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RESEARCH PAPER
Emergency and palliative care nurses’levels of anxiety about death and copingwith death: A questionnaire survey
Louise Peters, RN, PhD a,∗Robyn Cant, PhD a
Sheila Payne, PhD b
Margaret O’Connor, RN, DN a
Fiona McDermott, PhD a
Kerry Hood, RN, MN a
Julia Morphet, RN, MN a
Kaori Shimoinaba, RN, PhD a
a Monash University, School of Nursing and Midwifery, Melbourne, Vic., Australiab Lancaster University, Faculty of Health & Medicine, 224 Bowland Tower South, Lancaster, UK
Received 18 December 2012 ; received in revised form 5 August 2013; accepted 5 August 2013
KEYWORDSAttitude to death;Death;Emergency nursing;Palliative carenursing
SummaryBackground: Caring for dying patients and their families presents many challenges, and may benegatively affected by nurses’ Fear of Death. This study investigates attitudes of emergencyand palliative care nurses towards death and dying.Methods: A mixed methods design including questionnaire and interview, was utilised. Thispaper reports questionnaire results from the Death Attitude Profile-Revised Scale and copingskills.
Results: Twenty-eight emergency nurses and 28 palliative care nurses from two health servicesparticipated. Nurses held low to moderate Fear of Death (44%), Death Avoidance (34%), Escape
Please cite this article in press as: Peters L, et al. Emergency and palliative care nurses’ levels of anxiety about death andcoping with death: A questionnaire survey. Australas Emerg Nurs J (2013), http://dx.doi.org/10.1016/j.aenj.2013.08.001
Acceptance (47%) and Approach Acceptance (59%). Emergency nurses reported higher deathavoidance and, significantly lower coping skills than palliative care nurses. Both reported highacceptance of the reality of death (Neutral Acceptance 82%), and indicated they coped betterwith a patient who was dying than with, the patient’s family.
Conclusions: Nurses generally held positive attitudes towards death and dying. Participants couldcope with caring for dying patients, but were significantly less comfortable coping with patients’family members. Nurses should be aware of the impact their attitude towards death may haveon providing supportive nursing care for the dying.
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The contrast in death experiences between palliativecare and emergency department settings is well recognised,
• Individuals’ beliefs and attitudes towards death areinfluenced by their personal belief systems.
• Caring for dying patients can present challenges.Issues such as nurses’ Fear of Death can have animpact on nursing care particularly when caring fordying patients.
• Evidence suggests that the ability of health pro-fessionals to deal with death and dying requiresimprovement.
What this paper adds
• This study showed nurses had moderate levels ofdeath anxiety no higher than nurses in other workspecialties.
• Both emergency and palliative care nurses were sig-nificantly less comfortable coping with a patient’sfamily members than with the patient.
• Coping was mediated by the nurses’ older age andmore experience in nursing.
• This study has raised issues that chart current dilem-mas in the institutional care of patients at the endof their life.
ntroduction
ersonal, cultural, social and philosophical belief systemsnfluence individual’s attitudes towards death.1,2 Studiesuggest that nurses’ attitudes towards death may influencehe supportive behaviours they provide when caring for aying patient.3 The clinical setting has also been reportedo influence care provided to the dying patient and theiramily.4—6 In the emergency department (ED), the competingemands of other patients, and poor structural design fail torovide either the time or privacy required to provide opti-al end of life care.4,6 Alternatively, palliative care nurses
requently deal with death and dying.7 This study inves-igates the attitudes of emergency nurses and palliativeare nurses to death and dying, and explores how partic-pants perceive they cope with death in the professionaletting.
