Influencing factors of nurses' short-term bereavement reactions after patient death.

An online cross-sectional survey was performed among 181 nurses in mainland China who experienced their most recent patient death within the last month. Multivariate linear regressions were used following bivariate analysis to identify influencing factors for their short-term professional bereavement reactions. More intensive reactions were associated with the nurse's fewer experiences of patient death; the nurse's employment in the intensive care unit rather than the emergency, oncology, geriatrics, or internal medicine departments; and the patient experiencing more pain in the last few days. Higher reaction scores were also reported by nurses who lost the patient more than 1 week prior.

What makes advance care planning discussion so difficult? A systematic review of the factors of advance care planning in healthcare settings.

OBJECTIVES: Existing systematic reviews related to advance care planning (ACP) largely focus on specific groups and intervention efficacy or are limited to contextual factors. This research aims to identify the modifiable factors perceived by different users of ACP in healthcare settings and inform healthcare professionals about the factors affecting ACP practice. METHODS: Five English-language databases (ProQuest, PubMed, CINAHL Plus, Scopus, and Medline) and two Chinese-language databases (CNKI and NCL) were searched up to November 2022. Empirical research identifying factors related to ACP in healthcare settings was included. ACP is defined as a discussion process on future end-of-life care. Thematic synthesis was performed on all included studies. RESULTS: A total of 1871 unique articles were screened; the full texts of 193 were assessed by 4 reviewers, and 45 articles were included for analysis. Twenty-two (54%) studies were qualitative, 15 (33%) were quantitative, and 6 (13%) used mixed methods. Foci varied from 28 (62%) studies on a single subject group (either patient, family, or physician), 11 (25%) on 2 subject groups (either patient and family or patient and healthcare professional), and 6 (13%) covered 3 subject groups (patient, family, and healthcare professional). Among the 17 studies involving more than 1 subject group, only 2 adopted a dyadic lens in analysis. Complex interwoven factors were categorized into (1) intrapersonal factors, (2) interpersonal factors, and (3) socio-environmental factors, with a total of 11 themes: personal belief, emotions, the burden on others, timing, responsiveness, relationship, family dynamics, experience, person taking the lead, culture, and support. SIGNIFICANCE OF RESULTS: Patients, families, and healthcare professionals are the essential stakeholders of ACP in healthcare settings. Factors are interweaved among the intrapersonal, interpersonal, and socio-environmental dimensions. Research is warranted to examine the dynamic interactions of the 3 essential stakeholders from a multidimensional perspective, and the mechanism of the interweaving of factors.

The meaning of patient deaths for professional caregivers: A quantitative construct validation.

The meaning of patient deaths is key to understanding professional bereavement. To validate its construct, we applied partial least square structural equation modeling (PLS-SEM) to online survey data from 563 Chinese physicians and nurses. Both the personal meaning and professional meaning contribute significantly while not interchangeably to the meaning of patient deaths. In addition to the loss of an acquaintance, the loss of a valuable life, and the loss of a professional goal, patient deaths can also mean trauma, bad luck, identity crisis, a warning, a learning opportunity, and a time to empathize with others' sufferings.

Redefining caregiver strain for family caregivers in end-of-life care in Hong Kong.

OBJECTIVES: Caregiving for family members at their end of life is stressful. Caregivers' strain, burden, or stress has been measured in various geographical and sociodemographic contexts. The concept of stress, burden, and strain are sometimes used interchangeably. By analysing the factor structure of the Chinese version of the Modified Caregiver Strain Index (C-M-CSI), this study aimed to examine the caregiving strain concept and its demographic correlates. METHODS: A sample of 453 family caregivers of patients with a terminal illness in Hong Kong was employed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. In addition, generalized linear models (GLM) were used to examine the demographic correlates. RESULTS: The EFA yielded a 3-factor model termed "Perception of Caregiving," "Empathetic Strain," and "Adjustment Demand." This 3-factor model explained 50% of the variance and showed good internal consistency. The CFA confirmed the 3-factor construct with satisfactory internal reliability (χ2 [61, N = 226] = 108.86, p < 0.001, CFI = 0.96, TLI = 0.95, SRMR = 0.04, and RMSEA = 0.06). Inspired by this factor structure and concepts of stress and strain from engineering discipline, a new model of caregiver strain is proposed. Additionally, family caregivers of non-cancer patients, who were not living with the patient, or younger were associated negatively with different dimensions of caregiver strain. SIGNIFICANCE OF RESULTS: The results gave insights into the advancement of the conceptualization of caregiver strain, its multidimensional nature, and process of change, which inform directions for future research and practices.

