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Table of Contents

I. Introduction

II. Statement of the Problem

Main Problem

Secondary Problems

III. Evidences

IV. Synthesis

Strength

Weaknesses

Answer to the Problem

V. Conclusion

VI. Recommendation

VII. Appendices

References

Curriculum Vitae
I. Introduction

Death is the irreversible cessation of all vital functions especially as indicated by

permanent stoppage of the heart, respiration, and brain activity: the end of life.

According to the world health organization, 55.3 million people die each year. In the

Philippines, there are 6.1 deaths/1,000 population recorded in 2016.

Confronting death is a formidable human concern that is influenced by personal

experiences and socio-cultural beliefs. Death anxiety, a negative affective state that is

incited by mortality salience, may be experienced by nurses and other health care

workers who are exposed to sickness, trauma, violence, and death factors that may

influence the experience and level of death anxiety in health providers.

While health care environments throughout the developed world have expanded the use

of technology and advanced sophisticated treatments to manage serious conditions,

many patients facing trauma and life-threatening conditions experience death in

institutional settings. Nurses play critical roles globally in preventing death, and also

they help patients and their family members with advanced directives, and end of life

decision-making. Nurses may become anxious and feel overwhelmed with the work

stressors associated with death and dying.

Nurses are especially vulnerable to the debilitating condition because of the nature of

their work and the constant exposure to death, according to Mike Brady, a doctoral

research student at Swansea University, lecturer at Open University, and clinical

supervisor paramedic at South West Ambulance Service in the U.K.


Critical care nursing is a complex and challenging nurse specialty to which

many registered nurses (RNs) aspire. Also known as ICU nurses, critical care nurses

use their advanced skills to care for patients who are critically ill and at high risk for life-

threatening health problems.

The care of death and dying patients is a challenge for nurses that has raised a special

interest in the recent years. Due to this concern, researchers would like to determine

how does death anxiety affects the nurses caring towards patients who are at the end

of life stage. Secondarily, on do nurses able to cope up on death of patient/s and the

barriers in caring for the dying patient/s.

II. Statement of the Problem

Main Problem:

1. How does death anxiety affects the nurses caring towards patients who are at the

end of life stage?

Secondary Problems:

2. How do nurses able to cope up on death of patient/s?

3. What are the barriers in caring for the dying patient/s?


III. Evidences

1. Nurses' characteristics and their Attitudes toward Death and Caring for Dying

Patients in a Public Hospital in Jordan (Hasheesh, 2013)

Introduction: Nurses are expected to care for death and many patients at their

end-of-life (EOL) stage. Care of death and the dying provoke many undesired emotions

and attitudes that reflect on the quality of patients' care. However, there are many

factors that can affect nurses' attitudes towards caring for death and dying patients,

such as nurses' demographics (age, gender, nursing experience, and others). Which

deserve carefully designed studies. Yet, limited Jordanian studies addressing these

factors are available.

The present study aims to assess how Jordanian nurses providing care for

terminal ill patients feel about death and caring for dying patients and to examine any

relationships between their attitudes and certain nursing characteristics.

Method: A descriptive quantitative design was utilized to accomplish the purpose

of this study. A total of 155 nurses were recruited to participate in the study. The nurses'

attitudes toward caring for dying patients were measured using the Frommelt Attitude

toward Care of the Dying (FATCOD) scale. The nurses' attitudes toward death were

measured using the Death Attitude Profile-Revised (DAP-R) scale. The t-test and F-test

were computed to examine the relationships between nurses' attitudes toward care of

dying and death and demographic factors.

Result: The present study showed that statistical significant association was

existed among age (P=.048; P=.049) and nursing experience (P=.000; P=.000) with
nurses' attitudes toward death and caring for terminal ill patients, and the total scores on

the FATCOD and DAP-R respectively. It also showed a significant correlation between

nurses' attitudes toward death and caring for dying patients (P=.002).

