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Park and Kim: The influence of Nursing Professionalism, Attitudes toward Advance Directive, and Death Anxiety on Terminal Care Performance of Nurses in Longterm Care Hospitals
Original Article

Korean J Adult Nurs 2018;30(2):183-193.

Published online: 21 April 2018

DOI: https://doi.org/10.7475/kjan.2018.30.2.183

The influence of Nursing Professionalism, Attitudes toward Advance Directive, and Death Anxiety on Terminal Care Performance of Nurses in Longterm Care Hospitals

Eun Hee Park1, Nam Young Kim2,

1Bright Mind Hospital, Naju, Korea

2Department of Nursing, Honam University, Gwangju, Korea

Corresponding author: Kim, Nam Young https://orcid.org/0000-0002-8525-1604 Department of Nursing, Honam University, 417 Eodeung-daero, Gwangsan-gu, Gwangju 62399, Korea. Tel: +82-62-940-5526, Fax: +82-62-940-5068, E-mail: aqua29@honam.ac.kr

Received 2 February 201828 March 2018       Accepted 10 April 2018

Copyright © 2018 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the level of terminal care performance of nurses in longterm care hospitals, and investigate how nursing professionalism, attitudes on advance directives and death anxiety affects their terminal care performance.

Methods

Total of 294 nurses from longterm care hospitals completed the structured questionnaires including nursing professionalism scale, advance directives attitude survey, death anxiety scale and terminal care performance scale. Data were analyzed using the SPSS/WIN 24.0.

Results

There were significantly correlation among terminal care performance of nurse, nursing professionalism, attitudes on advance directives, and death anxiety. The key factor that affected nurses terminal care performance was nursing professionalism(β=.26, p<.001), followed by attitudes on advance directive (β=.20, p<.001), participation of terminal care education (β=.15, p=.006), total work experience (β=.13, p=.015), and participation of Do-Not-Resuscitate education (β=.13, p=.018), which explained about 23.1% of the variance in nurses terminal care performance (F=17.05, p<.001).

Conclusion

The results of this research suggest that to enhance the nursing performance of nurses in longterm care hospital, it is necessary to develop an education program that can enhance a professionalism and the attitudes on advance directives, and reduce death anxiety experienced by nurses.

Keywords: Longterm care, Professionalism, Advance directives, Anxiety, Terminal care

