | 3.43±0.44 | a＜ c, d | 3.98±0.51 | b＜ d | 3.70±0.56 | b＜ d | |
| ≥121 d | 49(24.3) | 3.43±0.49 | 4.14±0.40 | 3.91±0.49 | ||||
| 86.64±83.83 | ||||||||
| Working experience as an ICU nurse (month) | ≤12 a | 37(18.3) | 3.18±0.51 | 3.59 | 3.99±0.46 | 1.10 | 3.73±0.56 | 1.36 |
| 13~36 b | 62(30.7) | 3.25±0.43 | (.015) | 3.85±0.50 | (.349) | 3.63±0.42 | (.255) | |
| 37~83 c | 60(29.7) | 3.45±0.47 | a＜ c | 3.93±0.55 | 3.80±0.58 | |||
| ≥84 d | 43(21.3) | 3.39±0.41 | 4.01±0.45 | 3.78±0.44 | ||||
| 54.32±50.89 | ||||||||
| Working department | Medical a | 67(33.2) | 3.36±0.46 | 0.44 | 4.03±0.45 | 3.46 | 3.73±0.53 | 4.47 |
| Surgical b | 55(27.2) | 3.29±0.44 | (.725) | 3.91±0.46 | (.017) | 3.81±0.44 | (.005) | |
| Neuro-Surgical c | 47(23.3) | 3.29±0.51 | 3.75±0.60 | c＜ a | 3.53±0.45 | c＜ b, d | ||
| Others† d | 33(16.3) | 3.38±0.45 | 4.03±0.43 | 3.90±0.55 | ||||
| Personal experience with LST in the past year | Yes | 14(6.9) | 3.31±0.36 | -0.18 | 3.87±0.37 | -0.46 | 4.05±0.59 | 2.47 |
| No | 188(93.1) | 3.33±0.47 | (.860) | 3.94±0.51 | (.649) | 3.71±0.49 | (.014) | |
| Necessity of having advance directives | Yes | 197(97.5) | 3.34±0.45 | 1.55 | 3.94±0.49 | 2.09 | 3.74±0.50 | 1.78 |
| No | 5(2.5) | 3.01±0.79 | (.122) | 3.48±0.57 | (.038) | 3.34±0.49 | (.076) | |
Table 2.
Nurses' Attitude and Role Perception about Life Sustaining Treatment (N=202)
| Variables | Items | M± SD |
|---|---|---|
| Nurses' attitude about LST | • Even for a LST patient, life should be extended using every available treatment methods.† | 3.45±1.08 |
| • If a LST patient and family request WLST due to financial difficulties, it should be allowed. | 3.55±0.82 | |
| • If a patient choose WLST instead of pursuing painful treatment, it can be a way for the patient. | 3.68±0.82 | |
| • WLST can be one of the methods for older patients with incurable diseases to end their life. | 3.64±0.91 | |
| • If a LST patient or family request WLST due to religious faith, it should be respected. | 3.57±0.97 | |
| • If a LST patient or family refuse airway intubation, it should be discontinued even if it is needed. | 3.30±0.95 | |
| • If a LST patient or family request, pressor-agents should be stopped even if blood pressure is low. | 3.38±0.93 | |
| • CPR for cardiac arrest should be performed for a patient on LST.† | 3.16±1.19 | |
| • A patient's family has a right to choose WLST on behalf of the patient. | 3.30±0.99 | |
| • A patient has a right to choose WLST. | 4.20±0.91 | |
| • WLST should be allowed for organ transplant. | 2.76±0.99 | |
| • Use of ventilator for unconscious patient on LST should be discontinued if the pt's family request. | 2.76±1.03 | |
| • Weaning ventilator according to the family's request is an act of consideration for the patient. | 3.01±0.99 | |
| • Medical staff's decision of WLST is advisable if a patient with incurable status have no supporting family. | 2.95±1.03 | |
| • A LST patient should be discharged under family's signature if the family want. | 3.40±0.97 | |
| • It is advisable to get a consent on CPR prohibition when cardiac arrest is expected for the LST patient. | 3.91±0.90 | |
| • It is unacceptable for health professionals just to watch patient dying without providing any treatments.† | 2.57±0.91 | |
| Total | 3.33±0.46 | |
| Nurses' role perception about LST | • Nurses should support a patient and family emotionally. | 4.26±0.80 |
| • Nurses should explain thoroughly on disease and prognosis to a patient and family. | 4.05±0.83 | |
| • Nurses should take care of a patient as much as they can until the last even when WLST is decided. | 4.31±0.76 | |
| • Nurses should help a patient with incurable status to spend time with his/her family. | 4.02±0.77 | |
| • Nurses should offer necessary information from objective and professional perspective, and respect a patient and family's decision. | 4.20±0.64 | |
| • Nurses should act as a mediator between doctor and family. | 4.02±0.78 | |
| • While a patient and/or family can decide WLST, nurses should not be involved.† | 3.00±1.04 | |
| • Nurses should support a patient or family to get religious support if they want. | 3.89±0.88 | |
| • Nurses should participate in the decision making of WLST with the doctor, patient, and family. | 3.68±0.83 | |
| • Nurses should play a role of counselor for a patient and family. | 3.96±0.70 | |
| • Nurses should help a patient die peacefully. | 4.16±0.67 | |
| • Pain relief should be done first when a patient's physical pain is severe. | 4.26±0.67 | |
| • A patient and family can be influenced by nurses' belief in WLST. | 3.31±1.04 | |
| Total | 3.93±0.50 |
Table 3.
Nursing Stress on Life Sustaining Treatment (N=202)
Table 4.
Correlational Relationships among the Key Variables (N=202)
| Variables | Attitude | Role perception | Nursing stress |
|---|---|---|---|
| r (p) | r (p) | r (p) | |
| Attitude | 1 | ||
| Role perception | .18 (.012) | 1 | |
| Nursing stress | .07 (.351) | .26 (＜.001) | 1 |
Table 5.
Influencing Factors on Nursing Stress related to Life Sustaining Treatment (N=202)
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