Nurses' Attitude Toward End of Life Care in Emergency Departement and Intensive Care Unit In Rural Hospital

Muhamad Zulfatul A'la, Zumrotul Farikhah, Mulia Hakam


Background: Death is a psychological and physical event that affects patients caring for, especially in Emergency Departement (ED) and the Intensive Care Unit (ICU). Patients and families need the end of life care from a health professional, including nurses. Nurses need to have knowledge, skill, attitude, and interpersonal competencies to provide end of life care.

Objective: This study aimed to explored differences of attitudes towards dying care between ED and ICU ward nurses in a rural hospital.

Method: Variable in this study was the nurse's attitude. This study used a quantitative comparative cross-sectional research design. The samples were 24 nurses from the emergency ward and 16 from the intensive care unit who were recruited by total sampling. Data were collected to use Frommelt Attitudes Towards the Care of the Dying Care Form B Indonesian version (FATCOD-BI).

Result: The results revealed that nurses' attitudes toward caring for dying patients in the ED were 101.42±6.646 (30-150) on average, and in the intensive care unit was 106.44±7.633 (30-150) on average. Nurses in the ICU had a more positive attitude than the ED (p = 0.034). There are differences between the proportion of respondents based on gender, level of education, length of time working in the emergency ward, and ICU. The result showed gender, level of education, and range of time working could influence nurses' attitudes towards caring for dying patients in the emergency ward and ICU.

Conclusion: There is a difference between nurses' attitudes towards EOLC in the ED and ICU room at rural hospitals. Moreover, the ICU nurses have a more positive attitude than ED nurses.


caring; dying patients; emergency departement; ICU; nurse’s attitudes

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A’la, M. Z. (2016). The Frommelt Attitudes toward Care Of The Dying Care Form B (FATCOD- B) Indonesia Version: Measurement validity using factor analysis in nursing students. Nurseline Journal, 1(1), 73–82.

A’la, M. Z., Setioputro, B., & Kurniawan, D. E. (2018). Nursing students’ attitudes towards caring for dying patients. Nurse Media Journal of Nursing, 8(1), 25–34.

Ali, W. G. M., & Ayoub, N. S. (2010). Nurses’ attitude toward caring for dying patient in Mansoura University Hospital. Journal of Medicine and Biomedical Sciences, 10, 16–23.

Bakitas, M. A., Elk, R., Astin, M., Ceronsky, L., Clifford, K. N., Nicholas Dionne-Odom, J., Emanuel, L. L., Fink, R. M., Kvale, E., Levkoff, S., Ritchie, C., & Smith, T. (2015). Systematic review of palliative care in the rural setting. Cancer Control, 22(4), 450–464.

Baliza, M. F., Bousso, R. S., & Paganini, M. C. (2013). Factors influencing Intensive Care Units nurses in end-of-life decisions. Journal of School of Nursing, 49(4), 571–578.

Beckstrand, R. L., Smith, K. E., Beth, K. E., & Macintosh, J. L. B. (2017). Rural emergency nurses’ suggestions for improving end-of-life care. Journal of Emergency Nursing, 43(3), 214–220.

Buglass, E. (2010). Grief and bereavement theories. Nursing Standard, 24(41), 44–47.

Decker, K., Lee, S., & Morphet, J. (2015). The experiences of emergency nurses in providing end-of-life care to patients in the emergency department. Australasian Emergency Nursing Journal : AENJ, 18(2), 68–74.

Dunn, K. S., Otten, C., & Stephens, E. (2005). Nursing experience and the care of dying patients. Oncology Nursing Forum, 32(1), 97–104.

Gallagher, A., Bousso, R. S., McCarthy, J., Kohlen, H., Andrews, T., Paganini, M. C., Abu-El-Noor, N. I., Cox, A., Haas, M., Arber, A., Abu-El-Noor, M. K., Baliza, M. F., & Padilha, K. G. (2015). Negotiated reorienting: a grounded theory of nurses’ end-of-life decision-making in the intensive care unit. International Journal of Nursing Studies, 52(4), 794–803.

Gama, G., Barbosa, F., & Vieira, M. (2012). Factors influencing nurses ’ attitudes toward death. International Journal of Palliative Nursing, 18(6), 267–273.

Gastmans, C. (2012). Nursing ethics perspectives on end-of-life care. Nursing Ethics, 19(5), 603–604.

Gloss, K., & Hospitals, C. (2017). End of life care in emergency departments : a review of the literature. Evidence & Practice / Literature Review, 25(2), 29–38.

Green, M. A., Dorling, D., Minton, J., & Pickett, K. E. (2017). Could the rise in mortality rates since 2015 be explained by changes in the number of delayed discharges of NHS patients ? J Epidemiol Community Health, 71, 1068–1071.

Grubb, C., & Arthur, A. (2016). Student nurses’ experience of and attitudes towards care of the dying: A cross-sectional study. Palliative Medicine, 30(1), 83–88.

Gurung, M., & Timalsina, R. (2018). Attitudes of Nepalese hospital nurses towards care of dying people. Journal of Aging Studies and Therapies, 1(1), 1–4.

Henoch, I., Browall, M., C, M. J., Danielson, E., Udo, C., A, J. S., Björk, M., Ek, K., Hammarlund, K., Bergh, I., & Strang, S. (2013). The Swedish version of the Frommelt Attitude Toward Care of the Dying Scale aspects of validity and factors influencing nurses’ and nursing Students’ attitudes. Cancer Nursing, 37(1), 1–11.

Higgs, C. (2010). The Palliative care handbook: Advice on clinical management (7th ed.). Hierographics Ltd.

Kassa, H., & Murugan, R. (2014). Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia. BMC Palliative Care, 13(6), 1–11.

Lancaster, R. J., Kautzmann, C., Micheal, J. C. J., Chandrasekaran, L., Jambunathan, J., & Chapin, T. M. (2017). Attitudes of nurses towards care of the dying patient in India. International Journal of Palliative Nursing, 23(11), 558–566.

National Consensus Project for Quality Palliative care. (2009). Clinical practice guidelines for quality palliative care (2nd ed.). National Consensus Project for Quality Palliative Care.

Ozcelik, H., Aksoy, F., Sonmez, E., & Fadiloglu, C. (2018). Attitudes to death of nurses in Turkey and factors affecting them. Hospice & Palliative Medicine International Journal, 2(6), 303–309.

Polit, D., & Beck, C. (2009). Nursing research: Principle and method (Seventh). William&Wilkins.

Rainsford, S., MacLeod, R. D., Glasgow, N. J., Phillips, C. B., Wiles, R. B., & Wilson, D. M. (2017). Rural end-of-life care from the experiences and perspectives of patients and family caregivers: A systematic literature review. Palliative Medicine, 31(10), 895–912.

Tait, V., Higgs, M., Magann, L., Dixon, J., Davis, J. M., & Fernandez, R. (2015). Attitudes of nonpalliative care nurses towards palliative care. International Journal of Palliative Care, 2015(xx).

Tripathy, S., Routray, P. K., & Mishra2, J. C. (2017). Intensive care nurses’ tttitude on palliative and end of life care. Indian Journal of Critical Care Medicine, 21(10), 39–43.

WHO. (2014). Global Atlas of Palliative Care at the End of Life (S. R. Connor & M. Cecilia Sepulveda Bermedo (eds.)). WHO.

Yaqoob, M., Nasaif, H., & Kadhom, H. (2018). Undergraduate final year nursing students ’ attitudes toward caring for dying patients: Bahrain’s experience. Clinical Nursing Studies, 6(4), 53–58.


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