REFERENCES

1. Statistics Korea. 2030 Elder statistics [Internet]. Seoul: Statistics Korea;2017. [cited 2017 September 01]. Available from:. http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1BPA002&vw_cd=MT_TM1_TITLE&list_id=101_A0502&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=MT_TM1_TITLE#.
2. Woo YW, Kim KH, Kim KS. Death anxiety and terminal care stress among nurses and the relationship to terminal care performance. The Korean Journal of Hospice and Palliative Care. 2013; 16(1):33–41. https://doi.org/10.14475/kjhpc.2013.16.1.33.
crossref
3. Statistics Korea. The current status of longterm care facilities longterm care facilities [Internet]. Seoul: Statistics Korea;2018. [cited 2018 March 06]. Available from:. http://kosis.kr/statHtml/statHtml.do?orgId=354&tblId=DT_MIRE01&vw_cd=MT_ZTITLE&list_id=354_MT_DTITLE&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=MT_ZTITLE#.
4. Kim WS, Cho HH, Kwon SH. The influence of terminal care performance, death anxiety and self-esteem on terminal care stress of geriatric hospital nurses. The Korean Journal of Hospice and Palliative Care. 2016; 19(2):154–62. https://doi.org/10.14475/kjhpc.2016.19.2.154.
crossref
5. Berman AT, Snyder S, Frandsen G. Kozier & Erb's fundamentals of nursing: concepts, process, and practice. 10th ed.Har-low: Pearson;2016. p. 1025–8.
6. Hong EM, Jun MD, Park ES, Ryu EJ. Death perceptions, death anxiety, and attitudes to death in oncology nurses. Asian Oncology Nursing. 2013; 13(4):265–72. https://doi.org/10.5388/aon.2013.13.4.265.
crossref
7. Ko MJ, Moon SH. Factors influencing performance of end-oflife care by ICU nurses. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2016; 25(4):327–37. https://doi.org/10.12934/jkpmhn.2016.25.4.327.
crossref
8. Peters L, Cant R, Payne S, O'Connor M, Mcdermott F, Hood K, et al. How death anxiety impacts nurses' caring for patients at the end of life: a review of literature. The Open Nursing Journal. 2013; 7:14–21. https://doi.org/10.2174/1874434601307010014.
crossref
9. Yoon EJ, Kwon YM, Ahn OH. Development of a nursing professional value scale. Journal of Korean Academy of Nursing. 2005; 35(6):1091–100. https://doi.org/10.4040/jkan.2005.35.6.1091.
10. Shin HJ. The influence of performance of terminal care on professionalism and good death awareness in clinical nurses [master's thesis]. Chungju: Chungju National University;2012. p. 65.
11. Miller CA. Nursing for wellness in older adults. 7th ed.New york: Wolters Kluwer;2014. p. 146–9.
12. Park JA, Jung DY. The comparing perception of advance directives in one general hospital doctors and nurses. Health & Nursing. 2013; 25(2):25–33.
13. Cho JA. A study on attitude to DNR and terminal care performance of clinical nurse [master's thesis]. Suwon: Ajou University;;2015. p. 24.
14. Jo KH, Park AR, Lee JJ, Choi SJ. The effect of suffering experiences, compassionate competence, caring behaviors on the terminal care performance of clinical nurses. Korean Journal of Medical Ethics. 2015; 18(2):103–16.
15. Baliza MF, Bousso RS, Poles K, Santos MR, Silva L, Paganini MC. Factors influencing intensive care units nurses in end-of- life decisions. Journal of School of Nursing USP. 2015; 49(4):571–8. https://doi.org/10.1590/S0080-623420150000400006.
16. Wolf LA, Delao AM, Perhats C, Clark PR, Moon MD, Baker KM, et al. Exploring the management of death: emergency nurses' perceptions of challenges and facilitators in the provision of end-of-life care in the emergency department. Journal of Emergency Nursing. 2015; 41(5):23–33. https://doi.org/10.1016/j.jen.2015.05.018.
crossref
17. Cohen J. A power primer. Psychological Bulletin. 1992; 112(1):155–9. https://doi.org/10.1037/0033-2909.112.1.155.
crossref
18. Nolan MT, Bruder M. Patients' attitude toward advance directives and end of life treatment decisions. Nursing Outlook. 1997; 45(5):204–8. https://doi.org/10.1016/s0029-6554(97)90066-x. https://doi.org/10.1016/s0029-6554(97)90066-x.
19. Lee HL, Park YH. Attitudes toward advance directives of older adults using senior centers. Journal of Korean Gerontological Nursing. 2014; 16(2):160–9. https://doi.org/10.17079/jkgn.2014.16.2.160.
crossref
20. Collett LJ, Lester D. The fear of death and the fear of dying. Journal of Psychology. 1969; 72(2):179–81. https://doi.org/10.1080/00223980.1969.10543496.
crossref
21. Suh HK. The relationships among life satisfaction, locus of control, and death anxiety as perceived by Korean and American older adults using selected personal demographic variables. The Journal of Korea Society for Health Education. 1987; 4(2):95–135.
22. Shim MK. The relationships between death anxiety and social support in the elderly people [master's thesis]. Busan: Busan National University;2001. p. 96.
23. Park SJ, Choi SH. A study on the degrees of death orientation and terminal care performance of nurses. The Korean Journal of Fundamentals of Nursing. 1996; 3(2):285–97.
24. George D, Mallery P. IBM SPSS statistics 23 step by step: a sim-ple guide and reference. 14th ed.New York: Routledge;2016. p. 204–14.
25. Chung MJ, Eun Y. Development and effectiveness of a spiritual care education program for nursing students-based on the ASSET model. Journal of Korean Academy of Nursing. 2011; 41(5):673–83. https://doi.org/10.4040/jkan.2011.41.5.673.
26. Kwon KJ, Ko KH, Kim KW, Kim JA. The impact of nursing professionalism on the nursing performance and retention intention among psychiatric mental health nurses. Journal of Korean Academy of Nursing Administration. 2010; 16(3):229–39. https://doi.org/10.11111/jkana.2010.16.3.229.
crossref
27. Kwon SA. Factors influencing the attitudes of social work professionals toward advance care planning. Health and Social Welfare Review. 2016; 36(4):284–313. https://doi.org/10.15709/hswr.2016.36.4.284.
28. Heyman JC, Gutheil IA. Attitudes of social work students toward end-of-life planning. Educational Gerontology. 2003; 29(4):313–26. https://doi.org/10.1080/713844339.
crossref
29. Black K. Health care professionals' dealth attitudes, experiences, and advance directive communication behavior. Death Studies. 2007; 31(6):563–72. https://doi.org/10.1080/07481180701356993.
30. Lee LJ, Park HS. Death anxiety and terminal care performance of nurses at long term care hospitals. The Korean Journal of Hospice and Palliative Care. 2017; 20(1):37–45. https://doi.org/10.14475/kjhpc.2017.20.1.37.
crossref