ackground
he World Health Organisation (WHO) defines palliative care
Please cite this article in press as: Peters L, et al. Emergency ancoping with death: A questionnaire survey. Australas Emerg Nur
s ‘‘an approach that improves the quality of life of patientsnd their families facing the problem associated with life-hreatening illness, through the prevention and relief ofuffering by means of early identification and impeccable
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ursing Australasia Ltd. Published by Elsevier Ltd. All rights
ssessment and treatment of pain and other problems, phys-cal, psychosocial and spiritual’’.8 par.1 End of life (EOL) cares generally considered to be the care provided in the ‘‘lastew days of life, when a person is irreversibly dying, alsonown as the terminal phase’’.9 par.5 In the ED, EOL care haseen defined as the care delivered during the time directlyreceding death.10
Palliative and end of life care is delivered over a periodf weeks to months or years, in the home or within a spe-ialty palliative care setting.5,11 In contrast, death in the EDay be sudden, and can occur within hours of the patientresenting. EOL care can however, include interventions toctively prevent death.5
In the palliative care setting, death may be antici-ated, planned and facilitated. The ED workplace cultures ‘rescue-oriented’, and death is perceived as preventable.ypically patients presenting to the ED are unexpected andnknown to ED staff. In these circumstances, it can be dif-cult to know whether the illness or condition is potentiallyeversible. In a setting where the focus is on cure, death cane seen as a failure of treatment, rather than something toe welcomed.12—14 Further, the suddenness of the presen-ation means there is no relationship between ED staff andhe patient or family, and this makes meeting family needsore difficult.Time and workload have been reported as obstacles to
he delivery of optimal EOL care in the ED.6 Patients areorted in order of priority, by severity of illness or injury.mergency nurses need to prioritise the demands of caringor those who have a chance of survival, with the needs ofn actively dying person.5,15
Palliative care nurses are confronted by death on a dailyasis, and there is an assumption that nurses selecting thiseld of work will feel comfortable with the open acknowl-dgement of death and dying.14 Death in palliative care isxpected and anticipated by family members. By contrast,eath in ED is frequently traumatic and unexpected by fam-ly members, and bereaved family members need support.16
Both culture and religious faith impart particular beliefsbout death and dying.2,17 Exposure to death has also beenound to influence the way nurses perceive death.14 It haseen reported that exposure to the death of others can makendividuals conscious of their own mortality, giving rise tonxiety and unease. ‘Death anxiety’ is described as a feel-ng of dread, apprehension or solicitude (anxiety) when onehinks of the process of dying, or ceasing to ‘be’.18 Deathnxiety has been reported to negatively affect the qualityf care nurses provide to dying patients.2,19,20
d palliative care nurses’ levels of anxiety about death ands J (2013), http://dx.doi.org/10.1016/j.aenj.2013.08.001
ith ‘sudden, traumatic’ deaths in the ED, and expected,acilitated deaths in palliative care. Given these opposingxperiences, it might be presumed that nurses within eachpecialty would have opposing views on death, contrasting
levels of death anxiety, and therefore differing foci inpatient care.
A UK study compared the levels of death anxiety betweenhospice nurses and emergency nurses. It found the levels ofdeath anxiety were similar, although one-quarter of emer-gency nurses showed both less acceptance of death andmore fear than hospice nurses.14 This trend was also foundin another study.21
The present study arose from a need to explain theapproaches to death and dying of Australian nurses whoare frequently exposed to death and dying in emergencydepartments and in palliative care services. The study aimedto answer the research questions: (i) Do both emergencydepartment nurses and palliative care nurses experienceanxiety about regular patient deaths? and (ii) how do nursesin these units perceive they cope with exposure to frequentpatient deaths? The findings would form the basis of inter-ventions to support emergency nurses and palliative carenurses, aiming to ultimately improve the quality of care thatis provided to dying patients and their families.