Conclusion: Based on the obtained results, older registered nurses with more

experience tended to have more positive attitudes toward death and caring for dying

patients. Therefore, understanding the effect of nurses' factors that are associated with

their attitudes toward care of dying and death can guide hospital and health care

agencies to devel.

As revealed in this study, older registered nurses with more experience tended to

have more positive attitudes toward death and caring for dying patients. RNs without

this experience had more negative attitudes, reported more feelings of fear toward

death, and avoided thoughts of death as much as possible. Therefore, the need to

educate the youngest and less experienced nurses caring for dying patients is

warranted. Thus, improving quality care to dying patients and their families.

2. How Death Anxiety Impacts Nurses Caring for Patients at the End of Life: A

Review of Literature (Peters, 2013)

Introduction: Numerous studies over the last 30 years have explored death

anxiety among individuals. This is a feeling of dread, anxiety or fear at the thought of

death or anything to do with dying: a common fear or phobia. Nurses, in the course of

their clinical work are frequently exposed to the processes surrounding patient deaths.

Nurses personal attitudes towards death and dying may, however, influence the quality
of care they provide during the terminal stages of a persons life. Faced with emotional

issues such as the reality of deaths, nurses need skills and experience to manage such

fears.

Method: Publications were sought using electronic databases in healthcare and

global search engines Google and GoogleScholar. Few studies were identified using

common healthcare databases- perhaps owing to the terms used in indexing. For

example a search of Ovid Medline using key search terms was unproductive with regard

to nursing studies. The search terms included death anxiety; attitude to death; anxiety

or fear; hospice care, death; human; patient and stress- psychological.

The main sources were PubMed and the reference lists of identified studies.

Studies conducted prior to 1990 were excluded in order to maintain the currency of

data. The titles of papers and the abstracts were examined and where relevant the full

papers were read to select articles for review. Owing to various designs, sampling

methods, levels of evidence and outcomes the results are presented as a descriptive

narrative report rather than in another format such as a meta-analysis.

Result: It was unsurprising, then, that some nurses facing the prospect of a

patient dying felt anxious and were uncertain how to cope with the procedures that

surround death. A number of studies reported inverse statistically significant correlations

between staff attitudes to death and intention to discuss death and dying. Depending on

a nurses orientation to fear of death, nurses who held higher anxiety scores on fear of

death were less likely to have a positive attitude towards caring for a patient at the end

of life. There was evidence that short courses in death education could reduce the

death anxiety of registered nurses with likely subsequent improvement in nurses coping
with death and dying. Hutchison and Shermans work with student nurses also showed

positive results after participation in a 6 hour workshop on death and dying. Thus, there

are opportunities to improve education for nurses at both undergraduate level and post-

registration, through continuing education. It would also be important to evaluate the

depth of death education provided at undergraduate level. A planned system of

mentoring for younger, inexperienced nurses in the workplace could provide further

support for nurses.

Conclusion: Nursing care of the dying is a particularly demanding role that

requires nursing skill and also necessitates nurses to have insight into their personal

beliefs about death and dying. Nurses who had a more positive attitude towards death

were more likely to have a positive attitude towards providing end of life care for

patients. Nurses need to consider their own race and spiritual beliefs (as well as those

of the dying patient) because these may affect their objectivity in caring for a patient and

the end of their life. Regardless of the cultural settings in which nurses work (or their

continent) younger nurses under age 30, with less ability to cope with negative attitudes

and the demands of emotional work would benefit from death education in the

workplace.

3. Death Anxiety among Nurses and Health Care Professionals: A Review Article

(Nia, 2016)