Bereavement After Patient Deaths Among Chinese Physicians and Nurses: A Qualitative Description Study.

In order to achieve an in-depth understanding of professional caregivers' experiences of bereavement after patient deaths in Mainland China, qualitative description was employed. 24 physicians and nurses from hospitals in Nanjing, China, participated in one-to-one, semi-structured interviews. Thematic analysis was adopted for data analysis. Five themes were generated: the nature of professional bereavement experiences, the meaning of patient deaths, immediate bereavement reactions, long-term changes, and coping strategies. Each theme included personal and professional dimensions. Professional bereavement experiences in Mainland China were found to be influenced by workplace violence against professional caregivers, traditional Chinese medical ethics, the strong death taboo, and inadequacies of the healthcare system. Professional bereavement experiences are meaning-driven, comprehensive, and usually disenfranchised. They involve multidimensional reactions and have both short-term and long-lasting, both event-specific and accumulated impacts. Cultural and systemic factors could shape professional bereavement experiences.

Determinants of Organ Donation Registration Among University Students in Hong Kong.

The present study explored the determinants of registration to facilitate the promotion of posthumous organ donation based on the theory of reasoned actions. A total of 211 university students participated in the study. Logistic regression, multiple regressions, and path analysis were conducted. The logistic regression model correctly predicted nearly 80% of registration status, and a good fit model of registration for posthumous organ donation (MRPOD) was proposed. Findings suggested that affective attitude, subjective norm of family, self-rated knowledge, distance from death, and age were predictors of registration. Worries about organ removal and postmortem mutilation anxiety were also mediated through bodily integrity, which had an indirect effect on the registration through affective attitude. Policymakers are suggested to address the negative emotions associated with challenges towards bodily integrity, encourage parents to initiate discussions with children, instill correct knowledge of brain death, and intervene the bystander effect on organ donation.

To IPAS or not to IPAS? Examining the construct validity of the Interprofessional Attitudes Scale in Hong Kong.

Students' attitudes toward interprofessional teamwork can be linked to successful interprofessional education. This points to the importance of identifying a scale that may be useful in keeping track of the change in students' attitudes over time. In response to this, using a combination of within- and between-network approaches to construct validity, we examined the psychometric acceptability of the Interprofessional Attitude Scale (IPAS) involving 274 Chinese healthcare and social care pre-licensure students in Hong Kong. Overall results indicated that IPAS had good internal consistency. Results of the confirmatory factor analysis provided support to the overall five-factor solution although one negatively worded item obtained non-significant factor loading. Results of the between-network analysis suggest that various subscales of IPAS correlated systematically with other theoretically relevant variables: teamwork attitudes, communication, and team effectiveness. The IPAS is a valid measure to examine predominantly Chinese healthcare and social care students' interprofessional attitudes in online interprofessional education.

Assessment of professional bereavement: The development and validation of the Professional Bereavement Scale.

OBJECTIVES: To develop and validate Professional Bereavement Scale (PBS), a specific measurement tool for professional bereavement experiences. METHODS: An online cross-sectional survey collected data from 563 physicians and nurses from urban hospitals in Mainland China. Item consistency analysis, component factor analysis, exploratory factor analysis, and confirmatory factor analysis were run to develop and validate the scale. Correlational analysis was conducted to evaluate the psychometric property of the scale. RESULTS: Two subscales of the PBS were developed: the 17-item Short-term Bereavement Reactions Subscale (PBS-SBR) and the 15-item Accumulated Global Changes Subscale (PBS-AGC). Four factors, namely, frustration and trauma, guilt, grief, and being moved, are involved in PBS-SBR. Five factors are involved in PBS-AGC, which are new insights, more acceptance of limitations, more death-related anxiety, less influenced by patient deaths, and better coping with patient deaths. Both subscales have good content validity, construct validity, and criterion validity, as well as satisfactory internal consistency and split-half reliability. SIGNIFICANCE OF RESULTS: PBS is a specific assessment tool for professional bereavement which is clearly defined, comprehensive, rigorously tested, and generalizable to different professional caregivers from various departments. Unveiled constructs illustrate that professional bereavement experiences contain a professional dimension in addition to a personal dimension both in an event-specific and a global perspective, which distinguishes them from familial bereavement experiences.

Preliminary Development of a Postmortem Bodily Integrity Concerns Scale Among the University Students in Hong Kong.

