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Nursing Autonomy Plays an Important Role in Nurses' Attitudes Toward Caring for Dying Patients

Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, miyasita-tky{at}umin.net.

Yuko Nakai, RN

Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo

Tomoyo Sasahara, RN, PhD

Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo

Yurie Koyama, RN, MHlthSci

National Cancer Center, Tokyo

Yoichi Shimizu, RN

Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo

Naoko Tsukamoto, RN, PhD

College of Nursing, School of Medicine, Yokohama City University, Yokohama, Japan

Masako Kawa, RN, PhD

Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo

The aim of this study was to clarify the relationship of nursing autonomy and other factors related to attitudes toward caring for dying patients. A cross-sectional survey of nurses was conducted in November 2003 using a self-administered questionnaire. We collected demographic data from 178 (75%) participants and used the Frommelt Attitude Toward Care of the Dying scale, Form B, Japanese version (FATCOD-Form B-J), the Pankratz Nursing Questionnaire (PNQ), and the Death Attitude Inventory (DAI). FATCOD-Form B-J measures nurse's attitude toward caring for dying patients. It includes two subscales: positive attitude toward caring for the dying patient and perception of patient- and family-centered care. The PNQ measures nursing autonomy of individual nurses and has three subscales: nursing autonomy and advocacy, patients' rights, and rejection of traditional role limitations. The DAI measures attitudes toward death in context of Japanese cultural characteristics. It includes seven subscales: afterlife beliefs, death anxiety, death relief, death avoidance, life purpose, death concern, and supernatural beliefs. We investigated the factors associated with the FATCOD-Form B-J. Support of a mentor regarding end-of-life issues (ß = .19, P = .001), death avoidance domain of the DAI (ß = —.14, P = 0.03), life purpose domain of the DAI (ß = .23, P = .001), and rejection of traditional role limitations domain of the PNQ (ß = .51, P = .001) were selected as significant independent variables by multivariate analysis to evaluate nurses' positive attitudes toward caring for dying patients. Death anxiety domain of the DAI (ß = —.17, P = .02), patients' rights domain of the PNQ (ß =.46, P = .001), and rejection of traditional role limitations domain of the PNQ (ß = .34, P = .001) were selected as significant independent variables by multivariate analysis to evaluate the nurses' perception of patient-and family-centered care. In conclusion, nursing autonomy plays an important role in the attitudes of Japanese nurses who care for dying patients. Educational and administrative efforts to strengthen nursing autonomy are necessary.

Key Words: palliative care • attitude toward death • nursing • professional autonomy • nursing education

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