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Quality of palliative nursing care: Meaning, death anxiety, and the mediating role of well-being

Published online by Cambridge University Press:  10 February 2022

Mar Zulueta Egea Open the ORCID record for Mar Zulueta Egea [Opens in a new window] ,
María Prieto-Ursúa ,
Laura Bermejo Toro  and
Rafa Jodar Anchía
Mar Zulueta Egea*
Affiliation:
Nursing, Centro Universitario de Ciencias de la Salud San Rafael-Nebrija, Madrid, Spain
María Prieto-Ursúa
Affiliation:
Psychology Department and Clinical Unit of Psychology (UNINPSI), Comillas Pontifical University - Cantoblanco Campus, Comunidad de Madrid, Spain
Laura Bermejo Toro
Affiliation:
Psychology Department and Clinical Unit of Psychology (UNINPSI), Comillas Pontifical University - Cantoblanco Campus, Comunidad de Madrid, Spain
Rafa Jodar Anchía
Affiliation:
Psychology Department and Clinical Unit of Psychology (UNINPSI), Comillas Pontifical University - Cantoblanco Campus, Comunidad de Madrid, Spain
*
Author for correspondence: Mar Zulueta Egea, Nursing, Centro Universitario de Ciencias de la Salud San Rafael-Nebrija, Madrid, Spain. E-mail: mzulueta@nebrija.es
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Abstract

Background

There is increasing concern regarding the quality of palliative nursing care. However, despite the growing number of studies identifying related variables, there is still a paucity of studies analyzing models of how these variables interrelate.

Objective

The study aimed to identify the role played in the quality of palliative care of nursing professionals by the variables meaning and death anxiety and to investigate the mediating role of psychological well-being and engagement.

Method

176 palliative nursing professionals participated, selected by non-probabilistic convenience sampling using the snowball method. A simple mediation analysis and a multiple mediator model were performed in parallel, and data were collected using a paper and online questionnaire between January and May 2018.

Results

Well-being mediated the impact of meaning (indirect effect = 0.096, SE = 0.044, 95% confidence interval (CI): 0.028, 0.213) and death anxiety (indirect effect = −0.032, SE = 0.013, 95% CI: −0.064, −0.010) on the quality of care. Engagement, on the other hand, only mediated the impact of meaning (indirect effect = 0.185, SE = 0.085, 95% CI: 0.035, 0.372), while the indirect effect of death anxiety with the quality of care through engagement was not statistically significant (indirect effect = 0.008, SE = 0.009, 95% CI: −0.004, 0.032).

Significance of results

Death anxiety is not directly related to the quality of care, but rather has an effect through psychological well-being, a variable acting as a mediator between the two. The effect of meaning on the quality of care is explained by the mediation of both engagement and psychological well-being, and its impact on the quality of care is thereby mediated by more variables than death anxiety.

Keywords

Death anxietyHospice and palliative care nursingMeaningPsychological well-beingQuality of care
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 2 , April 2023 , pp. 205 - 213
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

