dc.contributor.author	Schlairet, Maura C.	en_US
dc.coverage.spatial	United States	en_US
dc.coverage.temporal	2000-2006 CE	en_US
dc.date.accessioned	2010-09-23T13:59:16Z	en_US
dc.date.accessioned	2011-03-02T17:29:02Z
dc.date.available	2010-09-23T13:59:16Z	en_US
dc.date.available	2011-03-02T17:29:02Z
dc.date.issued	2006-05	en_US
dc.identifier.uri	http://hdl.handle.net/10428/453	en_US
dc.description.abstract	A decade after release of the landmark Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment, improvements in end of life (EOL) care are apparent. Notwithstanding an improved dialogue focused on EOL care, evidence suggests persistent shortcomings in our ability to meet the needs of the dying. Registered Nurses must possess the knowledge/skill to assist patients/families in managing health across all stages of life, including the EOL phase. A significant proportion of practicing nurses have not received formal EOL care education. Of further concern, deficiencies in existing formal EOL care education have been well described. Insufficient information exists on specific EOL care educational needs of practicing RNs. Few surveys exploring educational needs of nurse generalists have been available and no large scale utilization of any one instrument has been identified. To aid in development of EOL continuing education (CE) for RNs, a survey was designed to explore nurses EOL care attitude/belief, knowledge/skill, education, and learner characteristics. The survey was published in a state nurse association newspaper and mailed to all RNs in one southeastern state. A Web based version of the survey was also available. The accessible population consisted of 51,000 licensed RNs. Return of 567 surveys, primarily via the Web, resulted in a response rate of 1.1%. Reliability was assessed with calculation of coefficient alpha of 0.96 across survey sections. The majority of respondents had neither formal EOL education nor prior EOL CE. Yet, nurses held positive attitude/belief toward EOL care and the majority desired EOL CE. T tests revealed nurses with prior EOL CE scored significantly better than nurses without CE across all survey subsection nurses who received formal EOL instruction during initial nursing education failed to score better on objective EOL knowledge/skill questions than nurses without formal EOL education. MANOVAs identified a similar counterintuitive pattern. Bimodal distributions were observed in analyses of workplace appropriateness and desire for education scores across 23 EOL care topics. Chi square analyses revealed significant contributions of EOL attitude/belief, prior EOL CE, and objective EOL knowledge/skill toward positive views on EOL workplace appropriateness and desire for EOL education.	en_US
dc.description.tableofcontents	I. INTRODUCTION.............................................................................1 Overview.......................................................................................1 Aims...........................................................................................6 Goals ..........................................................................................8 Justification ..................................................................................9 Definition of Terms.........................................................................12 Theory.........................................................................................15 Induction...........................................................................15 Paradigm...........................................................................16 Typology...........................................................................17 Exploration.........................................................................17 Description.........................................................................17 Survey..............................................................................18 Learning Styles....................................................................18 Competency Assessment.........................................................19 Joint Construct.....................................................................19 Assessment Framework..........................................................20 Common Meaning................................................................20 Previous Research...........................................................................21 Availability of Data.........................................................................23 Limitations..................................................................................23 v v v v v II. LITERATURE REVIEW...................................................................24 Registered Nurses..........................................................................24 Population..........................................................................24 Nurses and Research..............................................................27 The State of End of Life Care............................................................31 A National End of Life Perspective.............................................31 The Georgia End of Life Perspective............................................43 Attitudes Toward End of Life Care.............................................46 The State of End of Life Care Nursing Education......................................49 A National Educational Perspective............................................49 The Georgia Educational Perspective..........................................52 Essential End of Life Education.................................................53 Existing End of Life Educational Initiatives...................................59 The Influence of Education on Attitudes Toward End of Life Care........63 Studies of Nurses Educational Needs Related to End of Life Care.................65 Surveys with Healthcare Professionals and Others...........................65 Surveys with End of Life Nurse Specialists...................................66 Surveys with Nurse Generalists.................................................69 Surveys with Nurse Generalists in the Region................................73 The Role of Professional Organizations in End of Life Education..................74 Continuing Education for Nurses........................................................77 Educational Needs Assessment...........................................................82 Utilization of a Web Survey..............................................................86 vi III. METHODOLOGY...........................................................................97 Participants..................................................................................99 Instrument.................................................................................100 Survey Instrument................................................................100 Reliability of Constructs........................................................105 Validity...........................................................................106 Pilot Testing.......................................................................108 Procedure..................................................................................108 Data Analysis..............................................................................111 Study Limitations..........................................................................111 IV. RESULTS....................................................................................115 Interval Level Statistics and Ordinal Data.............................................115 Demographic Information...............................................................115 Nurses in Georgia...............................................................115 Nurse Learner Characteristics..................................................121 Nurse Association Member Characteristics..................................130 Univariate Analysis.......................................................................136 Bivariate Analysis........................................................................155 Nurses End of Life Attitude/belief...........................................155 Nurses End of Life Knowledge/skill.........................................160 Nurses and End of Life Continuing Education ..............................168 Nurses and Formal End of Life Education...................................169 Results by null hypotheses.....................................................169 vi III. METHODOLOGY...........................................................................97 Participants..................................................................................99 Instrument.................................................................................100 Survey Instrument................................................................100 Reliability of