Author/Setting/ Nursing Discipline |
Design/Sample & Instruments |
Findings |
Outcomes |
Effect/Correlations |
Black (2007)[22]Healthcare Professionals including nurses in New York state, USA |
Cross-sectional survey (N=135) (nurses, doctors social workers): who
managed older patients- using Death Attitude Profile-Revised (DAP–R). |
Age correlated positively with fear of death, (p= .004), avoidance of death
(p= .007); negatively with neutral acceptance of death (p =.001), escape
acceptance of death (p=.034). Negative correlations were found between
collaborating with other professionals regarding directives and fear of
death, avoidance of death, and escape acceptance of death. |
Death anxiety was a predictor of professionals, communication with others
about advance directives. Experts in end-of-life care recommend probing
the relationship between healthcare provider communication behavior and
personal death attitudes. |
Significant inverse relationship between 2 attitude subscales ‘Avoidance, and
‘Escape, and caring for dying. |
Braun 2010[4] Oncology nurses in Israel |
Survey of nurses (N=147) using Frommelt Attitude Toward Care of the Dying Scale (FATCOD),
Death Attitude Profile - Revised (DAP-R) |
Nurses had moderate levels of fear of death (x2=4.11), death avoidance (x2=2.93), approach acceptance
(x2=3.53), & escape acceptance (x2=3.6), with correlation of Fear of death with Death avoidance &
Approach acceptance. Approach acceptance was correlated with Death
avoidance & Escape acceptance. Mean FATCOD: 125.7. |
Nurses, personal attitudes towards death were associated with their attitudes to
caring for dying patients, with most demonstrating positive attitudes. A
mediating role was found for death avoidance, suggesting some may use
avoidance to cope with fear of death. Culture and religion may be key to
attitudes (most were Jewish). |
Significant
positive relationship between 4 subscales. |
Deffner 2005 [11] Registered nurses in USA |
Correlation study- Cross sectional survey (N= 190) using Death Anxiety Scale |
Regression analysis showed death anxiety level was significantly inversely related
to comfort level of nurse when communicating with patients/ families
regarding death (p = .000). Age, education, years of nursing, exposure
to communication education for dealing with death showed negative Gamma
values or R, indicating that discomfort decreases as age, education,
experience, current nursing employment, work in other areas, and
exposure to communication education increase. |
Comfort level of the nurse during communication with patients and families is
adversely affected by an increase in the nurse's own death anxiety, and
positively affected by exposure to communication education. Importantly,
nurses should identify their level of death anxiety/be exposed to education on communicating with
patients/families regarding death. |
Significant inverse relationship: comfort and attitude to death. |
Dunn 2005 [16] Oncology and med-surg registered nurses in USA |
Cross-sectional survey (N=58) using Fromelt Attitudes Towards Care of
the Dying (FATCOD) and Death
Attitude Profile- Revised (DAP-R) scale |
Nurses who reported spending more time with dying patients had more positive
attitudes. No significant association was found between nurses,’ attitude
towards death and attitude to caring for dying patients. |
Nurses were positive about caring for the dying; there was no effect of death
anxiety on attitude towards caring for dying patients; some subscales
were associated with demographic variables & scales.Education programs on death and dying are recommended. |
Non-significant relationship death anxiety and caring for dying. |
Ho et al.2012 [21] Renal registered nurses in Spain |
Cross sectional survey (N=202) using Frommelt Attitude
Toward Care of the Dying Scale-Form B. |
Nurses were managing elderly patients at end of life (EOL); they held positive
attitudes towards caring for the dying,
88.9% viewed EOL care as an emotionally demanding task, 95.3%% reported
that addressing death issues require
special skills and 92.6% reported that education on EOL care is
necessary. |
Further education about end of life care was recommended for Spanish renal nurses. |
N/A |
Author/Setting/ Nursing Discipline |
Design/Sample & Instruments |
Findings |
Outcomes |
Effect/Correlations |
Hutchison and Sherman 1992 [23] Student nurses in USA |
Non-random trial of didactic or experiential death & dying training for students
(N=74): pretest- posttest using Templer Death Anxiety Scale (DAS) |
No differential effects of training technique were found. However, DAS
post-test scores were significantly lower than the pre-test scores for
both groups; also maintained at 8-week follow-up. |
There was inconclusive evidence of the effect of training on students’ level of
death anxiety. Training positively impacted on students’ levels of
anxiety. |
Anxiety was lower after training and at 8 weeks. |
Inci 2007 [12] Oncology & ICU Nurses in Turkey (not in English) |
Pretest-postest- Surveys: Effects of death education - using Death Anxiety Scale (DAS),
Death Depression Scale (DDS), & Attitude Scale Euthanasia, Death and
Dying Patients (EDDP). |
DAS and DDS scores decreased significantly (p=<.05) after training; Non significant
change in EDDP (p>0.05). No effect of death education by age, years of
work, how they were affected by terminal patient nursing or the meaning
attributed to death. |
There was a positive effect on nurses, death anxiety after death and dying training
over 7 sessions, however there was no impact of nurses’ age, years
working or how they reported being affected. |
Anxiety was lower after training. |
Iranmaneshet al. 2008 [13] Hospital general and oncology nurses in Iran |
Cross sectional survey of nurses (N=114) using translated Death Attitude Profile-Revised (DAP-R) and Frommelt,s Attitude towards
Caring for Dying Patients (FATCOD) |
Fear of death was negatively (r -.199) correlated with attitude toward giving care to the dying.