Materials and methods
This study is a replication of the study by Payne et al.14
using questionnaire and in-depth interview of 43 nurses.This paper reports the results of the first phase of thestudy a quantitative survey. Nurses employed in the emer-gency department or the in-patient palliative care unit oftwo metropolitan health services in Melbourne, Australiawere invited to participate. On average, per week, 2—3deaths occurred in the selected emergency departments and8—10 in the palliative care units. Aiming for an equal num-ber of ED and PC nurses, a convenience sample of nurseswas recruited through key staff members and researcherattendance at education sessions. The design of the studyprecluded recruitment of a sample larger than 60. The ques-tionnaire was administered individually to the nurses priorto conducting interviews. Data was collected by trainedresearchers between November 2011 and April 2012.
Survey instruments
All participants completed a paper-based questionnaire.This incorporated a demographic survey with questionsabout age, gender, nursing qualifications, and length ofnursing experience in speciality. They subsequently com-pleted the Death Attitude Profile-Revised (DAP-R) scale.22
The 32-item Likert scale measures attitudes towards death,incorporating five sub-scales. These are: (i) Fear of Deathincludes fear of death and fear of the death of significantothers (7 items); (ii) Neutral (or natural) Acceptance mea-suring the extent to which a person accepts the reality ofdeath in a natural manner and neither fears it, nor wel-comes it (5 items). (iii) Approach Acceptance about belief inan afterlife (10 items), (iv) Escape Acceptance measures theoption of death as an alternative to a miserable life (5 items)and, Death Avoidance measures attempts to avoid thoughts
Please cite this article in press as: Peters L, et al. Emergency ancoping with death: A questionnaire survey. Australas Emerg Nur
about death (5 items). Responses ranged from 1 (stronglydisagree) to 7 (strongly agree). On the original scale thesubscales had demonstrated good validity and acceptablereliability ranging from .65 (Neutral Acceptance) to a high
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f .97 (Approach Acceptance).22 Response options were pre-ented as a mix of negative and positive items, each ratedetween 1 and 7. This scale has been used to examinehe attitudes of registered nurses13,23 as well as those inarious specialties including palliative care and emergencyurses.14,24
As a measure of nurses’ perceptions of personal cop-ng skills, four additional researcher-designed questionsere posed: the Clinical Coping Skills Questionnaire-Peters:
CCSQ-P). The questions are given in Table 3. Each item wasated from 1 (not coping at all) to 10 (coping extremelyell). Open-ended comments were also invited. Two ques-
ions invited textual commentary. These were: Why did youhoose to work in this specialty? and Further comments, forxample, regarding coping with death and dying situationsn your clinical area? Face validity of this section was exam-ned by ED and PC nurse experts in the research team, andhe whole survey was pilot-tested by both PC and ED nurses.
nalysis
he statistics software IBM-SPSS 20 (IBM, Chicago, Ill: 2011)as used for data analysis. The statistical analysis pur-osely followed the analysis strategies of the primary studyy Payne et al. that had applied parametric statisticalnalysis because this would allow direct comparison ofhe key results. Factor scores for the DAP-R scale werebtained from the sum of subscale scores. This scoringechnique allowed comparison between factors with a vary-ng number of items with variable dispersion. In line withnalysis of metric scales25 Pearson product-moment corre-ation coefficients and t-tests of independence were used toest for differences between related variables. p ≤ 0.05 wasegarded as significant. Open-ended responses were clus-ered by theme and quotations were selected to representhe views of both ED and PC nurses.
Approval to conduct the research was given by Monashniversity Human Research Ethics Committee and the ethicsommittees of the two health services’ approved the partic-pation of nurses.
esults
eplicating the study by Payne et al. and the sample size,14
6 registered nurses participated: 28 from two emergencyepartments and 28 employed in two specialist palliativeare inpatient units.
articipant characteristics
he nurses were predominantly female with a median agef 41years (Table 1). All were registered nurses and expe-ienced in terms of both years in nursing and years in theirlinical specialty. Almost half held postgraduate qualifica-ions that were mainly related to their clinical specialty;ither in PC or emergency care or critical care.