REFERENCES

Ablett, JR and Jones, RSP (2007) Resilience and well-being in palliative care staff: A qualitative study of hospice nurses’ experience of work. Psycho-Oncology 16, 733–740. doi:10.1002/pon.1130CrossRefGoogle Scholar
Bakker, AB, Rodríguez-Muñoz, A and Derks, D (2012) La emergencia de la psicología de la salud ocupacional positiva. Psicothema 24(1), 66–72.Google Scholar
Barnett, MD, Moore, JM and Garza, CJ (2019) Meaning in life and self-esteem help hospice nurses withstand prolonged exposure to death. Journal of Nursing Management 27(4), 775–780. doi:10.1111/jonm.12737CrossRefGoogle ScholarPubMed
Barnett, MD, Reed, CM and Adams, CM (2020) Death attitudes, palliative care self-efficacy, and attitudes toward care of the dying among hospice nurses. Journal of Clinical Psychology in Medical Settings. doi:10.1007/s10880-020-09714-8Google Scholar
Benito, E, Dones, M and Babero, J (2016) El acompañamiento espiritual en cuidados paliativos. Psicooncologia 13(2–3), 367–384. doi:10.5209/5442CrossRefGoogle Scholar
CHPCA Nursing Standards Committee (2002). Hospice palliative care nursing standards of practice. Available at: https://www.chpca.ca/resource/norms.Google Scholar
Cibanal, L, Siles, J, Arce, MC, et al. (2001) La relación de ayuda no quema, es vivificante. Cultura de Cuidados 10, 1–13. doi:10.14198/cuid.2001.10.12Google Scholar
Codorniu, N, Guanter, L, Molins, A, et al. (2013) Competencias enfermeras en cuidados paliativos. Sociedad Española de Cuidados Paliativos 3, 3–48. Available at: http://aecpal.secpal.com/archivos-on-line-2.Google Scholar
Cohen, J (1988) Set correlation and contingency tables. Applied Psychological Measurement 12(4), 425–434. doi:10.1177/014662168801200410CrossRefGoogle Scholar
Davies, B and Oberle, K (1990) Dimensions of the supportive role of the nurse in palliative care. Oncology Nursing Forum 17(1), 87–94.Google ScholarPubMed
Díaz, D, Rodríguez-Carvajal, R, Blanco, A, et al. (2006) Adaptación española de las escalas de bienestar psicológico de ryff. Psicothema 18(3), 572–577.Google Scholar
Dobrina, R, Tenze, M and Palese, A (2014) An overview of hospice and palliative care nursing models and theories. International Journal of Palliative Nursing 20(2), 75–81. doi:10.12968/ijpn.2014.20.2.75CrossRefGoogle ScholarPubMed
Dunn, KS, Otten, C and Stephens, E (2005) Nursing experience and the care of dying patients. Oncology Nursing Forum 32(1), 97–104. doi:10.1188/05.ONF.97-104CrossRefGoogle ScholarPubMed
Farran, CJ, Miller, BH, Kaufman, JE, et al. (1999) Finding meaning through caregiving: Development of an instrument for family caregivers of persons with Alzheimer's disease. Journal of Clinical Psychology 55(9), 1107–1125.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
Fernández-Capo, M and Gual-García, P (2005) Sentido del cuidado y sobrecarga. Revista Española de Geriatría y Gerontología 40, 24–29. doi:10.1016/S0211139-X 0575070-8CrossRefGoogle Scholar
Fillion, L, Duval, S, Dumont, S, et al. (2009) Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses. Psycho-Oncology 18(12), 1300–1310. doi:10.1002/pon.1513CrossRefGoogle ScholarPubMed
Freeney, YM and Tiernan, J (2009) Exploration of the facilitators of and barriers to work engagement in nursing. International Journal of Nursing Studies 46(12), 1557–1565. doi:10.1016/j.ijnurstu.2009.05.003CrossRefGoogle ScholarPubMed
Gama, G, Barbosa, F and Vieira, M (2014) Personal determinants of nurses’ burnout in end of life care. European Journal of Oncology Nursing 18(5), 527–553. doi:10.1016/j.ejon.2014.04.005CrossRefGoogle ScholarPubMed
García-Sierra, R, Fernández-Castro, J and Martínez-Zaragoza, F (2017) Implicación de las enfermeras en su profesión. Un estudio cualitativo sobre el engagement. Enfermería Clínica 27(3), 153–162. doi:10.1016/j.enfcli.2017.03.006CrossRefGoogle Scholar
