| Life and death is the natural law of development of human life. As the final stage of human life, Death is an inevitable result of human life. Hence, patients need to care for the end of life as other stages of life. Nurses play a very important role in providing care for the dying people. Hospice service requires not only comprehensive knowledge, but also positive attitude toward hospice care. At present, there have been several self-designed questionnaires employed to evaluate nurses’ attitude toward care of the dying. Developed by Frommelt in 1989, Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B) was designed to measure participants’ attitudes toward providing care to dying patients. The scale has already been widely used with its Japanese, Swedish, Spanish, Israeli, Italian versions. However, there is no complete validity and reliability research, as well as the application report concerning the scale.ObjectiveTo evaluate the reliability and validity of the Chinese version of Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B-C) and form the suitable attitudes toward caring for the dying for Chinese culture. Then, use the scale to survey nurses and practice nurses, so as to understand their attitudes toward care of dying patients. Examine relationship between demographic variables and nurses’ attitudes toward death & caring for dying patients. Moreover, possible influencing factors concerning the attitudes mentioned above were investigated, so as to provide a scientific basis for further intervention, thus improving the positive attitudes toward care of the dying patients in the future research.Methods1. After being authorized by the author of the original English version, the original English version of FATCOD-B was translated into Chinese version, back translated and culturally modified, so as to form the Chinese version of attitudes toward care of the dying patients. FATCOD-B-C was used to test construct validity, content validity, test-retest reliability and internal consistency.2. The study sample included a convenience sample of 1133 practice nursing students from 8 nursing schools and medical universities located in 5 provinces. Practice nursing students all completed the survey of 2 measurement tools:a demographic survey and Chinese version FATCOD-B scale, which aim to investigate Practice nursing students’ attitude toward caring for dying patients and its influencing factors.3. A convenience sampling method was used to recruit nurses from 15 hospitals located in 5 provinces in China. A demographic survey, FATCOD-B-C and Chinese version Death Attitude Profile-Revised (DAP-R) were employed in the survey, in order to investigate nurses’ attitude toward caring for dying patients and its influencing factors.Results1.The Chinese version of FATCOD-B scale includes 29 items, and after the exploratory factor analysis, six factors were identified in exploratory factor analysis, which can explain 56.106% of the total variances. Confirmatory Factor Analysis showed that observation indexes were good fit the six factors model and indicated that the Chinese version of FATCOD-B scale has a good construct validity. Moreover, each item has comparatively higher factor loading at the corresponding levels (≥0.4). The Cronbach’s alpha coefficient of the Chinese version of the FATCOD scale, Form B (FATCOD-B-C) was 0.796. The Cronbach’s alpha coefficients for each subscale ranges from 0.647 to 0.863. The test-retest reliability is satisfactory (r=0.959, P<0.001), while the overall content validity index was 0.92.2. The Chinese version of FATCOD-B scale was used to evaluate the attitudes of practice nursing students toward caring for dying patients, with the mean score of all FATCOD-B-C item being 95.42(SD=6.76). Univariate analysis has been employed to analyze the Chinese version of FATCOD-B-C of different base data.. Results reveal that the scale total score difference relating to Chinese version of FATCOD-B of the willingness to care dying patients (t=5.382,P<0.0010) is of statistical significance; scale total score difference of religious beliefs (t=-2.886,P=0.004);scale total score difference of previous education on death and dying (F=39.931,P<0.001); scale total score difference of previous experience in dealing with terminally ill persons (t=4.488,P<0.0010 scale total score difference of different,present experiences (F=5.352,P=0.005); these factors would significantly influence the attitudes of practice nursing students toward caring for dying patients and families.3. Factors that could affect the attitudes of practice nursing students toward caring for dying patients were identified. The factors were shown as follows:willing to caring for dying patients, previous education on death and dying, previous experience in dealing with terminally ill persons, present experience, religious beliefs, gender and only child. Through the multiple linear regression analysis, it indicated that attitudes of practice nursing students toward caring for dying patients have been affected by those factors, ranked in the order as previous education on death and dying willing to caring for dying patients previous experience in dealing with terminally ill persons religious beliefs.4. The Chinese version of FATCOD-B scale was used to evaluate nurses’ attitudes toward caring for dying patients, and the mean score of all FATCOD-B-C item was 95.62 (SD=7.45). Univariate analysis has been employed to analyze the Chinese version of FATCOD-B-C of different base data.. Results revealed that the scale total score difference of age group (F=2.285,P=0.045,scale total score difference of years employed as a nurse (F=3.353,P=0.036), scale total score difference of technical title (F=5.692,P=0.004), scale total score difference of level of hospital (t=2.058,P=0.040), scale total score difference of religious beliefs (t=-2.788,P=0.005), scale total score difference of previous education on death and dying (F=9.743,P<0.001), scale total score difference of previous experience in dealing with terminally ill persons (t=2.761,P=0.006); these factors would significantly influence the attitudes of practice nursing students toward caring for dying patients and families..5. Factors that could affect nurses’ attitudes toward caring for dying patients were identified. The factors were shown as follows:age, labour relation, years employed as a nurse, degree, technical title, religious beliefs, previous education on death and dying, previous experience in dealing with terminally ill persons, present experience, fear of death, natural acceptance, approach acceptance. Multiple linear regression analysis indicated that nurses’ attitudes toward caring for dying patients have been affected by those factors ranked in the order as highest degree>fear of death> approach acceptance> natural acceptance> technical title> previous experience in dealing with terminally ill persons.Conclusions1. The Chinese version of FATCOD-B scale has a good reliability and validity, which can be used as a valid tool for the investigation of the practice nursing students’ and nurses’ attitudes toward caring for dying patients and their families.2. Practice nursing students demonstrated a relatively low attitude toward caring for dying patients and their families. previous education on death and dying, willing to caring for dying patients, previous experience in dealing with terminally ill persons, religious beliefs seems would affect practice nursing students’ attitudes toward care of the dying, which the most influential factor is previous education on death and dying. It is suggested to improve practice nursing students’ positive attitudes toward caring for dying patients and their families by adding death and dying education in the nursing courses, delivering training about end of life care, and sharing personal and work-related experiences by teachers.3. It was seen that nurses FATCOD-B-C scores were at a low level. Highest degree, fear of death, approach acceptance, natural acceptance, technical title, previous experience in dealing with terminally ill persons seem to affect nurses’attitudes toward caring for dying, which the most influential factor is educational background. It is suggested to improve nurses’ positive attitudes of caring for dying patients and their families through death education and hospice education, as well as creating a reflective environment in which nurses can express their own feelings. |
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