The idea of keeping a body intact has been a major barrier that hinders people from making decision for posthumous organ donation or making consent for their deceased family member. The present research thus attempted to bridge the knowledge gap by conducting an exploratory study to identify the underlying beliefs, and a preliminary validation study to confirm the scale developed thereof. Nineteen university students participated in 5 semistructured focus groups; 115 participated in the exploratory factor analysis, while 96 in the confirmatory factor analysis. An 18-item scale, the Postmortem Bodily Integrity Concerns Scale was developed with 4 subscales: Filial Piety Beliefs, Worries of Organ Removal, Postmortem Mutilation Anxiety, and Detachment to Death. The corresponding measures were established and validated with acceptable psychometric properties and a model of good fit. The findings provided implications for the policymakers to devise plans in dealing with the postmortem bodily integrity issue.

A Validation Study of the Posthumous Organ Donation Reasoned Action Scale.

The posthumous organ donation reasoned action scale (PODRAS) may be the first multidimensional scale measuring individuals' perceptions, which is developed based on the Theory of Reasoned Action and guided by empirical data. This study moves further to validate the scale and examine its psychometric properties. Two hundred and twenty-one university students participated in the study. Results suggested that the scale has a structure with six dimensions: Mutilation and Imperfectness, Legacy for Family, Altruism, Detachment, Eradication of Hope, and Burden on Family. The scale was evaluated with acceptable to good psychometric properties and model fit (χ2/df = 1.58; root mean square error of approximation = .07; standardized root mean square residual = .08; comparative fit index = .92; incremental fit index = .92; Tucker-Lewis index = .90). Construct validity was also supported. The study has significant contributions that theoretically, the scale proposed a conceptualization framework in understanding posthumous organ donation, whereas methodologically, the scale serves as a tool that facilitates future studies of organ donation behaviors.

A pilot study to validate measures of the theory of reasoned action for organ donation behavior.

The present study aimed at taking the first attempt in validating the measures generated based on the theory of reasoned action (TRA). A total of 211 university students participated in the study, 95 were included in the exploratory factor analysis and 116 were included in the confirmatory factor analysis. The TRA measurements were established with adequate psychometric properties, internal consistency, and construct validity. Findings also suggested that attitude toward organ donation has both a cognitive and affective nature, while the subjective norm of the family seems to be important to students' views on organ donation.

The body of knowledge in thanatology: An outline.

The Association for Death Education and Counseling has updated its articulation of the body of knowledge in the field of thanatology. In doing so it has relinquished the use of a matrix format in favor of a more serviceable outline containing three major sections: Arenas of Thanatology, Practice Considerations for Professionals in the Field, and Contextual and Theoretical Considerations. Accompanying the outline is a new commentary on the state of the field itself, along with an annotated bibliography of recent relevant publications.

An Exploratory Study on University Students' Perceptions of Posthumous Organ Donation Base on the Theory of Reasoned Action.

In view of the general support for organ donation but low registration rate in Hong Kong, the present research attempted to understand the attitude-behavior inconsistency by identifying the underlying beliefs for organ donation through employing the theory of reasoned action. A qualitative approach using semi-structured focus groups was adopted and 19 students from three universities in Hong Kong participated; 10 constructs were identified: attitude, subjective norm, helping, continuation, contribution, body intact, distrust to the medical system, indifference to organ donation, negative affect, and family burden. Findings suggested that their attitudes toward organ donation were of both the cognitive and affective nature; subjective norm of family, friends, and people they respect were identified as influential to students' views on organ donation. The study provided insight in promoting organ donation, that the cognitive concerns about keeping the body intact, and the negative affects introduced should also be addressed.

Comparative analysis of symptom burdens and influential factors among diverse terminally-ill patients.

