ARE BACKGROUND AND PALLIATIVE EDUCATION AND TRAINING VARIABLES ASSOCIATED WITH NURSES’ ATTITUDES TOWARD DEATH? Julie Dudash RN-BC, MS, CNML, NE-BC University of South Florida Ph.D. Candidate

Why this topic? Past experience teaching Nurses and their reaction Reluctance to share Lack of educational materials Lack of exposure

Importance in our Society Over 65 will double in number from 2000 to 2030 (Admin. On Aging) Oldest of the old group growing

Importance in our Culture Importance of youth Changes in exposure to death Ways people die Where people die Technology can save us all

Palliative Care versus Hospice Care

Lack of training 2009 study 50% of 2300 nurses polled 50 textbooks only 2% content

Nurse as Advocate Only get one chance to get this right Wishes and plans are supported

Primary Purpose Describe nurses’ attitudes toward death and the extent of education and training in palliative care Complementary goal: determine whether nurses’ attitudes are associated with background and extent of palliative education and training

Research Questions 1. What is the nurses’ profile of attitudes toward death (anxiety, escape, neutrality)? 2. What is the extent of nurses’ education and training on palliative care? 3. What background (age, gender, years of experience, nursing area, ethnicity, state of residency) and educational and training variables have impacts on nurses’ attitudes toward death (anxiety, escape, neutrality)? 4. What is the best set of background and educatin and training variables explaining attitudes toward death (anxiety, escape, neutrality)?

Attitudes “The way a person views something or tends to behave towards it” (Dictionary.com, 2014). 1970’s: Kubler-Ross: Denial, Anger, Bargaining, Depression and Acceptance What about the emotional toll?

Emotional Labor Being present False bravado Stress, psychological and physiological harm

Limitations Online survey May be comfortable with subject Others may not respond

Literature Review Aging population Growth of those over 85: 5.8 million (2010) to 19 million by 2050 (Russakoff, 2010) Chronic diseases

Public Attitude Age Ethnicity Life experience with death Terror Management Theory

Nursing Workforce & Attitudes Age of Registered Nurses Shortage of nurses Percentage in end-of-life areas Higher death anxiety Understanding end-of-life care Self awareness Demanding and emotional task

Current Practices/Nurses’ Experiences ICU: weak communication Lack of knowledge More experience = more positive attitude Fear of patriarchal system Exposure to death

Conceptual Framework Emotional Labor Hochschild 1983 Stewardesses: smile and be friendly Fear, disgust, boredom Issues of well being Good and bad patients Emotional jugglers

Methods Research Questions

Research Design Non-experimental Survey strategies

Target Population Registered Nurses United States Survey via

Variables & Instrumentation Variables= attitudes toward death, extent of palliative education and training, background characteristics

Attitudes toward death DAP-R: Death Attitude Profile-Revised survey by Wong, Reker & Gesser questions 5 subsets Good/Very good reliability Fear of death & death avoidance = anxiety toward death Approach & Escape Acceptance = Escape Acceptance Neutral Acceptance Likert Scale Higher score = higher identified with that category

Extent of education & training Complementary survey 12 items Palliative Care Education Needs Assessment Survey Nurses’ education/training background Level of confidence in performing tasks

Background Variables 6 related items Age, gender, ethnicity, years of nursing practice, area of nursing work, formal educational level, state of residence

Open-ended questions How would you describe your attitudes toward death? How prepared do you feel you are in meeting patients’ end-of-life needs?

Focus Group After Survey is Complete Verify and gather further insight on attitudes toward death and views on palliative preparation. Getting reactions to results

Data collection Survey Goal = responses 4 sections of the Survey

Analysis Questions 1 & 2: Descriptive statistics (mean, standard deviation) Open ended questions Survey Monkey’s Text Analysis Questions 3 & 4: Dependent variables Independent variables Simultaneous regression: recommended when there is no prior evidence of causal priority Multiple regression SPSS software Question 3: Beta weights Question 4: R-square results Focus group data

Limitations/Ethics Registered Nurse English only Anonymous Anonymous: no names Confidentiality IRB process