d palliative care nurses’ levels of anxiety about death ands J (2013), http://dx.doi.org/10.1016/j.aenj.2013.08.001
The PC nurses were significantly older than ED nurses by0 years on average (47 versus 36) (t (56) = 3.488, df 54,
= .001; CI 4.51—16.70). In addition, PC nurses had signif-cantly more years of experience in nursing (t (56) = 4.290,
Years of nursing experience8.54 21.4 14.84 ± 12.62 (range 1—43)
Years employed in nursing specialty
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a ED, emergency department; PC, palliative care unit.
f 54, p = .000; CI 6.72—18.50) averaging 21years (ED: 8.5;C 21.4), and reported more years in their clinical specialtyPC mean 7.14; ED 3.93) (t (56) = 2.247, df 54, p = .29; CI35—6.08). There was no between group difference in theroportion with a post-graduate qualification.
AP-R scale results
he 32-item DAP-R scale exhibited a high internal consis-ency reliability with a Cronbach Alpha of 0.81 comparedith an expected ˛ > 0.80.26 The scale included five atti-
ude domains, or factors: Fear of Death, Death Avoidance,eutral Acceptance, Approach Acceptance and Escapecceptance. The computed subscale scores are shown inable 2. The average DAP-R score was 53%. Overall, thearticipants’ factor scores were: Fear of Death 44%; Deathvoidance 34%; Neutral Acceptance 82%; Approach accep-ance: 59%; Escape acceptance: 47%. Each of the factorsperated as independent scales with an adequate Cron-ach alpha, with correlations ranging from 0.69 for Neutralcceptance to 0.93 for Death Avoidance which aligned withhe reliability of the primary instrument.22
When the factor scores were examined by specialty,nly one of the five attitude subscales was significantlyssociated with the nurses’ work environment. ED nursesad a significantly higher score on Death Avoidance (t56) = −.2.138, df 38.29, p = .039; CI −7.44 to −.20) show-ng that ED nurses had a stronger attitude towards avoidingeath than PC nurses. See Table 2 (PC nurses: 10.00 ± 4.01ersus ED 13.82 ± 8.56). There was a trend of greaterear of Death in ED nurses (mean 23.9 versus 19.2 in PCurses). There was no significant association of the nurses’emographic characteristics (age, years in nursing, yearsn speciality, postgraduate qualification) with the factorcores.
With few differences in attitudes demonstrated betweenurses by work group, the association of attitudinal factorsas explored. There were strong inter-correlations (i.e., >5)etween three DAP-R factors. Death Avoidance and Fear of
Please cite this article in press as: Peters L, et al. Emergency ancoping with death: A questionnaire survey. Australas Emerg Nur
eath were inversely associated with Neutral Acceptancep = −.506; p = −.452: both: p = .000), with a strong posi-ive association between Death Avoidance and Fear of Deathp = .701; p = .000). This indicates that those participants
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7.14 5.54 ± 5.55 (range 0—30)
ho held stronger attitudes towards Fear of Death wereess likely to view the reality of death in a natural manner,either fearing nor welcoming it.
erceptions of coping and coping by work settingork specialty was a predictor of nurses’ perception of cop-
ng. Ratings on four items of the CCSQ-P asking nurses aboutheir perceived level of coping with death and dying were alln the positive domain: overall mean 29.14 ± 6.39 (ED: 26.8;C: 31.6) out of a possible 40. An independent samples t-testhowed that each item was significantly associated with theurses’ work unit and that ED nurses reported lower copingkills (p = .002—.031) (Table 3).
In addition to nursing specialty, nurses’ age and yearsf nursing experience influenced coping responses. Thereas a moderate significant effect of age on scores forll four coping items (older nurses were more positive)p = .000—.042) and similarly with length of nursing expe-ience (p = .002—.023). Conversely, the duration of specialtyursing experience was not associated with coping with onlyne item implicated, and there was no significant effect ofostgraduate qualifications on coping perceptions.