BACKGROUND: The suffering experienced by terminally-ill patients encompasses physiological, psychosocial and spiritual dimensions. While previous studies have investigated symptom burden intensity for specific disease groups, such as cancer or heart failure patients, a research gap exists in understanding major distressing symptoms among diverse terminally-ill patients. This study assessed symptom burden intensity and explored its influential factors among diverse patient disease groups. METHODS: This cross-sectional study utilized the baseline Integrated Palliative care Outcome Scale (IPOS) assessment data. The study participants were terminally-ill patients enrolled in an end-of-life care (EoLC) intervention in Hong Kong. Statistical methods including relative importance index (RII), one-way analysis of variance (ANOVA), and generalized linear regression (GLR) were employed. RESULTS: Final sample consisted of 1,549 terminally-ill patients (mean age =77.4 years, SD =11.6). The five top-rated distressing symptoms among these patients, revealed by the RII analysis, were poor mobility (RII =64.4%), family anxiety (RII =63.5%), sharing feelings with family/friends (RII =61.4%), weakness/lack of energy (RII =58.1%), and hardly feeling at peace (RII =50.7%). One-way ANOVA showed significant differences among the eight disease groups in perceived physical and emotional symptom burden intensity (P<0.05). Analysis of RII symptom scores for each disease group revealed that poor mobility was rated as the most distressing symptom (RII =85.1-62.9%) by patients with motor neurone disease, Parkinson's disease, heart failure, dementia, end-stage renal disease and other serious diseases (including stroke, hematological disease, multiple sclerosis and liver diseases). Perceived family anxiety (RII =66.1%) and shortness of breath (RII =63.8%) were the most distressing symptoms for cancer patients and those with chronic obstructive pulmonary disease, respectively. GLR analysis showed that illness type is the most significant factor influencing the perceived burden intensity in terms of the IPOS total and subscale scores of physical symptoms, emotional symptoms and communication/practical issues. Demographic characteristics such as age, gender, marital status and co-residing status were also identified as influential factors of various symptom categories. However, patients' educational level and relationship with primary caregiver did not significantly influence any perceived symptom burden. CONCLUSIONS: This study provides valuable insights into the symptom burdens experienced by diverse patient disease groups at end-stage of life. The findings highlight the major distressing symptoms of poor mobility, family anxiety, and shortness of breath. Addressing these symptoms is crucial in improving the quality of care for terminally-ill patients. Furthermore, the study identifies influential factors that can affect the perceived intensity of symptom burden, primarily the main type of terminal illness and patient's age. Tailored care support and improved clinical care should be implemented, particularly for high-risk groups such as patients with non-cancer terminal illnesses and older aged patients. These findings contribute to existing literature and emphasize the need for comprehensive and individualized care in EoLC.

Global Research Trend and Bibliometric Analysis of Current Studies on End-of-Life Care.

The growing emphasis on evidence-based practice has led to a need for more research on healthcare disciplines, and for the synthesis and translation of that research into practice. This study explored the global research trend in regard to End-of-Life Care (EoLC), and assessed the impact and influence, on the scientific community, of relevant EoLC publications EoLC. Over 350,000 related publications on EoLC were retrieved from three databases (PubMed, Scopus, and Web of Science). Our analysis of the global research trend revealed an exponential rise in the number of related publications on EoLC since the year 1837. This study assessed the bibliometric information of 547 current journal publications on EoLC, sorted by relevance, from the three databases. The USA (47.3%) and the UK (16.1%) were the most productive countries, in terms of the number of relevant publications. The bibliometric analysis also revealed which EoLC research was most impactful and influential, from different parameters including documents, authors, sources, and organisations. The keyword analysis further suggested the growing importance of advance care planning and decision-making in regard to EoLC, as well as an episodic upsurge of EoLC publications related to the COVID-19 pandemic. There were few collaborations among the prolific research on EoLC. This study recommends increased research collaboration across the globe, for wider wisdom-sharing on EoLC issues.

Effectiveness of Educational Programs on Palliative and End-of-life Care in Promoting Perceived Competence Among Health and Social Care Professionals.

BACKGROUND: There is a growing need for palliative care for patients near the end of life and their caregivers. Palliative and end-of-life care (EoLC) education are recommended for all health care (e.g., physicians, nurses, and allied health practitioners) and social care professionals (e.g., social workers) to ensure the quality of services. However, less attention has been afforded to generic, in contrast to specialized, EoLC education. This study evaluated the effectiveness of a series of short-term generic EoLC educational programs for health and social care professionals. METHOD: A pre-post survey design was adopted, focusing on different EoLC core competences. RESULTS: Significant improvement was observed in all perceived competences after the educational programs, regardless of participants' occupation or EoLC experience. Perceived competence in self-care was rated significantly higher than all other competences prior to the programs. Healthcare professionals rated significantly higher on competence in symptom management than social workers. Scores on communication skill and self-care competences were significantly higher following longer (i.e., 16-24 hours) than shorter (i.e., 4-8 hours) programs. CONCLUSION: Generalist palliative/EoLC educational programs may enable health and social care professionals to refresh and extend their knowledge and skills and enhance their perceived competence in providing EoLC. Further research on generalist palliative/EoLC education is needed to examine the impact of continuing training on professionals' actual practice in EoLC and palliative care.

What characterize high and low achieving teams in Interprofessional education: A self-determination theory perspective.