Grunfeld, E, Zitzelsberger, L, Coristine, M, et al. (2005) Job stress and job satisfaction of cancer care workers. Psycho-Oncology 14, 61–69. doi:10.1002/pon.820CrossRefGoogle ScholarPubMed
Gutiérrez, S, Sanz, J, Espinosa, R, et al. (2016) La escala de deseabilidad social de marlowe-crowne: Baremos para la población general española y desarrollo de una versión breve. Anales de Psicología 32(1), 206–217. doi:10.6018/analesps.32.1.185471CrossRefGoogle Scholar
Hayes, AF and Rockwood, NJ (2016) Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behaviour Research and Therapy 98, 39–57. doi:10.1016/j.brat.2016.11.001CrossRefGoogle ScholarPubMed
Kirkpatrick, A, Cantrell, M and Smeltzer, S (2017) A concept analysis of palliative care nursing: Advancing nursing theory. Advances in Nursing Science 40(4), 356–369. doi:10.1097/ANS.0000000000000187CrossRefGoogle ScholarPubMed
Lester, D and Abdel-Khalek, A (2003) The collett-lester fear of death scale: A correction. Death Studies 27(1), 81–85. doi:10.1080/07481180302873CrossRefGoogle ScholarPubMed
Limardi, S, Stievano, A, Rocco, G, et al. (2016) Caregiver resilience in palliative care: A research protocol. Journal of Advanced Nursing 72(2), 421–433. doi:10.1111/jan.12829CrossRefGoogle ScholarPubMed
Limonero, J (1997) Ansiedad ante la muerte. Ansiedad y Estrés 31(1), 37–46.Google Scholar
Malloy, D, Fahey-McCarthy, E, Murakami, M, et al. (2015) Finding meaning in the work of nursing: An international study. OJIN: The Online Journal of Issues in Nursing 20(3), 7. doi:10.3912/OJIN.Vol20No03PPT02CrossRefGoogle ScholarPubMed
Miočević, M, O'Rourke, HP, MacKinnon, DP, et al. (2018) Statistical properties of four effect-size measures for mediation models. Behaviour Research Methods 50(1), 285–301. doi:10.3758/s13428-017-0870-1CrossRefGoogle ScholarPubMed
Moreno-Milan, B, Cano-Vindel, A, Lopez-Dóriga, P, et al. (2019) Meaning of work and personal protective factors among palliative care professionals. Palliative & Supportive Care 17(4), 381. doi:10.1017/S147895151800113XCrossRefGoogle ScholarPubMed
Mystakidou, K, Parpa, E, Panagiotou, I, et al. (2013) Caregivers’ anxiety and self-efficacy in palliative care. European Journal of Cancer Care 22(2), 188–195. doi:10.1111/ecc.12012CrossRefGoogle ScholarPubMed
Nencetti Pereira Rocha, RC, Ramos Pereira, E, Silva, CRA, et al. (2020) The meaning of life of nurses working in palliative care: Integrative literature review. Revista Eletronica de Enfermagem 22, 1–12. doi:10.5216/ree.v22.56169Google Scholar
Oliver, A, Sansó, N, Galiana, L, et al. (2017) Evaluación psicométrica en profesionales de enfermería de cuidados paliativos. Aquichan 17(2), 83–194. doi:10.5294/aqui.2017.17.2.7CrossRefGoogle Scholar
Oriol, I, Gómez, M, Gándara, A, et al. (2014). Informe de la situación actual en cuidados paliativos. Available at: https://www.aecc.es/es/todo-sobre-cancer/observatorio/estudios-realizados/situacion-actual-cuidados-paliativos.Google Scholar
Peters, L, Cant, R, Payne, S, et al. (2013) Emergency and palliative care nurses’ levels of anxiety about death and coping with death: A questionnaire survey. Australasia Emergency Nursing Journal 16(4), 152–159. doi:10.1016/j.aenj.2013.08.001CrossRefGoogle ScholarPubMed
Poblete-Troncoso, MC, Valenzuela-Suazo, SV and Merino, JM (2012) Validación de dos escalas utilizadas en la medición del cuidado humano transpersonal basadas en la teoría de jean watson. Aquichan 12(1), 8–21.CrossRefGoogle Scholar
Ranse, K, Yates, P and Coyer, F (2016) Modelling end-of-life care practices: Factors associated with critical care nurse engagement in care provision. Intensive and Critical Care Nursing 33, 48–55. doi:10.1016/j.iccn.2015.11.003CrossRefGoogle ScholarPubMed
