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Palliative Care: Can Education Decrease Fear of Death with...
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There were 50 nurses (45 females and 5 males) with valid data on pretest and posttest surveys the Multidimensional Fear of Death Scale (MFDOS) the domains did not reveal a statistical significance however, there was an increase in six of the domains post educational program (shown in Figure 1). The Palliative Care Knowledge Test (PCKT) showed a statistical significance, pretest M = 12.4, SD = 1.97, posttest M = 15.8, SD = 2.61. As shown in Figure 1, the results were statistical significance for the nurses. Quality of Dying in Long Term Care (QOD-LTC) and Self-efficacy Palliative Care Scale (SEPC) revealed a statistical significance. As shown in Figure 2, the QOL-LTC and SEPC results had statistical significance.
q The work of informed, educated, and knowledgeable nursing professionals is a prerequisite to high standards in end of life care.1
q Fear of the individual dying in the nursing homes is a concern. Educating the nursing professionals on palliative care concepts can alleviate fear of death and promote quality of care.
q Researchers have identified that inadequate care for dying residents in long-term care resulted from a lack of formal training for the long-term care nurses.2, 3, 4
q Scholarly education could produce evidence based care for long-term care residents and families who face challenges and suffering associated with chronic illness and end of life issues.1, 5, 6
INTRODUCTION
REFERENCES
Palliative Care: Can Education Decrease Fear of Death with Long Term Nurses?
Sharon Bronner, DNP, MSN, GNP, BC School of Nursing and Health Professions, Brandman University
Purpose: Nursing professionals lack knowledge about palliative care and fear providing palliative care modalities in the long term care setting. Aim: The aim of the study was to determine if palliative care education can decrease fear in long term care nurses when the resident is approaching the end of life. Null hypothesis was rejected (Ho: M1 = M2, Ha: M1 ≠ M2). Design: Quantitative descriptive cross sectional study including pretest and posttest with intervention palliative care educational program Setting: Skilled Nursing Facilities Sample: Fifty nurses (LPN’s, RN’s and APRN’s) age ranging from 23-66 years old Measurement: Four tools were utilized. Multidimensional Fear of Death Scale, Palliative Care Knowledge Test, Quality of Dying in Long Term Care, and Self-efficacy Palliative Care Scale
METHODS
RESULTS
Furnished upon request: [email protected]/[email protected]
DISCUSSION
q The competence and knowledge of nurses caring for the dying in long-term care facilities were improved by palliative care education.7, 8
q Palliative care education increased the awareness of long-term care nurses regarding the death process and increased their utilization of palliative care modalities.
q Nurses could change their behaviors to provide good
symptom management at the end of life. Knowledge and skills are important; however, sometimes they do not equal a change in behavior.9
q Providing resources for nurses could be a positive
achievement, and education for nurses could assure compliance with best practice standards in long-term care facilities and benefit the quality of care for patients/residents at the end of life.1, 2,3, 5,10
FIGURE 1
IMPLICATIONS
Improve the nurses self-confidence and palliative care knowledge. Enhancement of the clinician’s abilities to provide quality of care at the end of life. Best practices for end of life care in long-term care facilities is achievable.
ACKNOWLEDGEMENTS Thank you!
I would like to thank Dr. Jennifer Johnson and Dr. Edith Onua for the revisions of the manuscript, Dr. Mary Mays for her statistical expertise and Susan Mullaney GNP for her endless assistance and dedication. I would like to thank all the nurses who participated in the evidence-based project (Bethel Nursing and Rehabilitation, Wingate at Beacon, Wingate at Dutchess, and Wingate at Ulster). I would like to thank my husband and my young men (Lloyd, Brandon, and Lloyd III) for being part of my joyous endeavor.
Multidimensional Fear of Death Scale
Subscales Pre-intervention Mean (SD)
Post-intervention Mean (SD)
t df p-value
Fear of the Dying
Process
M = 2.37 (.948)
M = 2.64 (1.13)
-2.06
49
.044 Fear of the
Dead
M = 3.31(.608)
M = 3.36 (.637)
-723
49
.473 Fear of Being
Destroyed M = 3.20 (1.02)
M = 2.86 (.979)
2.60
49
.012 Fear for
Significant Others
M = 2.42 (.779)
M = 2.59 (.815)
-1.75
49
.085 Fear of the Unknown
M = 3.19 (.648)
M = 3.11 (.738)
0.76
49
.447 Fear of
Conscious Death
M = 3.54 (.845)
M = 3.75 (.889)
-1.84
49
.071 Fear for the Body after
Death
M = 3.62 (.859)
M = 3.77 (.809)
-1.38
49
.173 Fear of
Premature Death
M = 2.86 (1.15)
M = 3.13 (1.24)
-2.49
49
-.016 *Psychometric tool to evaluate fear of death in the nurses t = paired sample t test, df = degree of freedom (subjects), SD = Standard Deviation, p < 0.05 is statistically significant
Quality of Dying in Long-Term Care
Subscales t df p-value Mean Difference
95% Confidence Interval of the Difference
Lower Upper Closure 1.70 49 0.96 .188 -.034 .410 Control 1.45 49 .154 .240 -.092 .683 Social
Connection 6.05 49 .000 .824 .550 1.10
Preparatory Task
6.50 49 .000 .857 .583 1.10
Sense of Purpose
2.72 49 .009 .380 .099 .660
*Psychometric testing for monitoring, maintenance of quality of life and satisfaction with care in Long Term Care. t = One sample t test, df = degree of freedom (subjects), p < 0.05 is statistically significant
Self-efficacy Palliative Care Scale
Subscales t df p-value
Mean Difference
95% Confidence Interval of the Difference
Lower Upper Communication -17.5 45 .000 -1.22 -1.36 -1.08
Patient Management
-15.7 45 .000 -1.16 -1.31 -1.01
Teamwork -13.2 45 .000 -1.12 -1.30 -.952 *Psychometric testing of nurses’ ability to perform specific behaviors or skills. t = One sample t test, df = degree of freedom (subjects), p < 0.05 is statistically significant
Palliative Care Knowledge Test
Subscales Pre-intervention Mean (SD)
Post-intervention Mean (SD)
t df p-value
Total 12.4 (1.97) 15.8 (2.61) -.699 49 .000 Philosophy 1.58 (.609) 1.80 (.534) -1.87 49 0.67
Pain 3.50 (.974) 4.54 (1.05) -5.02 49 .000 Dyspnea 2.22 (.953) 3.14 (.783) -5.80 49 .000
Psychiatric Problems
2.50 (.995)
3.14 (.931)
-3.50
49
.001
Gastrointestinal Problems
2.64 (.827)
3.24 (.870)
-4.48
49
.000 *Psychometric tool to assess palliative care knowledge, t = paired sample t test, df = degree of freedom (subjects), SD = Standard Deviation, p < 0.05 is statistically significant