The effects of death preparation education program on the death anxiety, death attitude, and attitudes toward end-of-life care of nurses in convalescent hospitals 

Chu Eun-yeong

Department of Nursing

Graduate School of Changshin University

The purpose of this study was to examine the effects of the death preparation education program for nurses those who were working for the convalescent hospitals on death anxiety, death attitude, and attitudes to end-of-life care. The study design was a quasi-experimental study of non-equivalent control group with a pre-test and post-test design. 

The participants of the study were nurses who had been working for the convalescent hospitals in the C city that were accredited as a class-2-hospital or better by the appropriateness tests of the Health Insurance Review and Assessment Service.

Being used by G*Power 3.1 program, based on the effect size (d)=.5, power of .80 and significance level of .05 with a 10% attribution rate in mind, 60 subjects were selected. However, when the study completed, the only 53 subjects were remained; being eliminated 4 out of the experimental group(n=26) and 3 out of the control group(n=27) respectively. 

The death preparation education program ran from July. 2 to August. 11, 2018. The program contents were included as following; understanding the meaning of life and death, mystery of life, the meaning of life, the meaning of death, preparing for death, vicarious experiencing death, sorrow and loss, a life of fullness, orientation and wrap-up session. The program was performed as the formats of lecture, video watching, group discussion and sharing and consisted of 10 sessions, twice a week, for 5weeks, 90 minutes per session. The pre-test for the experimental group was performed just before the beginning of the program, and the post-test was performed at the end of the program of the 10th session. The pre-test and the post-test for the control group were adapted in the same manner as the experimental group except for the intervention. 

Death anxiety was measured using the Fear of Death Scale (FODS) developed by Collett and Lester (1969), revised by Lester and Abdel-Khalek (2003), and adapted by Kim Bok-yeon et al. (2015). Death attitude was measured using an instrument developed by Go Seung-deok et al. (1999) based on the FODS developed by Collett and Lester (1969) as well as a tool modified and supplemented to fit the characteristics of the participants of the present study by referring to the data of Kim Eun-hui (2006). Attitudes toward end-of-life care were measured using the Frommelt Attitudes toward Nursing Care of Dying Scale (FATCOD) developed by Frommelt (1991) and translated by Jo Hye-jin and Kim Eun-sim (2005).

Descriptive statistics were used to analyze the general characteristics of the participants, and Chi-square test, independent t-test, and Fisher’s exact test were used to compare the general characteristics of the experimental and control groups and test the homogeneity of the dependent variables before the experiment using SPSS/WIN 21.0. The effectiveness of death education was tested using the paired t-test, and the hypothesis test after the experimental treatment to the experimental and control groups was performed using the independent t-test.

The results of this study were as follows.

The first hypothesis, “The level of death anxiety in the experimental group participated in the death preparation education program, will be lower than that of the control group, which did not participate in the death preparation education program,” was supported in that the average score of the experimental group (2.40 points) for death anxiety was significantly lower (t=7.62, p<.001) than that of the control group (3.48 points) after the experiment. 

The second hypothesis, “The death attitude of the experimental group, which participated in the death preparation education program, will be more positive than that of the control group, which did not participate in the death preparation education program”, was supported in that the average score of the experimental group (4.13 points) for death attitude was significantly higher (t=7.58, p<.001) than that of the control group (3.37 points) after the experiment.

The third hypothesis, “The attitudes toward end-of-life care of the experimental group, which participated in the death preparation education program, will be more positive than that of the control group, which did not participate in the death preparation education program”, was supported in that the average score of the experimental group (3.54 points) for attitudes toward end-of-life care was significantly higher (t=-10.30, p<.001) than that of the control group (2.91 points) after the experiment.

Based on the findings above, the significance of this study lies in the fact that the death preparation education program used in this study searched for a specific intervention measure that reduced death anxiety and derived positive changes related to death attitude and attitudes toward end-of-life care of nurses in convalescent hospital. Accordingly, the application of the death preparation education program developed in this study in clinical sites where dying patients are nursed appears to be useful.

Keywords: death education, convalescent hospitals, nurses, death anxiety, death to attitude, terminal care attitude