Introduction: Confronting death is a formidable human concern that is

influenced by personal experiences and socio-cultural beliefs. Death anxiety, a negative


affective state that is incited by mortality salience, may be experienced by nurses and

other health care workers who are exposed to sickness, trauma, violence, and death

factors that may influence the experience and level of death anxiety in health providers

include age, ego integrity, physical problems, psychiatric conditions, religiosity ethnicity,

occupational stressors, personal death experiences, and media influences. While there

is an increasing focus on burnout and compassion fatigue among nurses who care for

patients at the end of life, there has been limited research that has examined the role of

death anxiety in contributing to these occupational stressors. Furthermore, there is less

focus on death anxiety among nurses who care for patients in a variety of environments

including intensive care units, psychiatric wards, emergency rooms, and inpatient and

outpatient settings. Nursing staff have also perceived educational gaps relative to their

preparation to provide effective care for dying patients. The purpose of this review is to

examine death anxiety and management strategies among health providers in different

health settings across cultures. A better understanding of the experience of death

anxiety in nurses globally may ultimately lead to interventions that can offset serious

consequences such as leaving positions, poor patient care, and decrements in personal

health.

Method: A literature review limited to the health sciences of multiple databases

and search engines was undertaken using the keywords death anxiety, fear of death,

nursing, health care, and thanatophobia. To maintain the currency of the findings,

inclusion criteria incorporated only research articles that were published since 2000 in

the English language. Exclusion criteria included commentary and theory papers, non-

research studies, and non-English language articles. Data sources included PubMed,
Science direct, CINAHL, and PsychInfo. Titles and abstracts were first examined to

determine their relevancy for review.

After the articles were retrieved, two reviewers conducted an analysis of each

study using quality criteria for qualitative and quantitative studies. Following this

rigorous process, we were left with 38 articles that met the review inclusion criteria.

Three of the papers were qualitative studies.

Result: The studies that have tested interventions to manage death anxiety in

health care professionals identify common themes that appear to be beneficial.

Emphasizing personal growth and building capacities to regulate emotions appear

necessary for auxiliary nurses to manage the stressors associated with caring for dying

patients. Strengthening adaptive and individualized coping strategies for nurses and

teaching the important self-care qualities during nursing training is recommended to

offset burnout. While the interventional studies have identified important information that

can be used to expand psycho-education programs related to death and dying content,

these studies have primarily used the pre-posttest design, which is a limitation. While

research examining death anxiety and its implications for nursing is growing, most

studies have used cross-sectional descriptive approaches. Furthermore, the reliance on

self-report measures increases the possibility of social desirability bias. The studies

have largely used convenience samples that limit generalizability of the findings. Also,

convenience sampling may lead to samples that are more comfortable with engagement

relative to thanatology content. While extensive research has examined the role of

culture and religiosity as factors that impact death anxiety, there is yet only limited
research in nursing that has examined these factors along with cross-cultural

comparative approaches.

Conclusion: There are few practice areas where nurses are not inclined to be

faced with death, e.g. life-threatening illnesses, accidents, code situations, post-

operative compromise, long term care, psychiatric nursing with post-traumatic stress

disorder victims, to name a few. There has been an increasing recognition of the

importance of death education for nursing and allied health professionals. Coincident

with the need for heightened training in optimizing death and dying care are curriculum

that addresses emotion awareness and regulation for providers.

4. The Nurse Advocate in End-of-Life Care (Hebert, 2011)

Introduction: In the United States in the 20th century, with advances in medical

technology and science, the care of the dying patient shifted from family and community

to health professionals. Throughout history, nurses have sought ways to improve quality

of life for individuals, families, and communities during every phase of life's journey.

Advocacy is a common thread of quality end-of-life (EOL) nursing care, encompassing

pain and symptom management, ethical decision making, competent culturally sensitive

care, and assistance through the death and dying process. The foundation of advocacy

is the nurse-patient relationship. Advocacy has 2 parts: information and support. The

nurse experiences the patient as uniquely human, with individual strengths and beliefs,

and uses this understanding to intervene on the patient's behalf. Patients exhibit the

following traits when in need of advocacy: powerlessness, helplessness, dependency,


vulnerability, inability to speak, and loss of self-control. Trigger situations, including

illness, hospitalization, or change in diagnosis, require decision making and action; thus,

the act of advocacy begins. The nurse's ability to represent the patient and

communicate on the patient's behalf is a core behavior at the EOL.