OBJECTIVES: Calls to promote team-based interprofessional collaborative practice in managing patients with complex health problems are ubiquitous. However, the literature remains silent on what characterises successful teams in interprofessional education (IPE) and on profiling successful teams. To help conceptualise successful teams, this study investigated the differences in attitudes and achievement between high- and low-performing teams in an online asynchronous and synchronous IPE programme, and the role of autonomous motivation in determining team membership. METHODS: Using extreme case sampling involving health and social care students, we identified ten high-performing teams and seven low-performing teams based on their team composite scores on three interprofessional collaborative outcomes: team effectiveness, goal achievement, and scores on the readiness assurance test. Each team had five to seven members of diverse backgrounds. Independent t-tests were performed to identify differences in interprofessional collaborative outcomes, namely teamwork and collaboration, patient-centredness, diversity and ethics, community-centeredness, and interprofessional biases for the affective domain and application exercise for the cognitive domain. We employed logistic regression in which autonomous motivation was used to predict group membership. RESULTS: High-performing teams were characterised as those whose members endorsed or valued "teamwork and collaboration" in IPE simulations. Compared with the low-performing groups, they better recognised and endorsed diversity and ethics, patient-centeredness, and community-centeredness. Membership to high- and low-performing teams was linked to autonomous motivation. CONCLUSIONS: High-performing teams have higher favourable valuing of important interprofessional collaborative competencies, and membership to which is predicted by autonomous motivation. The results suggest the need to pay special attention to struggling teams to facilitate desirable collaborative competencies, especially in terms of members' motivation. Theoretical, methodological, and practical implications are discussed.

What factors facilitate interprofessional collaboration outcomes in interprofessional education? A multi-level perspective.

OBJECTIVES: Interprofessional education (IPE) harnesses the power of teams to facilitate collaborative learning across disciplines. However, prior research has not paid sufficient attention to the role of team-level factors on IPE outcomes, posing a major theoretical and methodological limitation. In response to this, using social interdependence theory (SIT), this study aimed to delineate the independent contributions of both team-level and student-level interprofessional attitudes (teamwork, roles, and responsibilities; patient-centeredness; and community-centeredness) in predicting IPE collaboration outcomes (goal achievement, team effectiveness, and team performance) employing multi-level analysis. METHODS: To test whether interprofessional attitudes at the team and student levels predict IPE collaboration outcomes, conducted multilevel modeling. We used the pretest and posttest data from 323 healthcare students in Hong Kong from Chinese medicine, medicine, nursing, pharmacy, and social work programmes enrolled in the IPE Cancer module. RESULTS: Among the interprofessional attitudes, "teamwork, roles, and responsibilities" was found to be the best predictor of IPE outcomes, both at the student and team levels. Students who recognized the benefits of shared learning had better goal achievement and team effectiveness. Furthermore, teams that emphasized shared learning also had better overall team performance. CONCLUSIONS: Students' attitudes towards teamwork, roles, and responsibilities in interprofessional collaborative practice, both at the student and team levels, are important to attaining positive student- and team-level outcomes. The study contributes to the expansion of existing knowledge in medical education, theoretically, by adopting SIT as a lens through which collaborative learning in healthcare teams can be understood, and methodologically, by applying multi-level approaches and delineating important student- and team-level predictors of IPE outcomes.

Self-Determination Competencies, (Dis)Agreement in Decision-Making, and Personal Well-Being of Adults with Mild Intellectual Disabilities in Hong Kong.

BACKGROUND: The self-determination of people with an intellectual disability (ID) in the contexts of adulthood and Chinese culture is under-examined in the field of ID, even though the concept of self-determination has vigorously developed in recent decades. This study examined the relationship between self-determination competencies and the personal well-being of adults with mild ID in Hong Kong, as well as their personal goals and decision-making (dis)agreements with their significant others. METHODS: We interviewed 170 participants using the AIR Self-Determination Scale-Chinese Version (AIR SDS-C) and the Personal Well-Being-Intellectual Disability (Cantonese) (PWI-C), along with a self-constructed questionnaire. RESULTS: When the demographic characteristics were controlled, self-determination competencies correlated positively with personal well-being (r = 0.313, p < 0.001), diverse personal goals were identified, and agreement with significant others was dominant in both daily and major decision-making. CONCLUSIONS: A positive correlation between self-determination and personal well-being was confirmed in a Chinese population with mild ID. These findings expand the understanding of the types of personal goals and agreement patterns of people with mild ID and yield implications for further research and practices.