A stronger attitude to Death Avoidance in ED nurses (aore negative view) and a trend of greater Fear of Deathas reported earlier. All four coping items were significantlyegatively related to attitudes to Death Avoidance and toear of Death (ranging from −.396 to −.546). There was nossociation between coping items and the other factors.
ED nurses reported significantly lower mean coping skillsor each item than PC nurses, and both groups rated theirevel of coping with family members lower than coping with
patient who was dying or had died. In open-ended com-ents, ED nurses described their experiences of death aseing unique: ‘‘it is different in ED because many of theeaths are unexpected and traumatic, rather than orga-ised, planned, progressive expected death’’. PC nursesoiced an objective of helping a patient and their familyembers to experience ‘‘a good death’’. As seen in Table 4,uotations from both groups are used to illustrate nurses’erceptions of coping in the different work environments.
d palliative care nurses’ levels of anxiety about death ands J (2013), http://dx.doi.org/10.1016/j.aenj.2013.08.001
The four coping items of the CCSQ-P were found reliables a scale (Cronbach alpha .912). Each item was signifi-antly positively associated (p = .000), with strong inter-itemorrelations (between .62 and .89: mean .72) and an
* Significant difference p ≤ .05; PC, palliative care nurses; ED, em
intra-class correlation coefficient of .71 for single measures.This suggests the results present reliable data about nurses’perceptions of coping.
Discussion
The overall study results found similar attitudes in EDnurses and PC nurses according to the Death AttitudeProfile-Revised Scale, although, importantly, also a signifi-cant difference for one of five DAP-R subscales. The resultswhen grouped by the DAP-R subscales showed ED nursesheld significantly stronger attitudes towards avoiding death,according to the factor Death Avoidance (39.5% versus PC:28.5%). This factor, including five items such as ‘I avoid deaththoughts at all costs’; ‘I try to have nothing to do with thesubject of death’; ‘I always try not to think about death’and so on, measures attempts to avoid thoughts about deathas suggested by Wong et al.22 However, it should be notedthat these ratings below 40% indicated a low range of con-cern on a scale from 1 to 7, suggesting nurses voiced littleconcern about avoidance of thinking about death. A mod-erate attitude was mirrored in the factor Fear of Death,with the ED nurses’ score of 49%, versus a lower attitude
Please cite this article in press as: Peters L, et al. Emergency ancoping with death: A questionnaire survey. Australas Emerg Nur
to fear of death of 39% for PC nurses although this trendwas not found to be significantly different beyond chance(p = .052). This concurs with results of Payne et al.’s compar-ative study of emergency nurses and hospice nurses in the
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ncy nurses; ratings: 1 (not coping at all) to 10 (coping very well).
K that reported emergency nurses had stronger attitudesowards Death Avoidance and some significant differencesstronger fear) in the Fear of Death items.14 Further com-arison was limited as full results of subscale scores wereot reported.
urses shared moderate death anxiety
he results indicate, however, that although both ED andC nurses are exposed to death (with PC nurses experienc-ng death more frequently) in the course of their work, theverage death anxiety score derived from both groups at3% on the DAP-R scale, was moderate rather than high. Thisas confirmed in results for Fear of Death (44%); Approachcceptance (59%) related to nurses’ belief in an afterlife,nd in Escape Acceptance (47%) that assessed the option ofeath as an escape, as an alternative to a miserable life,nd low scores for Death Avoidance (34%). Furthermore, acore of 82% for Neutral Acceptance indicated nurses’ strongcceptance of the idea of the reality of death as a naturalccurrence, with an accompanying neutral attitude- neitherearing it, nor welcoming it.
Although studies of ED and PC nurses using DAP-R are
d palliative care nurses’ levels of anxiety about death ands J (2013), http://dx.doi.org/10.1016/j.aenj.2013.08.001
carce, the strength of nurses’ death anxiety could beompared with nurses in other specialties. Oncology andedical-surgical nurses in USA were found to have an aver-
ge death anxiety score of 64%.13 Another study of hospital
Table 4 Perceptions of patient deaths and impact of workplace environment.
