Factors Affecting Death Attitudes among Nursing Staff Working in Tertiary Hospitals

Abstract

Introduction: Clinical nurses very often confront death and dying mostly in caring for patients at the end-of-life. Their
death attitudes and their involvement in the dying process is a multifactorial and personal process. Aim: To investigate
the death attitudes of nursing staff working in tertiary hospitals and the factors affecting them. Material and Method:
A descriptive study was conducted with a convenience sample of 210 nurses and assistant nurses, employed in two
large oncology hospitals and in one general hospital in Attica, Greece. Data collection was performed between June
to October 2020. Participants completed a demographic questionnaire and the Greek version of the Death Attitude
Profile-Revised (DAP-R) questionnaire. Results. The mean±SD age of the participants was 43±9.9 years and 86.7% of
them were women, with mainly Greek nationality (97.1%). Among them 38.6% worked in oncology hospitals, 61.4%
worked in a large general hospital, 64.3% had higher education, 84.6% had experienced a loss of a loved one and
54.2% had not received help/guidance for the management of end-of-life stage patients. The frequency of participants'
experience of death was associated negatively with the attitudes of "fear of death" (p=0.003) and "death avoidance"
(p=0.001). Receiving help/guidance for the management of dying patients was negatively correlated with the "death
avoidance" attitude (p=0.31). The loss of a loved one was found to be correlated with the attitude "approach acceptance" (p=0.031) and "death avoidance" (p=0.036). Finally, it was found that there was no significant correlation in
death attitudes between participants' workplace (oncology and general hospital) as well as their other occupational
and demographic characteristics, with the exception of the Greek nationality which was found to correlate with a
reduced attitude "neutral acceptance"(p=0.034). Conclusions: The frequency of the experience of nursing staff with
death and dying patients as well as receiving help and guidance, on an empirical or cognitive level, seems to weaken
their negative death attitudes. Therefore, it is suggested that educational and support programs for nurses and health
professionals, are needed to provide knowledge for the management of death, the dying process and the management of families, and this could also shape nurses’s personal attitudes toward death.