Lee Shu-Ling, Wu Hung-Lan
MS, RN, Supervisor, Department of Nursing, Taitung MacKay Memorial Hospital, Taiwan, ROC.
PhD, RN, Associate Professor, Graduate Institute of Long-term Care, Tzu Chi University, Taiwan, ROC.
Hu Li Za Zhi. 2024 Oct;71(5):58-69. doi: 10.6224/JN.202410_71(5).08.
End-of-life care in long-term care institutions is increasingly important. Nursing assistants are the primary care workforce, and their end-of-life care capabilities affect the quality of care provided to residents as well as residents' physical and mental health.
This study was designed to explore the life attitudes, fear of death status, end-of-life care abilities and experience, and coping styles of nursing assistants in long-term care institutions in the eastern region and the effects of these variables on care.
A cross-sectional, mixed-methods research design was used. The study included 165 nursing assistants working in long-term care facilities in Taitung and Hualien counties. The study questionnaire included items covering life attitudes, fear of death, and dying care abilities. In addition, in-depth interviews were conducted with 12 of the participants.
Most of the participants held positive attitudes toward life and reported having a low to moderate fear of death. A significant and positive correlation between life attitude and dying care ability was identified (r = .426, p < .001). Although average ability to provide physical care to residents at end of life was found to be relatively good, ability to provide emotional support and allow residents to express their emotions was generally poor. The scales of fear of death, life attitude toward love and care, ideals, and high school education were identified as significant predictors of dying care ability, together explaining 22.8% of the variance. The interview results were summarized into five major themes that also echoed the quantitative results.
CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Attitudes toward life and fear of death partially were shown to influence the dying care ability of the nursing assistants in this study. Dying care skills should be strengthened in nursing assistants, and they should be encouraged to explore the meanings of life and death through on-the-job education. Also, long-term care institutions should show concern for and support their nursing assistants by sponsoring case discussions, care experience sharing sessions, and support groups.
长期护理机构中的临终关怀日益重要。护理助理是主要的护理人员，他们的临终关怀能力会影响为居民提供的护理质量以及居民的身心健康。
本研究旨在探讨东部地区长期护理机构中护理助理的生活态度、对死亡的恐惧状况、临终关怀能力与经验以及应对方式，以及这些变量对护理的影响。
采用横断面混合方法研究设计。该研究纳入了165名在台东县和花莲县长期护理机构工作的护理助理。研究问卷包括涵盖生活态度、对死亡的恐惧和临终关怀能力的项目。此外，对12名参与者进行了深入访谈。
大多数参与者对生活持积极态度，报告对死亡的恐惧程度为低到中度。确定生活态度与临终关怀能力之间存在显著正相关（r = 0.426，p < 0.001）。尽管发现护理助理在为临终居民提供身体护理方面的平均能力相对较好，但提供情感支持和让居民表达情感的能力普遍较差。对死亡的恐惧、对爱与关怀的生活态度、理想和高中教育程度被确定为临终关怀能力的显著预测因素，共同解释了22.8%的方差。访谈结果总结为五个主要主题，也与定量结果相呼应。
结论/对实践的启示：本研究表明，生活态度和对死亡的恐惧部分影响了护理助理的临终关怀能力。应加强护理助理的临终关怀技能，并鼓励他们通过在职教育探索生与死的意义。此外，长期护理机构应通过主办病例讨论、护理经验分享会和支持小组来关心和支持其护理助理。