Emergency department nurses’ quotations Palliative care unit nurses’ quotations
Work environment Death was poorly managed in ED (particularlypalliative care) — I’m glad we have newpathways/protocols for this but I think we allneed further education
Support within your work environment isextremely important and can determine howwell you cope in all situations
I think we need counselling/debriefingopportunities
Having debriefing sessions helps
Coping with patient deaths I am comfortable with timely, expected deathsfar more so than young, tragic or unexpecteddeaths
. . .can provide satisfaction in the workenvironment that you have achieved your rolein providing patients and their families anexperience in a ‘good death’
The hardest part is children and babies dying-hard to grasp
Every death and every family are different andhow well I cope depends on their ability andacceptance to a degree
If the person dying is a Christian (bornagain/belief in Jesus) I believe a person isgoing to heaven to rest- otherwise hellfire.Hence, fear
Helping people get specialist care in a field notspoken of in public is a great feeling
I‘m also older than many of my peers, I thinklife experience helps
My personal view of death is — death is part oflife, and life a precious gift.
Coping with patient’s familymembers
I’m very unsure of what to say to immediateand extended family members
A patient’s death itself rarely stresses me, butdealing with difficult family, conflict ordifferent opinion among team members werestressing sometimes
I think I am able to comfort relatives fairly well A good death makes a lot of difference to thefamilies grieving process- supportive caringnurses are comforting to the family andprocess
[We need] education sessions outliningstrategies when dealing with patients andfamilies
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nd visiting nurses in USA found that the DAP-R scores aver-ged 60%, with Fear of Death 52% and Death Avoidance6%.27 In that study, nurses’ attitudes were significantlyelated to their gender, religious affiliation and current con-act with terminally ill patients. Of interest, nurses whoared for few dying patients per month had significantlyigher Death Avoidance scores than those who cared forore than 10 dying patients per month. Following this think-
ng, renal nurses in Greece who worked in hospital palliativeare teams or supportive care teams had statistically signif-cant different relationships with fear of death and neutralcceptance scores compared with other renal nurses in theervice.28 Thus there is an argument that nurses who haveittle experience of death and dying will have higher deathnxiety than colleagues who have longer nursing experiencend others such as PC nurses who frequently experience theerminal phases of a patients’ life. A survey of 190 registeredurses in USA using a different death anxiety scale confirmedhat nurses’ discomfort decreased as age, education, andursing experience increased.3
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oping skillslthough all nurses’ reported positive ratings for copingkills (Mean 29.1 of a possible 40) ED nurses consistently
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eported significantly lower coping regarding dealing with patient who was dying or had died, and for dealing withamily members. This fits with descriptions of the naturef death and dying in the ED; usually a sudden, unexpectedvent that occurs ‘in the company of strangers’ as clinicians,atients, and family members are thrown together in a timef sudden crisis for the patient. While some patient deathsay actually be expected — categories described by Chan29
s: ‘terminally ill and comes to the ED’, or ‘frail and hov-ring near death’, the ED remains an environment that isot designed to facilitate care of the dead or dying. Theres pressure for emergency nurses to work productively withultiple and conflicting clinical priorities.5 As this authorescribes, the ED culture, built environment and organi-ational focus is on rapid decision making, stabilisation of
patient and moving them out of the ED. There is littleime for anticipatory grief, or dealing with the emotionalssues surrounding death. In Australia, a national hospitalccess policy mandates that patients only remain in emer-ency units for 4 h before being discharged or admitted orransferred elsewhere.30 The time pressure on nurses to dis-
d palliative care nurses’ levels of anxiety about death ands J (2013), http://dx.doi.org/10.1016/j.aenj.2013.08.001
harge patients serves to highlight this lack of availability ofatient support.