Neutral to moderately positive attitude toward caring for dying (FATCOD
mean 3.55/15). Most were likely to give care and emotional support to
persons at the end of life whilst taking an authoritative approach. |
Lack of education and experience, as well as cultural and professional
limitations, may have contributed to the negative
attitude toward some aspects of the care
for people who are dying among the nurses
surveyed. |
Significant inverse and also positive relationships between attitude to death and
caring for dying. |
Lange, Thom and Kline 2008 [17] Inpatient & outpatient oncology nurses in USA |
Cross-sectional survey (n= 355) using FATCOD & DAP-R instruments. |
Statistically significant relationships were found among age, nursing
experience, previous experience with caring for the terminally ill, and
scores on FATCOD and DAP-R. Nursing experience and age were the
variables most likely to predict nurses' attitudes toward death and
caring for dying patients. |
RNs with more work experience tended to have more positive attitudes toward death
and caring for dying patients. Less experienced oncology nurses will
benefit from increased education, training, and exposure to providing
and coping effectively with end-of-life care. |
Significant inverse relationship: attitude to death and caring for dying. |
Matsui & Braun 2010 [14] Hospital adult and childrens’ nurses caring for terminal patients in Japan |
Pretest- posttest survey (N=190 RNs;176 care workers): using Death Attitude
Profile (DAP), Japanese version, and Attitude Scale about Euthanasia,
Death, and Dying Patient. |
After 7x 90min sessions of nurse education on death and dying- multiple
regression showed better attitudes toward caring for the dying were
positively associated with seminar attendance and negatively associated
with fear of death. There was no difference between RNs and care
workers’ responses. |
Attitudes (measured by FATCOD) were not correlated with job certification or work setting but with death attitudes and seminar attendance. Staff education is
important for maintaining and improving standards in end of-life care in
institutional settings. |
Significant inverse relationship: attitude to death and caring for dying. |
Myashita et al. 2007 [15]=Hospital general nurses in Japan |
Cross-sectional survey (n= 178) using FATCOD & Death Attitude Inventory (DAI). (Japanese versions) & Pankratz Nursing
Questionnaire. |
Multivariate linear regression identified various subscales that were related to
caring; Death anxiety domain, DAI (r= –.17, P =.02), death relief
(r = –.19, P = .012), death avoidance (r= .33, P
= .001), and life purpose (r = .38, P = .001) were
significantly correlated with DAI (positive attitude toward caring for
the dying). |
Most participants had a positive attitude toward caring for the dying patient
and recognized the need for patient- and family-centered care.
Educational and administrative efforts to strengthen nursing autonomy
are necessary. |
Significant inverse & positive relationships for attitude to death and caring for
dying. |
Payne et al. 1998 [19] Hospice and emergency nurses in England |
Mixed methods: survey (N=60) using Death Attitude Profile-Revised
Questionnaire & semi-structured interview. |
Hospice nurses had lower death anxiety, as shown by 8 of 32 items with
significantly more positive responses than emergency nurses. Subscale
differences were not reported. |
Limited differences were shown between disciplines. Between groups- hospice
nurses appeared to have low death anxiety despite frequent exposure to
deaths. |
Significant difference by demographics. |
Author/Setting/ Nursing Discipline |
Design/Sample & Instruments |
Findings |
Outcomes |
Effect/Correlations |
Rooda 1999 [3] Metropolitan private hospital nurses and visiting nurses (USA) |
Cross-sectional survey (N=403) using Frommelt Attitude Toward Care of
the Dying Scale, and Death Attitude Profile-Revised (DAP-R), |
DAP-R scores were related to sex, religious affiliation, and current contact with
terminally ill patients. FATCOD scores (e.g., showing acceptance of
death) were positively related to current contact with dying patients,
negatively correlated with two DAP-R subscales (Fear of Death and Death
Avoidance), and positively correlated with two other DAP-R subscales
(Approach Acceptance and Neutral Acceptance). |
Nurses' attitudes toward death and their current contact with terminally ill
patients were predictive of their attitudes toward caring for terminally
ill patients. |
Significant inverse relationship: 2 subscales of DAP-R and between attitude to death
and caring for dying. |
Santisteban 2006 [20] Various practitioners in palliative care unit in Spain |
Cross-sectional survey (N=24) using Templer's DAS and Maslach's MBI |
Average death anxiety was 5.75. Nurses scored highest on depersonalization.
Factors related to team relationships were most stressing. Assistant
nurses hardly ever sought family or colleague support to discuss
work-related topics. |
Average death anxiety was 5.75, similar to other studies, but this figure varies
depending on the presence of spiritual beliefs or otherwise. Differences
in MBI variables were seen between professions. |
Mean death anxiety 5.75.- context not reported. |
Zyga 2012 [25]Renal nurses including palliative- trained- in Greece |
Descriptive quantitative survey(N=49) using Death Attitude Profile-Revised (DAP-R) |
Nursing
experience and age predicted nurses'
attitudes towards
death. Nurses
with specific education on palliative care had less difficulty talking
about death and dying and did not have a
fear of death. |
Hospital-based teams (palliative care, supportive care or symptom
assessment teams) had statistically significant different relationships
with fear of death and neutral acceptance
scores. |
Significant difference by demographics. |