3.1 Participants’ general characteristics
Table 1 shows the characteristics of the participants. Of the 206 participants, 6.3% were men, and 93.7% were women. The mean age was 29.94 years, with 17% aged 25 years or younger, 67% between 26 and 35 years, and 16% aged 36 years or older. A total of 79.1% were single, and 62.1% did not have a religion. The majority of the participants had a bachelor’s degree (75.7%).
The mean length of career was 6.61 years, and 89.8% were staff nurses. Work units included general ward (51.0%), intensive care unit (ICU) (25.7%), emergency department (ED) (17.0%), and hospice ward (6.3%). The number of instances where EOLC was provided in the past year was two or fewer (18.0%) or three to ten (53.4%). A total of 51.9% had never witnessed the death of a close family member or friend, and 54.9% had prior hospice/EOLC education.
Table 1. Characteristics of Participants (n = 206)
|
|
|
|
Characteristics
|
Categories
|
N(%)
|
M±SD
|
Gender
|
Male
|
13(6.3)
|
|
|
Female
|
193(93.7)
|
|
Age
|
≤ 25
|
35(17.0)
|
29.94±5.35
|
(years)
|
26~35
|
138(67.0)
|
|
|
≥ 36
|
33(16.0)
|
|
Marital status
|
Married
|
43(20.9)
|
|
|
Single
|
163(79.1)
|
|
Religion
|
Yes
|
78(37.9)
|
|
|
No
|
128(62.1)
|
|
Educational level
|
College
|
24(11.7)
|
|
|
University
|
156(75.7)
|
|
|
Graduate school or higher
|
26(12.6)
|
|
Clinical experience
|
< 2
|
35(17.0)
|
6.61±5.25
|
|
2 ~ < 6
|
81(39.3)
|
|
|
6 ~ < 10
|
45(21.8)
|
|
|
≥ 10
|
45(21.8)
|
|
Job position
|
Staff nurse
|
185(89.8)
|
|
|
≥ Charge nurse
|
21(10.2)
|
|
Work unit
|
Emergency room
|
35(17.0)
|
|
|
Intensive care unit
|
53(25.7)
|
|
|
General ward
|
105(51.0)
|
|
|
Hospice unit
|
13(6.3)
|
|
Number of end-of-life care experiences
|
≥ 2
|
37(18.0)
|
13.91±20.31
|
3 ~ 10
|
110(53.4)
|
|
11 ~ 20
|
25(12.1)
|
|
> 20
|
34(16.5)
|
|
Experience of end-of-life for close family member or friend
|
Yes
|
99(48.1)
|
|
No
|
107(51.9)
|
|
Experience of hospice education
|
Yes
|
113(54.9)
|
|
No
|
93(45.1)
|
|
3.2 Levels of EOLC stress, calling, resilience, and EOLC performance
Table 2 shows the levels of EOLC stress, EOLC performance, calling, and resilience. The mean EOLC stress score was 3.68 out of 5. The mean calling score was 2.29 out of 4. The mean resilience score was 2.44 out of 4. The mean EOLC performance score was 2.31 out of 4.
Table 2. Levels of Terminal care stress, calling, resilience, terminal care performance (n = 206)
Variables (Item No.)