Notwithstanding the environment and policy whichuides the delivery of care, ED nurses in the current study
reported experiencing unexpected and traumatic patientdeaths. In such circumstances, they had trouble finding thewords to speak with families of dying patients and hoped fordebriefing discussions and staff education in their unit thatwould assist them. Nurses with longer experience in nurs-ing and of more advanced age rated their coping skills assignificantly higher. Salomé et al.31 found that emergencyroom nurses in Brazil were committed to the preservationof life and experiencing deaths induced feelings of sad-ness, loss, fear and failure. In USA the comfort level ofemergency nurses when communicating with dying patientsor their families was found to be adversely affected byan increase in the nurse’s own death anxiety.3 These feel-ings could be ameliorated, however, by death education fornurses, as was shown in several studies of nurses’ anxietyaround end of life care.3,24,32 Nurses’ comments (Table 4)suggested that sources of support in the workplace such asdebriefing, development of communication skills in dealingwith grieving families were thought valuable. These mayoffer emergency nurses greater confidence to care for thedying and enable them to fulfil the demanding role of car-ing for survivors by orchestrating supportive care for familymembers.33
OutcomesBased on prior studies that report younger age as com-monly associated with higher death anxiety in nurses3,27,28
and on our results that implicated younger age and shorternursing experience with a lack of coping, this study isable to answer the research questions. We conclude thatboth hospital emergency department nurses and palliativecare nurses had moderate death anxiety but differed intwo ways: ED nurses were more anxious regarding the fac-tor ‘avoiding death’ and were less likely than PC nursesto feel comfortable when dealing with death and dying.When examined by the DAP-R instrument and by a copingskills scale (CCSQ-P), PC nurses with greater nursing experi-ence and more life experience induced by their older agereported significantly higher perceptions of coping skills.A greater focus on nurse education may ultimately helpto improve care of the dying.24 A recent review of litera-ture identified a need for nurses to have insight into theirpersonal beliefs about death and dying.24 Nurses who hada more positive attitude towards death were more likelyto have a positive attitude towards providing end of lifecare for patients. Little was known about these factorssuggesting a need for further research into the topic ofdeath anxiety in palliative care and emergency departmentnurses.
Several limitations to this research are recognised. Atti-tudes to death are complex human phenomena and it maybe that the instrument used may not capture all aspects.Research techniques such as surveys are subject to biasof self-reporting.34 A small sample of registered nursesrecruited by convenience and drawn from two health ser-vices may not represent the views of all nurses in the
Please cite this article in press as: Peters L, et al. Emergency ancoping with death: A questionnaire survey. Australas Emerg Nur
specialty and a larger sample may have been able tobetter discriminate between work groups. Nevertheless,the study has raised issues that chart current dilemmasin the institutional care of patients at the end of theirlife.
PRESS7
onclusion
ursing care of the dying is a particularly demanding rolehat requires nursing skill and experience in nursing. Theurrent study revealed moderate levels of death anxietyn nurses in emergency departments and palliative carenpatient units that were no higher than those of nursesn other work categories. Emergency and palliative careurses, while positive about their skills to cope with deathnd dying, were significantly less comfortable coping with aatient’s family members than with the patient. However,oping was mediated by the nurses’ older age and morexperience in nursing. Nurses need to be made aware of thempact of their own attitudes to death in order that they ful-l a supportive nursing role, orchestrating appropriate care
ncluding physical, psychological, social and spiritual careor the dying.
unding
his research study was funded by a grant from the Schoolf Nursing and Midwifery, Monash University, Melbourne,ustralia.
uthorship
P and MO secured funding; LP and RC developed the studyrotocol; LP and RC conducted data collection and LP andC analysed the data. RC and LP prepared the manuscriptith SP, MO, FM, JM, KH and KS providing critical reviewf important intellectual content. All authors approved theanuscript.
rovenance and conflict of interest
ll the authors on this research project have no financial orther conflict of interest in this project. This paper was notommissioned.
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