| ObjectivesIn the perspective of constructivism learning theory,build a gradual death theme（hear death-see death-touch death-beyond death）of nurse death education program and to explore the effect of this program on nurses’death attitude,attitude towards caring for dying patients and coping ability of death,and to provide a reference for the development of nurses’death education,and further promote the implementation and promotion of hospice care.MethodsFirst of all,in the perspective of constructivism learning theory,using literature study,expert enquiry and preliminary experiments build nurse death education program,then,the quasi-experimental study design was adopted to select 112 nurses from Anhui Province some three grade a hospital for 1～5 years as the research object,there were 52 cases in the control group,60 cases in the experimental group,6 cases fell off during the training,and 54 cases in the end.The control group received routine training,while the experimental group received death education intervention based on constructivist learning theory on the basis of routine training.The Death Attitude Profile Revised（DAP-R）,The Frommelt Attitude Toward Care of Dying Patients（FATCOD）and The Coping with Death Scale（CDS）were used to evaluate the effects.The measurement points were four times before the training（T0）,during the training（T1）,after the training（T2）and after the training（T3）.The overall changes of each measurement index of nurses in the two groups at different measurement points were analyzed by two-factor repeated measurement ANOVA.The changes of each measurement index of nurses in the experimental group at different measurement points were analyzed by one-way repeated-measure ANOVA.Two independent samples t-test was used for the differences between the two groups at different measurement points.Results1 Construction of intervention plan1.1 Literature research:A total of 15 literatures were included after literature screening.Through content analysis,a draft intervention program for death education was preliminarily constructed,including"hearing death-seeing death-touching death-transcending death".1.2 Experts enquiry:A total of 23 experts from 11 provinces,including Beijing,Shanghai,Guangdong,Hubei,Anhui,Hunan,Xinjiang were selected to carry out two rounds of expert letter consultation in the fields of palliative care,cancer care,nursing management,nursing education and nursing psychology.All of them were female,with an average age of（47.39±5.63）years and working experience of（26.83±6.04）years.Expert judgment basis（Ca）=0.91,expert familiarity coefficient（Cs）=0.84,and expert authority coefficient（Cr）=0.87.The coefficient of variation of each item ranged from 0.04 to 0.18,and the coordination coefficient W of the two rounds of expert consultation was 0.174 and 0.465,respectively（P mean<0.001）.1.3 Final draft of death education intervention program for nurses based on constructivist learning theory:Through literature research,expert letter consultation,pre-test and brainstorming of the research group,the final draft of the intervention plan was formed,including 4 topics and 8 education methods:7 items of hearing death（teaching method+group discussion method）,and the intervention duration was 120minutes.5 items of seeing death（film appreciation method+experience sharing method）,the intervention duration was 150 minutes;5 items of touch death（situational simulation method+value clarification method）,the duration of intervention was 120minutes;Beyond death（life review method+experiential approach）5 items,the duration of intervention is 150 minutes.2 Application of intervention programs2.1 After intervention,the awareness of"living will"increased from 94.44%to 100%,the awareness of"my five wishes"increased from 37.04%to 100%,the awareness of"the way to fill in the living will"increased from 12.96%to 87.04%,and the awareness of"the living will is meaningful to maintain the dignity of patients"increased from96.30%to 100%.2.2 Comparison of the score of the death attitude scale between the two groups（1）The results of two-factor repeated-measure ANOVA showed that the scores of fear of death,avoidance of death and approach acceptance had time effect and interaction effect at different measurement points（P<0.01 or P<0.05）.There was grouping effect on the scores of death fear and death avoidance（P<0.01 or P<0.05）.The scores of fear of death and avoidance of death of nurses in the experimental group showed a gradually decreasing trend,and the scores of receiving dimension showed an increasing trend from before（T0）to after（T2）,but there was no obvious change from after（T2）to 4weeks（T3）.The scores of nurses in the control group fluctuated not significantly.（2）The results of single-factor repeated-measure ANOVA showed that the scores of fear of death,avoidance of death and approach acceptance of nurses in the experimental group had significant differences at different measurement points（P<0.01or P<0.05）.The scores of fear of death and avoidance of death were different between before and during training（T0-T1）,between before and after training（T0-T2）,and between before and after training（T0-T3）.The scores of approaching acceptance dimension were different between before and after training（T0-T2）and between before and after training（T0-T3）.