Table 1.
Difference in Terminal Care Performance according to Participant's General Characteristics (N=294)
Characteristics Categories n (%) M± SD t or F p M± SD
Age (year) 30 a 38 (12.9) 2.61±0.38 4.28 .006 42.55±10.09
30~39 b 74 (25.2) 2.57±0.38 c, d＞ b
40~49 c 103 (35.0) 2.76±0.42
≥50 d 79 (26.9) 2.77±0.46
Gender Female 281 (95.6) 2.67±0.42 0.66 .509
Male 13 (4.4) 2.59±0.43
Religion Yes 163 (55.4) 2.72±0.43 2.01 .045
No 131 (44.6) 2.62±0.41
Education level College a 178 (60.5) 2.62±0.40 5.51 .004
University b 99 (33.7) 2.71±0.43 c＞ a
Above master degree c 17 (5.8) 2.95±0.47
Total work duration (year) 5 a 74 (25.2) 2.57±0.41 7.40 .001 10.82±7.97
5~9 b 66 (22.4) 2.61±0.39 d＞ a, b
10~14 c 77 (26.2) 2.68±0.33
≥15 d 77 (26.2) 2.88±0.50
Longterm care work duration (year) 1 65 (22.1) 2.64±0.42 1.55 .200 2.03±2.18
1~2 139 (47.3) 2.68±0.40
3~4 63 (21.4) 2.81±0.53
≥5 27 (9.2) 2.62±0.28
Job position Staff nurse 216 (73.5) 2.63±0.41 -2.52 .012
Nurse manager 78 (26.5) 2.77±0.45
Experience of the acquaintance' death with in 1 year Yes 79 (26.9) 2.77±0.43 2.43 .015
No 215 (73.1) 2.63±0.41
Experience of DNR Yes 205 (69.7) 2.70±0.42 1.95 .051
No 89 (30.3) 2.60±0.43
Participation of DNR education Yes 216 (73.5) 2.72±0.41 2.92 .004
No 78 (26.5) 2.56±0.43
Participation of terminal care education Yes 114 (38.8) 2.80±0.40 4.45 .001
No 180 (61.2) 2.58±0.42

DNR=do not resuscitate.

Table 2.
Levels of Nursing Professionalism, Attitudes toward Advance Directive, Death Anxiety, and Terminal Care Performance (N=294)
Variables Categories n M± SD
Nursing professionalism Self-concept of the profession 9 3.53±0.49
Social awareness 8 3.26±0.51
Professionalism of nursing 5 3.76±0.51
The roles of nursing service 4 3.64±0.49
Originality of nursing 3 3.25±0.56
Mean score of total items 29 3.48±0.40
Attitudes toward advance directive Opportunity for treatment choices 4 2.72±0.40
Impact of advanced directives on the family 8 2.80±0.29
Effect of an advance directive on treatment 3 3.03±0.41
Illness perception 1 1.88±0.64
Mean score of total items 16 2.61±0.25
Death anxiety Fear of death the other 4 2.82±0.45
Fear of dying the other 6 2.56±0.38
Fear of dying the self 4 2.55±0.45
Fear of death the self 6 2.49±0.41
Mean score of total items 16 2.61±0.31
Terminal care performance Physical area 8 2.95±0.48
Psychological area 8 2.96±0.46
Spiritual area 6 1.95±0.66
Mean score of total items 22 2.62±0.43
Table 3.
Correlations among Nursing Professionalism, Attitudes toward Advance Directive, Death Anxiety, and Terminal Care Performance (N=294)
Variables Nursing professionalism Attitudes toward advance directive Death anxiety Terminal care performance
r (p) r (p) r (p) r (p)
Nursing professionalism 1
Attitudes toward advance directive .33 (＜.001) 1
Death anxiety -.07 (.239) -.20 (.001) 1
Terminal care performance .36 (＜.001) .26 (＜.001) -.12 (.049) 1
Table 4.
Factors Influencing Terminal Care Performance of Nurses in Longterm Care Hospitals (N=290)
Variables B SE β t p
(Constant) 0.77 0.25 3.02 .003
Nursing professionalism 0.26 0.06 .26 4.52 .001
Attitudes on advance directive 0.02 0.01 .20 3.56 .001
Participation of terminal care education (reference=yes) 0.13 0.05 .15 2.78 .006
Total work duration (reference=≥15) 0.10 0.04 .13 2.45 .015
Participation of DNR education (reference=yes) 0.12 0.05 .13 2.38 .018
Adj. R2=0.231, F=17.05, p＜.001
DNR=do not resuscitate; SE=standard error.
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