Doctor of Philosophy (PhD)
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Introduction. A number of challenges exist to providing effective, formalized end of life (EOL) education for undergraduate nursing students. Despite advanced resources provided by the End-of-Life Nursing Education Consortium (ELNEC), many nursing program curricula are overloaded with content and have little opportunity to incorporate other content and information.
In addition, the topic of EOL care may elicit significant emotional responses from nursing students with numerous studies indicating nursing students experience fear and anxiety when caring for patients at EOL. Recent research demonstrates the need to approach emotionally laden topics such as EOL care from a pedagogical perspective that acknowledges and addresses student attitudes and the potential effects they may have on learning. Recognizing that beliefs and emotional perspectives could potentially influence learning, Mezirow (1991) developed a teaching strategy known as a discourse intervention based on his Transformational Learning Theory (TLT) that has been effective across multiple disciplines such as sociology, education, and nursing. Therefore, the purpose of this study was to determine if the addition of a discourse intervention to the ELNEC Undergraduate (UG) Nursing Modules effectively improved junior level pre-licensure Bachelor of Science in Nursing (BSN) students’ knowledge and attitudes toward EOL care. In addition, the study examined possible moderating effects of demographics, past EOL education, and EOL experience on the participants’ knowledge and attitude.
Methods. A quasi experimental two-group comparison (control vs intervention), pretest/posttest design was used to determine the effectiveness of a theory-based discourse intervention added to the ELNEC UG nursing modules in a sample of BSN students located in the southern region of the U.S. Applying Mezirow’s TLT, the two-hour discourse intervention included a self-reflective journal, an unfolding case study focused on loss, and discussion with question and answer session that was implemented at the completion of the ELNEC UG nursing modules for the intervention group. Study participants (N = 135) completed surveys focused on demographics, EOL care knowledge (Palliative Care Quiz for Nurses-PCQN) and EOL care attitudes (Frommelt’s Attitudes Toward Care of the Dying-FATCOD) before and after the intervention. Ttests, path analysis and Hierarchical multiple linear regression analysis calculated the degree to which each independent variable explained the variance in self-reported knowledge and attitudes of junior level BSN nursing students.
Results. The intervention group had a statistically significant greater improvement on EOL care knowledge scores (M=3.86, SD=2.88 vs. M=2.37, SD=2.54, p = .002) and EOL care attitude (M= 6.35, SD= 8.71 vs. M= 2.62, SD= 9.56, p = .020) compared to the control group. No moderating effect was found for the relationship between group placement and knowledge and attitude. Knowledge (PCQN scores) and attitude (FATCOD scores) were moderately correlated (r = .311, p < .001). Hierarchical linear regression for knowledge revealed step one (demographics) explained 4% of the variance but was not significant; step two (group control vs. intervention) explained 11.2% [F (1, 126) = 9.793, p = .002]; step three (FATCOD difference scores treated as an independent variable) explained 17.5% [F(1, 125) = 9.469, p = .003] of the variance; step four (cohort) explained 29.5%. The final regression model with demographics, group, FATCOD difference scores and cohort accounted for 29.5% of the variance in self-reported PCQN scores and was significant [F (1, 124) = 21.041, p < .001]. Hierarchical linear regression for attitude revealed step one (demographics) explained 2.9% of the variance but was not significant; step two (group control vs. intervention) explained 8% [F(1, 126) = 7.008, p = .009]; step three (PCQN difference scores treated as an independent variable) explained 14.5% [F(1, 125) = 9.469, p = .003] of the variance; step four (cohort) explained 17.8% . The final regression model with demographics, group, PCQN difference scores and cohort accounted for 17.8% of the variance in self-reported FATCOD scores and was significant [F(1, 124) = 11.321, p < .028].
Discussion This study demonstrated the effectiveness of a discourse intervention when added to the ELNEC UG modules, affirming the application of reflective learning strategies when addressing emotionally laden content such as EOL. In addition, the study supports the value of theory-based educational interventions to enhance effective pedagogy. This study may have also given a glimpse into how a global pandemic may affect end-of-life knowledge and attitudes during a time where death is commonplace.
Control vs. Intervention; Death and Dying; Discourse; Mezirow; Nursing Education; Transformational Learning Theory
University of Nevada, Las Vegas
Haynes, Jayme Gullone, "Effects of a Discourse Intervention on End-Of-Life Knowledge and Attitudes of BSN Nursing Students" (2021). UNLV Theses, Dissertations, Professional Papers, and Capstones. 4245.
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