（3）Comparison between groups showed that the scores of death avoidance dimension of nurses in the experimental group were significantly lower than those in the control group at each measurement point（P<0.01或P<0.05）.At the two measurement points after training（T2）and 4W（T3）,the scores of fear of death dimension in the experimental group were significantly lower than those in the control group（P<0.01）,at the post-training（T2）measurement point,the scores of approach acceptance dimension of nurses in the experimental group were significantly higher than those in the control group（P<0.05）.2.3 Comparison of death coping ability scale scores between the two groups（1）The results of two-factor repeated-measure ANOVA showed that there were significant differences in the time effect,interaction effect and grouping effect of the total score of death coping ability and the scores of all dimensions（except the dimensions of death handling ability and life inspection ability）between the two groups（all P<0.01）.The total score and scores of various dimensions of the coping ability of nurses in the experimental group showed a significant upward trend from before（T0）to after（T2）,and a slight downward trend from after（T2）to 4W（T3）,while the changes of scores of nurses in the control group showed no significant fluctuations.（2）The results of single-factor repeated measure ANOVA showed that the total score and the scores of each dimension of the nurses in the experimental group had significant differences at different measurement points（P<0.01 or P<0.05）.The pairwise comparison showed that there were statistically significant differences in the total score of coping ability and scores of all dimensions（except for the dimension of coping ability）before and during the training（T0-T1）（P<0.01 or P<0.05）,the total score of death coping ability and the scores of all dimensions were statistically different before and after the training（T0-T2）and before and after the training 4W（T0-T3）（all P<0.05）,compared with the training（T1-T2）,there were statistically significant differences in the total score of coping ability to death and the scores of all dimensions（except for the ability to deal with death,the ability to examine life and the ability to discuss the death of others）（all P<0.01）,compared with 4W after the training（T1-T3）,there were statistically significant differences in the total score of coping ability to death,the ability to accept death,the ability to deal with loss,and the ability to discuss one’s own death（all P<0.01）.（3）Comparison between groups showed that the total score of coping ability and scores of all dimensions（except the dimension of coping ability and expression ability of thinking about death）of nurses in experimental group were significantly higher than those in control group（P<0.01 or P<0.05）.At the two measurement points after training（T2）and 4W（T3）,the total score of coping ability to death and the scores of all dimensions except for the ability to deal with death of nurses in the experimental group were significantly higher than those in the control group（P<0.01 or P<0.05）.2.4 Comparison of the score of the attitude scale of caring for dying patients between the two groups（1）The ANOVA results of repeated measures for the two factors showed that there were no significant differences in the time effect and interaction effect of the total score of the attitude of caring for the dying patients and the scores of each dimension（all P>0.05）,there was statistically significant difference in the grouping effect of the score of positive attitude dimension of caring for patients at the end of life（P<0.05）.The total score and scores of all dimensions of nurses in the experimental group showed a significant upward trend from before training（T0）to after training（T2）,and a significant downward trend from after training（T2）to 4 weeks after training（T3）,while the change of scores of nurses in the control group was not obvious.（2）The results of single-factor repeated-measure ANOVA showed that there were significant differences in the total score of nurses’attitude towards caring for the terminally ill patients in the experimental group at different measurement points（all P<0.05）.The differences are reflected in the pre-and post-training（T0-T1）,pre-and post-training（T0-T2）,and pre-and post-training 4W（T0-T3）.（3）Comparison between groups showed at the post-training（T2）measurement point,the total score of the attitude of nurses in the experimental group was significantly higher than that in the control group（P<0.05）.At the two measurement points after training（T2）and 4W（T3）,the positive attitude of nurses in the experimental group was significantly higher than that in the control group（P<0.01 or P<0.05）.ConclusionIn the perspective of constructivism learning theory,this study built the progressive death education scheme for nurses（hearing death--seeing death--touching death--surpassing death）has better scientific nature,validity and persistence.able to quickly and significantly alleviate nurse one’s own death negative emotions such as fear,anxiety,promote positive shift its attitude towards death,at the same time to improve the attitude of the nurses are taking care of dying patients,to improve their ability of dealing with death,can be used as a primary nurse death education courses,realize their own attitude toward death as the prerequisite to improve the nurse’s death education mode.At the same time,this study found that the scheme in the aspect of improving the durability of the nurses are taking care of dying patients’attitude,and the effect is not ideal in terms of dealing with death,so the team will die in the subsequent advanced sex nurse education training focus on increase of death and dying process and debugging related training,at the same time,strengthen the simulations and the application of experiential training methods,to further consolidate the training effect,to ensure the durability of the effect. |
PDF Full Text Request