Registered Nurses' attitudes towards end‐of‐life care: A sequential explanatory mixed method study

Abstract

AimsTo examine registered nurses' attitudes about end‐of‐life care and explore the barriers and facilitators that influence the provision of high‐quality end‐of‐life care.DesignA sequential explanatory mixed methods research design was used.MethodsAn online cross‐sectional survey was distributed to 1293 registered nurses working in five different hospitals in the Kingdom of Saudi Arabia. The Frommelt Attitudes Towards Care of the Dying Scale was used to assess nurses' attitudes towards end‐of‐life care. Following the survey, a subset of registered nurses were interviewed using individual semi‐structured interviews.ResultsFour hundred and thirty‐one registered nurses completed the online survey, and 16 of them participated in individual interviews. Although nurses reported positive attitudes towards caring for dying patients and their families in most items, they identified negative attitudes towards talking with patients about death, their relationship with patients' families and controlling their emotions. The individual interview data identified the barriers and facilitators that registered nurses experience when providing end‐of‐life care. Barriers included a lack of communication skills and family and cultural and religious resistance to end‐of‐life care. The facilitators included gaining support from colleagues and patients' families.ConclusionThis study has identified that while registered nurses hold generally favourable attitudes towards end‐of‐life care, they have negative attitudes towards talking with patients and families about death and managing their emotional feelings.Relevance to clinical practiceEducation providers and leaders in healthcare settings should consider developing programmes for undergraduate nurses and nurses in clinical practice to raise awareness about the concept of death in a cross‐section of cultures. Nurses' attitudes towards dying patients will be enhanced with culture‐specific knowledge which will also enhance communication and coping methods.Reporting methodThis study used the Mixed Methods Article Reporting Standards (MMARS).

Evaluating ICU nurses’ education, practice, and competence in palliative and end-of-life care in Saudi Arabia: A cross-sectional study

“…In settings where stress levels are naturally high, such as the ICU, where physicians are at the helm of decision-making and communication roles, Sexton et al (2018) propose that there is always an urgent need for nurses to be empowered. Several studies support this view and note the challenges faced by nurses as they engage with families when important decisions are made (Alshammari et al, 2023 ; Alshehri et al, 2022 ; Griffiths, 2019 ; Jung & Matthews, 2021 ; Meilando et al, 2022 ). When nurses are trusted to make decisions, their perceived expertise and efficacy in PEOL care can be boosted.…”

“…In Saudi Arabia, PEOL care was not part of the services made available by interdisciplinary specialties in the past (Alshammari et al, 2023 ). This has changed over the years, as PEOL care is becoming recognized as a priority in the Saudi Arabian healthcare sector, as illustrated by the Saudi Vision 2030 (Saudi Vision, 2022 ).…”

“…The attitudes of nurses and nursing students towards PEOL care have been investigated by several studies, the majority of which indicated favorable attitudes among nurses and nursing students (Alenezi et al, 2022 ; Alshammari et al, 2023 ; Wang et al, 2022 ; Zeru et al, 2020 ). These positive attitudes are encouraging, as they contribute to compassionate and patient-centered care.…”

“…Previous studies have evaluated a broad range of factors influencing PEOL care practice among nurses, including perceived advantages and obstacles, subjective norms, religious beliefs, intention, self-efficacy, skills, knowledge, qualifications, attitudes, experience, education, culture, and age (Alshammari et al, 2023 ; Jeong et al, 2020 ; Soikkeli Jalonen et al, 2020 ; Xu et al, 2023 ). From their studies, Alshammari et al ( 2023 ) and Carvajal et al ( 2019 ) concluded that nurses constantly emphasized the role of support from more experienced colleagues and collaboration with patients’ families in delivering impactful PEOL care. Nonetheless, together with these enablers, some hindrances to effective PEOL care have been noted.…”

“…Yet, navigating this realm is not without its complexities. Nurses frequently encounter challenges in facilitating and managing family participation in these crucial decisions (Alshammari et al, 2023 ; Alshehri et al, 2022 ; Griffiths, 2019 ; Jung & Matthews, 2021 ; Meilando et al, 2022 ).…”