|
Item score
|
Total score
|
Min
|
Max
|
Range
|
|
M±SD
|
M±SD
|
|
EOLC stress (42)
|
3.68±0.51
|
154.69±21.27
|
89
|
210
|
42~210
|
|
Negative attitude of patient and his/her family members (10)
|
3.80±0.63
|
38.00± 6.25
|
17
|
50
|
10~50
|
|
Burden about bereavement care (8)
|
3.62±0.59
|
28.94± 4.74
|
16
|
40
|
8~40
|
|
Difficulty of allocating time to dying patient (6)
|
3.29±0.77
|
19.73± 4.60
|
8
|
30
|
6~30
|
|
Overloaded duty (5)
|
3.80±0.66
|
18.98± 3.30
|
5
|
25
|
5~25
|
|
Conflict about limitations of medicine (6)
|
3.77±0.70
|
22.61± 4.19
|
10
|
30
|
6~30
|
|
Human relation conflict with dying patient (3)
|
3.78±1.14
|
11.33± 3.44
|
5
|
53
|
3~15
|
|
Insufficiency in professional knowledge and skill (4)
|
3.77±0.62
|
15.10± 2.48
|
6
|
20
|
4~20
|
|
Calling (12)
|
2.29±0.59
|
27.46± 7.13
|
13
|
48
|
12~48
|
|
Transcendent summons (4)
|
2.00±0.70
|
8.01± 2.82
|
4
|
16
|
4~16
|
|
Purpose/meaning (4)
|
2.42±0.69
|
9.68± 2.78
|
4
|
16
|
4~16
|
|
Prosocial orientation (4)
|
2.44±0.68
|
9.76± 2.72
|
4
|
16
|
4~16
|
|
Resilience (25)
|
2.44±0.53
|
60.91±13.17
|
26
|
96
|
0~100
|
|
Hardiness (9)
|
2.32±0.61
|
20.84± 5.49
|
8
|
35
|
0~36
|
|
Persistence (8)
|
2.50±0.61
|
20.03± 4.92
|
8
|
32
|
0~32
|
|
Optimism (4)
|
2.42±0.67
|
9.67± 2.66
|
3
|
16
|
0~16
|
|
Support (2)
|
3.16±0.61
|
6.31± 1.22
|
1
|
8
|
0~8
|
|
Spiritual influence (2)
|
2.03±0.76
|
4.07± 1.52
|
1
|
8
|
0~8
|
|
EOLC performance (22)
|
2.31±0.35
|
50.85± 7.77
|
32
|
71
|
22~88
|
|
Physical area (8)
|
2.60±0.53
|
20.84± 4.22
|
8
|
32
|
8~32
|
|
Psychological area (8)
|
2.67±0.47
|
21.38± 3.80
|
10
|
32
|
8~32
|
|
Spiritual area (6)
|
1.44±0.42
|
8.64± 2.51
|
6
|
18
|
6~24
|
|
3.3 Differences in EOLC performance according to participants’ characteristics
Table 3 shows the differences in EOLC performance according to participant characteristics. EOLC performance significantly differed according to age (F = 3.039, p = .050), education level (F = 3.874, p = .022), work unit (F = 3.179, p = .025), and witnessing the death of a close family or friend (F = 2.284, p = .023).
Table 3. Difference of EOLC performance according to nurses’ characteristics (n = 206)
Characteristics
|
Categories
|
N
|
M±SD
|
t/F
|
p
|
(scheffe)
|
Gender
|
Male
|
13
|
48.46±9.26
|
-0.972
|
0.349
|
|
Female
|
193
|
51.02±7.66
|
|
|
Age
|
≤ 25b
|
35
|
52.66±6.81
|
3.039
|
0.050
|
(years)
|
26 ~ 35a
|
138
|
49.93±7.80
|
|
(a < b)
|
|
≥ 36b
|
33
|
52.82±8.09
|
|
|
Marital status
|
Married
|
43
|
52.16±8.20
|
1.193
|
0.237
|
|
Single
|
163
|
50.51±7.64
|
|
|
Religion
|
Yes
|
78
|
50.05±7.87
|
-1.153
|
0.251
|
|
No
|
128
|
51.34±7.69
|
|
|
Educational level
|
Collegea
|
24
|
51.79±10.03
|
3.874
|
0.022
|
|
Universityb
|
156
|
50.10±7.22
|
|
(b < c)
|
|
Graduate school or higherc
|
26
|
54.50±7.76
|
|
|
Clinical experience
|
< 2
|
35
|
51.40±7.26
|
0.187
|
0.905
|
|
2 ~ < 6
|
81
|
50.44±7.40
|
|
|
|
6 ~ < 10
|
45
|
50.71±8.97
|
|
|
|
≥ 10
|
45
|
51.31±7.72
|
|
|
Job position
|
staff nurse
|
185
|
50.58±7.81
|
-1.644
|
0.112
|
|
≥ charge nurse
|
21
|
53.29±7.07
|
|
|
Work unit
|
Emergency rooma
|
35
|
48.37±8.12
|
3.179
|
0.025
|
|
Intensive care unitb
|
53
|
52.81±6.74
|
|
(a < d)
|
|
General wardc
|
105
|
50.33±7.74
|
|
|
|
Hospice unitd
|
13
|
53.77±9.01
|
|
|
Number of end-of-life care experiences
|
≥ 2
|
37
|
51.89±7.11
|
1.834
|
0.142
|
3 ~ 10
|
110
|
49.84±7.59
|
|
|
11 ~ 20
|
25
|
53.48±9.08
|
|
|
> 20
|
34
|
51.09±7.70
|
|
|
Experience of end-of-life of family member or friend
|
Yes
|
99
|
52.13±8.08
|
2.284
|
0.023
|
No
|
107
|
49.67±7.31
|
|
|
Experience of hospice education
|
Yes
|
113
|
51.08±7.58
|
0.455
|
0.649
|
No
|
93
|
50.58±8.03
|
|
|
3.4 Correlations between EOLC stress, calling, resilience, and EOLC performance
Table 4 shows the correlations between EOLC stress, calling, resilience, and EOLC performance. EOLC performance was significantly correlated with calling (r = .424, p < .001), resilience (r = .397, p < .001), and EOLC stress (r = .253, p < .001). This suggests that EOLC performance increases with increasing EOLC stress, calling, and resilience.