Result: A comparative analysis conducted in 3 mid-Atlantic regional hospitals

revealed acute care nurses' perceptions of advocacy behaviors in EOL nursing practice

and offered insight into supports and barriers that nurses at various skill levels

experience. The 3 most frequently identified barriers were the physician, the patient's

family, and fear. Novice nurses reported that lack of communication and lack of

time/support are barriers to their practice of advocacy. Today's nurse also faces barriers

with differing policies and practices in healthcare systems and professional relationships

with multidisciplinary caregivers. On the other hand, EOL nursing education and

advocacy education positively influenced nurses' perceived advocacy behaviors.

Conclusion: Nurses and physicians alike must increase their awareness of

cultural disparities and their impact on EOL issues, including the grieving process. As

patient advocates, nurses must ensure that patients and families of all ethnicities

experience death with dignity. But first, we must be educated about the grieving process

and how cultural differences affect that process. Our duty is then to communicate the

dying individual's beliefs to the physician(s) caring for that individual. Communication

between physician and nurse is the key to successful advocacy. Cultural sensitivity

training should be incorporated into annual nursing and physician competencies.


5. Caring for Dying People: Attitudes Among Iranian and Swedish Nursing

Students (Iranmanesh, 2012)

Introduction: To compare the attitudes of Iranian and Swedish nursing students

toward caring for dying persons.

Method: Their attitudes were measured with the Frommelts Attitude Toward

Caring of the Dying and the Death Attitude Profile Revised.

Result: The results indicated that the participating Iranian students were more

afraid of death and less likely to give care to dying persons than the Swedish

participants.

Conclusion: It is suggested that theoretical education should be individualized

and culturally sensitive in order to positively influence the students attitudes, and

promote professional development.

IV. Synthesis

Strengths

Research shows adequate evidences on aspects that influences the nurses caring

towards dying patients such as anxiety and how does it affect the type of care to be

rendered.

Weakness
Focusing only on the level of anxiety of patient towards caring on dying patients.

Researchers could also focus on patients such as critically ill or Grade 1-4 types of

patients.

Answer to the Statement of the Problem

1. How does death anxiety affects the nurses caring towards patients who are at the

end of life stage?

Nurses who held higher anxiety scores on fear of death were less likely to have a

positive attitude towards caring for a patient at the end of life. Nurses who had a more

positive attitude towards death were more likely to have a positive attitude towards

providing end of life care for patients. Nurses need to consider their own race and

spiritual beliefs (as well as those of the dying patient) because these may affect their

objectivity in caring for a patient and the end of their life.

2. How do nurses able to cope up on death of patient/s?

Nurses cope up on death of patient/s through emphasizing personal growth and building

capacities to regulate emotions appear necessary for auxiliary nurses to manage the

stressors associated with caring for dying patients. Strengthening adaptive and

individualized coping strategies for nurses and teaching the important self-care qualities

during nursing training is recommended to offset burnout.


3. What are the barriers in caring for the dying patient/s?

The 3 most frequently identified barriers were the physician, the patient's family, and

fear. Novice nurses reported that lack of communication and lack of time/support are

barriers to their practice of advocacy. Today's nurse also faces barriers with differing

policies and practices in healthcare systems and professional relationships with

multidisciplinary caregivers.

V. Conclusion

Researchers conclude that death anxiety affects the caring of nurses to patients in end

of life stage wherein the higher their anxiety level is, the poorer their caring is towards

the patient. It was also determined that the coping abilities of the nurses is based on

their age, experience, and the emotional capacity in managing stressors. Barriers in

caring for the dying patients were also determined.

VI. Recommendation

In light of the findings of the current research, the following recommendations were

suggested:

1. This study remark that nurses will be responsible for the care of a larger population of

dying patients in the future and, therefore, the need to be educated about death and

care of dying patients is warranted.

2. The researchers do believe that strong faith and satisfactory salaries contribute to

closer relations and understanding between nurses in one hand and the patients and
their families in the other. Therefore, investigation of the influence of the religious belief,

and economic status on nurses' attitudes toward death and care of dying is needed.

