JORT Journal

Keywords: End-of-life care; Influencing factors; Low seniority; Operating room nurses; Self-efficacy

Introduction

Hospice care, also known as hospice care, is a comprehensive “people-oriented” nursing care model that provides active care for patients with no hope of cure, and improves the quality of life of patients and their families as much as possible and to the best extent possible [1,2]. China’s end-of-life care started late, and is in the budding stage now, with fewer end-of-life care education and training courses, and a complete and mature system has not been constructed [3], and insufficient knowledge reserves and lack of end-of-life care experience led to low self-efficacy of nurses in the face of terminally ill patients, which affects the end-of-life experience of terminally ill patients.

Self-efficacy is a person’s confidence in his ability to successfully accomplish a particular task Self-efficiency [1] It is an early determinant of behavioral responses to challenging experiences such as hospice care [4]. There are fewer national and international studies on hospice self-efficacy among operating room nurses, but with the growth in organ donation acquisition and organ transplantation [5,6] and the need for and promotion of palliative surgical care for patients with malignant tumors [7,8], the exposure of operating room nurses to patients with end-of-life illnesses has increased dramatically. Low seniority nurses make up the majority of the nursing team and are an important new force on the nursing team, and initial guidance and training are an important part of improving the service quality of the nursing team. The level of end-of-life care self-efficacy of low seniority nurses can influence the quality of end-of-life care nursing services in the operating room. Self-efficacy is a major influence on the core competencies of nurses in the operating room [9], and nurses with high self-efficacy are more motivated to work and have stronger core competencies [10]. Therefore, this study focuses on understanding the current status of end-of-life care self-efficacy of low seniority nurses in the operating room and analyzing its influencing factors to improve the quality of end-of-life care services of nurses in the operating room, to improve the quality of patient’s survival in the terminal period, and to provide new ideas for the nursing training in the operating room.

Methods

Study Design

A convenience sampling method was used to distribute questionnaires for the survey from March 2023 to June 2023 among the operating room nurses who met the criteria in a tertiary general hospital in Guangdong Province.

Inclusion criteria:①have obtained the license to practice nursing;②voluntarily participate in this study, with normal reading and comprehension.③Fixed operating room nursing position, working hours ≤ 5 years, ≥ 3 months. Exclusion criteria:①Nurses in non-clinical work positions;②Long-term vacation or study away from home for ≥3 months.

Research Methodology

Research Tools

(1) General information Revised with reference to Guo Xiaoyan [11] based on age, ethnicity, years of clinical work, marital status, religious beliefs, participation in hospice education courses within one year, experience of accompanying family members in passing away, whether they thought about the pain of the terminally ill patient outside of work, and their attitudes toward death.

(2) End-of-life and post-mortem self-efficacy scales (EOLPMSS) The scale was developed by Carol E. Conley[12] in 2023. It consists of 18 items in 4 dimensions: recognizing death (5 items), caring for the body (6 items), comforting family (4 items), and taking care of oneself (3 items).The mean of the EOLPMSS items indicates the participant’s confidence level, with higher scores representing higher levels of self-efficacy. A score of 90100 indicates a “very high” confidence level, 80-89 “high,” 70-79 “medium,” 70-79 “medium,” and 70-79 “low” confidence levels.

A score of 90-100 indicates a “very high” confidence level, 8089 a “high” confidence level, 70-79 a “medium” confidence level, 60-69 a “low” confidence level, and 59 and below a “very low” confidence level. “Very low.” The scale had good reliability and validity with a Cronbach’s alpha coefficient of 0.938.

Survey Methodology

Through the questionnaire star (https://www.wjx.cn/) platform to meet the inclusion conditions of the nurses issued electronic questionnaires, and explain the purpose, significance and confidentiality of this study, the questionnaire content to set a unified description of the anonymous completion of the study by the subject, the background set the questionnaire of the same IP address or micro-signal can only be a single answer. Answers were mandatory to ensure the completeness of the questionnaire. After completing the survey, two researchers jointly checked the invalid questionnaires. A total of 204 questionnaires were recovered, 185 valid questionnaires, with an effective recovery rate of 90.69%.

Statistical Methods

After the raw data was exported from the background of the questionnaire star, the data were statistically analyzed using SPSS 22.0 statistical software. Measurement data were expressed as ±s; t-test or ANOVA was used for one-way analysis; multiple linear regression analysis was used for hospice self-efficacy influencing factors. Differences were considered statistically significant at P < 0.05.

Results

Univariate analysis of general information and end-of-life care self-efficacy of low seniority nurses in the operating room See Table 1.

Table 1: Univariate analysis of general information and end-of-life care self-efficacy of low seniority nurses in the operating room (n=185).

Hospice self-efficacy scores of operating room nurses See Table 2.

Table 2: Hospice self-efficacy scores of operating room nurses (n=185).

Results for Each Dimension of Hospice Self-Efficacy for operating room Nursing See Table 3.

Table 3: Hospice Self-efficacy Scores for Each Dimension of End-of-Life Care for operating room Nurses (n=185).

Multiple stepwise regression analysis of the factors influencing the self-efficacy of the operating room nurses in end-of-life care See Table 4.

Note:R=0.408，R²=0.166，align R²=0.143；F=7.131，P＜0.005

Table 4: Multiple stepwise regression analysis of the factors influencing the self-efficacy of the operating room nurses in end-of-life care (n=185).

Discussion

End-of-life care self-efficacy is at a low level among junior nurses in the operating room

The total score of end-of-life care self-efficacy of operating room nurses was (64.07±17.22), which was at a low level overall, lower than the results of the studies by Peng Jing [13] and Shen Yang [14], and was related to the limitations of the working environment in the operating room, and the low involvement of low seniority nurses in the process of caring for end-stage patients. Self-efficacy has a positive impact on nursing engagement [15], suggesting that managers should pay attention to the development of end-of-life care selfefficacy among low seniority nurses. In this study, the scores of the four dimensions of hospice self-efficacy in the dimension of taking care of oneself and comforting the family were lower than the total self-efficacy scores, indicating that low self-efficacy for emotion regulation of junior nurses in the operating room is related to their lack of awareness of end-of-life care, which is in line with the study of Li Fangfang [16]; and the low level of confidence in communicating with family members of terminally ill patients (low experience and self-confidence), which is in line with the results of the study such as Hsu Yinghua [17], etc. similar. Terminally ill patients have complex internal activities when they are near death, and they need more psychological comfort. Clinical nurses can learn from foreign mature communication models [18] and use them to communicate with terminally ill patients and their families, so as to better understand the psychological needs of terminally ill patients and their families at this time, and provide them with better care.