Table 4. Correlation among EOLC care stress, calling, resilience and EOLC performance (n = 206)
Variables
|
EOLC stress
|
Calling
|
Resilience
|
EOLC performance
|
r (p)
|
r (p)
|
r (p)
|
r (p)
|
EOLC stress
|
1
|
|
|
|
Calling
|
0.163(.019)
|
1
|
|
|
Resilience
|
0.068(.331)
|
0.501(< .001)
|
1
|
|
EOLC performance
|
0.253(< .001)
|
0.424(< .001)
|
0.397(< .001)
|
1
|
3.5 Effects of EOLC stress, calling, and resilience on EOLC performance
Table 5 shows the results of the multiple regression analysis to identify the predictors of EOLC performance. Age, work unit, and experience of loved one’s death, which significantly differed from participants’ characteristics, were entered as independent variables, and work unit and experience of loved one’s death were dummy-coded for the analysis. The regression equation was significant, indicating that EOLC stress, calling, and resilience significantly predicted EOLC performance (F = 11.113, p < .001), and the independent variables explained 28.3% of the variance in EOLC performance. The variance inflation factor (VIF) was below 10 at 1.042–2.117 and the Durbin-Watson index was 2.117, confirming the absence of multicollinearity and autocorrelation, respectively.
Calling had the greatest effect on EOLC performance (β = .282, p = .001), followed by EOLC stress (β = .185, p = .003) and resilience (β = .149, p < .001), while the EOLC performance was higher among nurses who worked in a hospice ward (β = .140, p = .041] and those who worked in the ICU (β = .218, p = .008) compared to those who worked in the ED.
Table 5. Factors influencing EOLC performance (n = 206)
|
B
|
SE
|
β
|
t
|
p
|
VIF
|
(Constant)
|
21.745
|
4.388
|
|
4.956
|
< .001
|
|
Age
|
0.043
|
0.089
|
-0.030
|
-0.484
|
.629
|
1.081
|
EOLC stress
|
0.067
|
0.023
|
0.185
|
2.988
|
.003
|
1.093
|
Calling
|
0.282
|
0.079
|
0.259
|
3.569
|
< .001
|
1.504
|
Resilience
|
0.149
|
0.041
|
0.252
|
3.601
|
< .001
|
1.402
|
Work unit (Hospice unit)*
|
4.454
|
2.162
|
0.140
|
2.060
|
.041
|
1.316
|
Work unit (Intensive care unit)*
|
3.868
|
1.446
|
0.218
|
2.675
|
.008
|
1.903
|
Work unit (General ward)*
|
1.981
|
1.334
|
0.128
|
1.485
|
.139
|
2.117
|
Experience of end-of-life (Yes)*
|
1.817
|
0.936
|
0.117
|
1.941
|
.054
|
1.042
|
R2= 0.311, Adjusted R2 = 0.283, F = 11.113, p < .001
|
Durbin-Watson = 2.117
|
* Dummy variables = Work unit (Emergency room: 0; Hospice unit, Intensive care unit, and General ward: 1); Experience of end-of-life (No:0, Yes:1)