Constructs........................................................105 Validity...........................................................................106 Pilot Testing.......................................................................108 Procedure..................................................................................108 Data Analysis..............................................................................111 Study Limitations..........................................................................111 IV. RESULTS....................................................................................115 Interval Level Statistics and Ordinal Data.............................................115 Demographic Information...............................................................115 Nurses in Georgia...............................................................115 Nurse Learner Characteristics..................................................121 Nurse Association Member Characteristics..................................130 Univariate Analysis.......................................................................136 Bivariate Analysis........................................................................155 Nurses End of Life Attitude/belief...........................................155 Nurses End of Life Knowledge/skill.........................................160 Nurses and End of Life Continuing Education ..............................168 Nurses and Formal End of Life Education...................................169 Results by null hypotheses.....................................................169 vii Null hypothesis I........................................................170 Null hypothesis II.......................................................174 Chi-square Test of Independence: Workplace Appropriateness and Education Desire.................................................................177 Multivariate Analysis.....................................................................186 Multiple Linear Regression: Formal Education and Continuing Education.........................................................................186 MANOVA and Differences in Scores: Formal Education and Continuing Education.........................................................................193 Nurses Views and Challenges of End of Life Care................................199 Results Summary.........................................................................203 Univariate and Demographics..................................................203 Bivariate...........................................................................205 Multivariate.......................................................................207 Supplemental Research Strategies.............................................208 V. Discussion, Implications, and Recommendations......................................210 Discussion.................................................................................210 Overview..........................................................................210 Are Educational Initiatives Working?.....................................................212 End of life care and nurses knowledge/skill........................212 End of life care and nurses attitude/belief..........................215 Influence of formal EOL education..................................216 Influence of continuing education....................................220 vii Null hypothesis I........................................................170 Null hypothesis II.......................................................174 Chi square Test of Independence: Workplace Appropriateness and Education Desire.................................................................177 Multivariate Analysis.....................................................................186 Multiple Linear Regression: Formal Education and Continuing Education.........................................................................186 MANOVA and Differences in Scores: Formal Education and Continuing Education.........................................................................193 Nurses Views and Challenges of End of Life Care................................199 Results Summary.........................................................................203 Univariate and Demographics..................................................203 Bivariate...........................................................................205 Multivariate.......................................................................207 Supplemental Research Strategies.............................................208 V. Discussion, Implications, and Recommendations......................................210 Discussion.................................................................................210 Overview..........................................................................210 Are Educational Initiatives Working?.....................................................212 End of life care and nurses knowledge/skill........................212 End of life care and nurses attitude/belief..........................215 Influence of formal EOL education..................................216 Influence of continuing education....................................220 viii End of life workplace appropriateness and education desire......222 Nurses Views and Challenges of End of Life Care........................225 Response Rate....................................................................226 Perspectives..............................................................226 Nurses and research....................................................228 Web survey format.....................................................229 Generalizability of Findings...................................................229 Selection bias concern..................................................229 Nurse characteristics: State and national level comparison.......230 Nurse association membership characteristics.......................233 Self assessment Concerns......................................................234 Validity issues...........................................................234 Novice to expert scale..................................................235 Subjective and Objective Knowledge/skill...................................237 How nurses know.......................................................237 Realistic knowledge appraisal.........................................239 Educational Needs Assessment.................................................239 Learner characteristics.................................................239 Identification of nurse attitude related needs........................240 Professional Association and end of life continuing education development......................................................................241 Instrument Utility................................................................241 Implications................................................................................243 Education..........................................................................243 Practice............................................................................244 Theory.............................................................................245 Research...........................................................................246 Recommendations.........................................................................246 Research...........................................................................247 Education.........................................................................248 Conclusion.................................................................................249 VI. REFERENCE LIST.........................................................................250 VII. APPENDICES..............................................................................291 Appendix A: Letter of Intent.............................................................291 Appendix B: Association Permission Letter...........................................293 Appendix C: Valdosta State University IRB Approval Letters.....................295 Appendix D: Existing Surveys Reviewed for Association Project.................298 Appendix E: End of Life Care Educational Needs Survey........................301 Appendix F: Association Project Descriptive Article................................305	en_US
dc.language.iso	en_US	en_US
dc.subject	Nursing	en_US
dc.subject	End of Life Care	en_US
dc.title	Survey of Nurses' Educational Needs Related to End of Life Care	en_US
dc.type	Dissertation	en_US
dc.contributor.department	Curriculum and Instructional Technology	en_US
dc.description.advisor	Fenster, Mark J.	en_US
dc.description.committee	Ballard, Chet	en_US
dc.description.committee	Wiley, Ellen W.	en_US
dc.description.committee	Wold, Susan J.	en_US
dc.description.degree	Ed.D.	en_US
dc.description.major	Education	en_US