The Study On The Status And Influencing Factors Of Quality Of Dying And Death In A Tertiary Hospital In Zunyi:From The Perspective Of Intensive Care Nurses

Objective:Using a mixed method study including the QODD-14 Scale for ICU Nurses and semi-structured interviews,the status quo and influencing factors of the death quality of patients from the perspective of ICU nurses were analyzed.Methods:Part I:Translation and Reliability and Validity Test of QODD-14 Scale for ICU NursesUnder the theoretical guidance of Maslow’s hierarchy of needs theory,according to the cross-cultural debugging guidelines,the Chinese version of the QODD 14-Item Version was developed through the process of translated,expert consulted,pre-investigated,etc.The reliability and validity test of the Chinese version was performed,including item analysis using the critical ratio method and correlation coefficient,validity testing using face validity,content validity and construct validity,and reliability testing using internal consistency and split-half reliability.Part II:The study on the Status and Influencing Factors of Quality of Dying and Death from the Perspective of Intensive Care NursesSimultaneous triangulation was adopted.Qualitative research and quantitative research were carried out simultaneously and independently,and the results were integrated into the discussion phase to comprehensively understand the status and influencing factors of quality of dying and death of ICU patients.1.A total of 342 ICU patients who met the inclusion criteria in a tertiary hospital in Zunyi City from August 2019 to October 2020 were selected as study subjects by convenience sampling method.The patients’primary nurses were investigated by questionnaire using the Chinese version of the Quality of Dying and Death in ICU from the Perspective of ICU Nurses Scale within 48 hours after the patients’death.The patients’data were collected using a self-designed patient data collection form.Descriptive analysis,univariate analysis,correlation analysis,and regression analysis were used to analyze the status and influencing factors of quality of dying and death in ICU.2.The descriptive qualitative research was used to conduct in-depth interviews with 15ICU nurses who met the inclusion criteria in a tertiary hospital in Zunyi city.The conventional content analysis method was used to analyze the data.Results:Part I:Translation and Reliability and Validity Test of QODD-14 Scale for ICU NursesThe Chinese version of the Quality of Dying and Death in ICU from the Perspective of ICU Nurses Scale was formed included 14 items and five dimensions:individual symptom care(4 items),family companionship(4 items),spiritual care(2 items),time of death(2 items)and end-of-life decision-making(2 items).The absolute values of CR in each item was more than 3 and P<0.05.The correlation coefficients between each item and the total score of the scale were 0.206-0.704.The analysis results of each item were in an acceptable range,and the items were not deleted.The Cronbach’sαcoefficient and Spearman-Brown coefficient for the overall scale were 0.848 and 0.802,respectively.The Cronbach’sαcoefficient for each dimension was 0.705-0.93.Analysis of content validity of this scale indicated that I-CVI was at least 0.85,S-CVI was 0.92.The exploratory factor analysis results showed that this scale has five common factors,and all items load was above 0.5,and there was no double load phenomenon,and the cumulative variance contribution rate was 76.125%.According to the scale structure obtained from the results of exploratory factor analysis,confirmatory factor analysis was carried out.The results showed that the modified model fitting indexχ~2/df=2.006,RMSEA=0.071,GFI=0.924,CFI=0.945,IFI=0.946.Part II:The study on the Status and Influencing Factors of Quality of Dying and Death from the Perspective of Intensive Care Nurses1.The total score of the scale was 45.71(40.71,52.14)points,and the scores of each dimension were as follows:individual symptom care 4.75(4.25,5.25)points,family companionship 5.5(4.75,6.75)points,spiritual care 1.5(1,2)points,death moment 5.5(4.5,6.5)points,and end-of-life decision-making 5(4.5,5.5)points.Logistic regression analysis found that the quality of dying and death from the perspective of ICU nurses was affected by marital status,medical payment mode,life-support limitation,use of analgesic drugs within 24 hours before death,cardiopulmonary resuscitation within 24hours before death,and use of restraint belt within 24 hours before death.2.The results of the qualitative study included five themes:Physical and mental status of dying patients,accompanying and understanding of family members,discussion and formulation of dying decision-making,influencing factors of quality of dying and death,and reflection during the nursing process.Among them,The influencing factors of quality of dying and death in ICU patients include hospitalization time,invasive operation times,loneliness,organ donation,and other factors.Conclusion:1.The Chinese version of the Quality of Dying and Death in ICU from the Perspective of ICU Nurses Scale has good reliability and validity and is worth promoting.2.The score of the quality of dying and death of ICU patients from the perspective of ICU nurses in this hospital is not high,especially the spiritual care dimension,which needs to be further improved.there have some influencing factors including patients’marital status,medical payment methods,limited life support,24-hour treatment before death(the use of analgesic drugs and restraint bands,cardiopulmonary resuscitation)and other factors.