VII. Appendices

References

Hasheesh, P., Nurses' characteristics and their Attitudes toward Death and Caring for

Dying Patients in a Public Hospital in Jordan. Retrieved from

http://journals.sagepub.com/doi/full/10.1177/2049463716635680. March 2013.

Iranmanesh, C., Caring for Dying People: Attitudes Among Iranian and Swedish

Nursing Students. Retrieved from

https://www.aorn.org/websitedata/cearticle/pdf_file/CEA13508- 0001.pdf.

March 2012.

Robleda, G., Influence of preoperative emotional state on postoperative pain following

orthopedic and trauma surgery. Retrieved from

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-

11692014000500785. October 2014.


Caumo, W., Risk factors for postoperative anxiety in adults. Retrieved from

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.2001.01842.x/pdf.

December 2012.

De Cosmo, G., Preoperative psychologic and demographic predictors of pain

perception and tramadol consumption using intravenous patient-controlled

analgesia. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18496304. June

2012.

Ghoneim, M., Depression and postoperative complications: an overview. Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736276/. February 2016.

NATIONAL UNIVERSITY
COLLEGE OF NURSING
551 MF Jhocson Street, Sampaloc Manila

EVIDENCE-BASED PRACTICE
(MIDTERM)
Submitted by:
NUR131 Group 2
Dimaporo, Nor Hazel
Fua, Sean Harvey
Gacayan, Wency
Venus, Paola Marie

Submitted to:
Ms. Teresita Santiago
Clinical Instructor

January 17, 2017


Date of Submission

Curriculum Vitae

Dimaporo, Nor Hazel M.


#513 M. Earn Shaw Street Sampaloc Manila
(+63) 09952466099
norhazeldimaporo@yahoo.com

EDUCATION

2013-present NATIONAL UNIVERSITY, Manila.


Bachelor of Science in Nursing

2009-2013 The University of Manila

2003-2009 National University


POSITIONS HELD

2011-2012 Sgt. at Arms

2006-2007 P.R.O in Filipino

School/University

NONE

Curriculum Vitae

Venus, Paola Marie


#95 D Malvar Street Project 4, Quezon City
(+63)9156016007
paolamarievenus@yahoo.com

EDUCATION

2013-present NATIONAL UNIVERSITY, Manila.


Bachelor of Science in Nursing
Deans List: 1st Semester A.Y. 2015-2016

2009-2013 Jose P. Laurel Sr. High School

2003-2009 Pura V. Kalaw Elementary High School


POSITIONS HELD
2016-2017 National University Nursing Student Council President

2015-2016 National University Supreme Student Council


Nursing Representative

2014-2015 Class President

School/University
Blue Scholar
Photojournalist
Science Feature Editor
Marian youth Movement Member
Curriculum Vitae

FUA, SEAN HARVEY S.


#123 Osmea St. Tondo Manila
(+63)9361445832
sean_harvey93@yahoo.com

EDUCATION

2016-present NATIONAL UNIVERSITY, Manila.


Bachelor of Science in Nursing

2014-2016 Adamson University

2010-2013 Universidad De Manila


2006-2010 Araullo High School

2002-2006 Holy Child Catholic School


POSITIONS HELD
2015-2016 Class President

2010-2012 Organization President

2005-2006 Organization President


School/University
Choir Member
Rondalla Member
Marian Youth Movement
Vincentian Missionary
Curriculum Vitae

Gacayan, Wency G.
#562 Main St. Sampaloc, Manila
(+63)9305214459
wencygacayan@yahoo.com
wencgacayan1196@gmail.com

EDUCATION

2013-present NATIONAL UNIVERSITY, Manila.


Bachelor of Science in Nursing

2008-2012 Victorino Mapa High-Scool

2002-2008 Balala Elementary School


POSITIONS HELD
2008-2009 Class Vice President

2010-2012 Class President

2014-2015 Class Representative

School/University
Swimming Athlete
Drum and Lyre Member
Young Mens Christian Association Member
ASG Leader

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