Reed, SM (2010) A unitary-caring conceptual model for advanced practice nursing in palliative care. Holistic Nursing Practice 24(1), 23–34. doi:10.1097/HNP.0b013e3181c8e4c7CrossRefGoogle ScholarPubMed
Ryff, C (1989) Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology 57(6), 1069–1081.CrossRefGoogle Scholar
Ryff, CD and Keyes, CLM (1995) The structure of psychological well-being revisited. Journal of Personality and Social Psychology 69(4), 719. doi:10.1037/0022-3514.69.4.719CrossRefGoogle ScholarPubMed
Salanova, M and Schaufeli, W (2009). El engagement en el trabajo: Cuando el trabajo se convierte en pasión. Editorial Alianza.Google Scholar
Salanova, M, Schaufeli, W, Llorens, S, et al. (2000) Desde el "burnout" al engagement: Una nueva perspectiva. Revista de Psicología del Trabajo y de las Organizaciones 16(2), 117–134.Google Scholar
Samson, T and Shvartzman, P (2018) Association between level of exposure to death and dying and professional quality of life among palliative care workers. Palliative & supportive care 16(4), 442–451. doi:10.1017/S1478951517000487CrossRefGoogle ScholarPubMed
Santisteban, I and Mier, O (2006) Estudio descriptivo de la ansiedad ante la muerte y factores estresantes en los distintos profesionales de una unidad de cuidados paliativos. Medicina Paliativa 13(1), 18–24.Google Scholar
Schaufeli, W and Bakker, A (2003) Utrecht Work Engagement Scale: Preliminary Manual. Utrecht : Occupational Health Psychology Unit, Utrecht University, , 64-000.Google Scholar
Shiri, S, Wexler, I, Marmor, A, et al. (2020) Hospice care: Hope and meaning in life mediate subjective well-being of staff. American Journal of Hospice and Palliative Medicine® 37(10), 785–790. doi:10.1177/1049909120905261CrossRefGoogle ScholarPubMed
Sinclair, S (2011) Impact of death and dying on the personal lives and practices of palliative and hospice care professionals. Canadian Medical Association Journal 183(2), 180–187. doi:10.1503/cmaj.100511CrossRefGoogle ScholarPubMed
Soikkeli-Jalonen, A, Stolt, M, Hupli, M, et al. (2020) Instruments for assessing nurses’ palliative care knowledge and skills in specialised care setting: An integrative review. Journal of Clinical Nursing 29(5-6), 736–757. doi:10.1111/jocn.15146CrossRefGoogle ScholarPubMed
Tomás-Sábado, J, Limonero, JT and Abdel-Khalek, AM (2007) Spanish adaptation of the collett-lester fear of death scale. Death Studies 31(3), 249–260. doi:10.1080/07481180601152625CrossRefGoogle ScholarPubMed
Vachon, M, Fillion, L and Achille, M (2009) A conceptual analysis of spirituality at the end of life. Journal of Palliative Medicine 12(1), 53–59. doi:10.1089/jpm.2008.0189CrossRefGoogle ScholarPubMed
Vachon, M, Fillion, L, Achille, M, et al. (2011) An awakening experience: An interpretative phenomenological analysis of the effects of a meaning-centered intervention shared among palliative care nurses. Qualitative Research in Psychology 8(1), 66–80. doi:10.1080/14780880903551564CrossRefGoogle Scholar
Vachon, M, Fillion, L and Achille, M (2012) Death confrontation, spiritual-existential experience and caring attitudes in palliative care nurses: An interpretative phenomenological analysis. Qualitative Research in Psychology 9(2), 151–172. doi:10.1080/14780881003663424CrossRefGoogle Scholar
Walker, L and Avant, K (2005). Strategies for Theory Construction in Nursing. Editorial Pearson Education.Google Scholar
Watson, J (1997) The theory of human caring: Retrospective and prospective. Nursing Science Quarterly 10(1), 49–52.CrossRefGoogle ScholarPubMed
Zulueta Egea, M, Prieto-Ursúa, M and Bermejo Toro, L (2020) Good palliative nursing care: Design and validation of the palliative nursing care quality scale (PNCQS). Journal of Advanced Nursing 76(10), 2757–2767. doi:10.1111/jan.14464CrossRefGoogle ScholarPubMed