收稿日期: 2023-07-25
网络出版日期: 2024-06-13
基金资助
湖南省哲学社会科学基金(22YBA016)
Meta-analysis of attitudes towards death and influencing factors among nurses in China
目的 了解国内临床护士死亡态度现状及相关因素，为护理管理者对其进行针对性干预提供参考。 方法 检索中国知网、中国生物医学文献数据库、维普、万方、Pubmed、Web of Science、EMbase、CINHAL、the Cochrane Library数据库，纳入使用修订版死亡态度描绘量表评估国内护士死亡态度横断面研究的文献，检索时限为建库至2023年5月10日，采用RevMan 5.4及Stata 17.0进行Meta分析。 结果 共纳入38篇文献，总样本量为17 284。我国护士死亡态度维度均分最高为自然接受维度3.79（95%CI：3.59，3.98）。女护士自然接受维度得分更高（Z=2.14，P=0.03，I2=9%）；与工作10年以上的护士相比，工作6~10年的护士死亡恐惧维度得分更高（Z=2.90，P=0.004，I2=46%）；与工作≤5年的护士相比，工作6~10年（Z=2.20，P=0.03，I2=68%）和10年以上（Z=3.60，P<0.001，I2=0%）的护士死亡逃避维度得分更高，工作10年以上护士趋近接受维度得分（Z=2.08，P=0.04，I2=0%）和逃离接受维度得分（Z=4.71，P<0.001，I2=0%）更高；有进行患者临终处置经历的护士死亡恐惧维度得分更低（Z=2.05，P=0.04，I2=0%），趋近接受维度得分更低（Z=2.57，P=0.01，I2=0%）。 结论 国内临床护士的死亡态度得分以自然接受维度得分最高，死亡逃避维度得分次之。护士的性别、工作年限、患者临终处置经历是影响其死亡态度的因素，护理管理者应了解临床护士死亡态度，针对性开展死亡教育。
黄玉婷 , 张慧琳 , 朱婧 , 邹颖 , 覃祖明 , 张晓可 . 国内护士对死亡的态度现状及影响因素的系统评价[J]. 中华护理教育, 2024 , 21(6) : 718 -724 . DOI: 10.3761/j.issn.1672-9234.2024.06.013
Objective To understand the state of attitudes towards death among nurses，and then provide references for targeted intervention. Methods The cross-sectional studies on attitude towards death among nurses using the Death Attitude Profiled-Revised（DAP-R）were searched in CNKI，CBM，VIP，Wanfang Data，PubMed，Web of Science，Embase，CINHAL，and the Cochrane Library from inception to May 10，2023. Meta-analysis was performed using RevMan 5.4 and Stata 17.0. Results Totally 38 articles were included with a total sample size of 17 284. The highest score of death attitudes among Chinese nurses was 3.79（95%CI：3.59，3.98） for neutral acceptance. Female nurses were more likely to neutral acceptance（Z=2.14，P=0.03，I2=9%）；Nurses with 6 to 10 years of service had higher scores on the fear of death dimension compared to nurses with more than 10 years of service （Z=2.90，P=0.004，I2=46%），and compared to nurses with ≤5 years of service，nurses with 6 to 10 years of service（Z=2.20，P=0.03，I2=68%） and more than 10 years of service（Z=3.60，P<0.001，I2=0%） death avoidance dimension scores were higher，and nurses with more than 10 years of employment had higher convergent acceptance dimension scores （Z=2.08，P=0.04，I2=0%） and escape acceptance dimension scores（Z=4.71，P<0.001，I2=0%）；nurses who had experience of end-of-life management of patients had lower fear of death scores（Z=2.05，P=0.04，I2=0%） and lower approach acceptance scores（Z=2.57，P=0.01，I2=0%）. Conclusion Clinical nurses’ attitudes toward death are complex，with neutral acceptance being predominant and death avoidance secondary. Nurses’ gender，working experience，and the exprience of managing patients at the end of life are the influencing factors of death attitude. The attitudes towards death of clinical nurses should be identified as soon as possible to carry out targeted death education.
Key words： Nurses; Attitudes towards death; Influencing factors; Meta-analysis
| [1] | 国家统计局. 中华人民共和国2021年国民经济和社会发展统计公报[EB/OL]. [2023-02-28]. http://www.stats.gov.cn/xxgk/sjfb/zxfb2020/202202/t20220228_1827971.html. |
| [2] | 李换则, 陈鸿芳, 黄丽群, 等. 急诊科护士临终照护体验质性研究的Meta整合[J]. 护理学报, 2021, 28(7):43-48. |
| [3] | Dezutter J, Luyckx K, Hutsebaut D. “Are You afraid to die?” religion and death attitudes in an adolescent sample[J]. J Psychol Theol, 2009, 37(3):163-173. |
| [4] | Yu H, Sun CY, Xie LF, et al. Using a mediating model of death attitude and meaning in life to understand nursing students attitude about hospice care[J]. Nurse Educ Today, 2022, 116:105448. |
| [5] | McKenzie EL, Brown PM, Mak AS, et al. ‘Old and ill’:death anxiety and coping strategies influencing health professionals’ well-being and dementia care[J]. Aging Ment Health, 2017, 21(6):634-641. |
| [6] | Wong PTP, Reker G, Gesser G. Death Attitude Profile—Revised:a multidimensional measure of attitudes toward death[M]//Neimeyer RA. Death anxiety handbook:research,instrumentation,and application. Washington, DC: Taylor & Francis,1994:121-148. |
| [7] | Xu Y. Death and dying in the Chinese culture:implications for health care practice[J]. Home Health Care Manag Pract, 2007, 19(5):412-414. |
| [8] | Tu J, Shen MX, Li ZY. When cultural values meets professional values:a qualitative study of Chinese nurses’ attitudes and experiences concerning death[J]. BMC Palliat Care, 2022, 21(1):1-10. |
| [9] | 陈蓄, 梁燕仪. 临床护理人员死亡态度现状及影响因素的研究进展[J]. 中国医学伦理学, 2016, 29(6):985-989. |
| [10] | Gesser G, Wong PTP, Reker GT. Death attitudes across the life-span:the development and validation of the death attitude profile(DAP)[J]. Omega(Westport), 1988, 18(2):113-128. |
| [11] | 唐鲁, 张玲, 李玉香, 等. 中文版死亡态度描绘量表用于护士群体的信效度分析[J]. 护理学杂志, 2014, 29(14):64-66. |
| [12] | 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四:观察性研究的质量评价工具[J]. 中国循证心血管医学杂志, 2012, 4(4):297-299. |
| [13] | 闫小妮, 郑婕, 厉英超, 等. 应用Stata软件实现观察性研究效应量及可信区间的Meta分析[J]. 中国循证医学杂志, 2018, 18(3):367-372. |
| [14] | 王小曼, 董凤齐, 郑瑞双. 肿瘤医院护士对待死亡及临终关怀态度的调查研究[J]. 中国实用护理杂志, 2013, 29(25):73-75. |
| [15] | 陈鹏, 王敏, 刘宇, 等. 北京市157名护士的死亡态度及临终关怀教育需求调查分析[J]. 护理学报, 2014, 21(16):29-32. |
| [15] | Chen P, Wang M, Liu Y, et al. Nurses’ attitude toward death and needs for hospice care education[J]. J Nurs(China), 2014, 21(16):29-32. |
| [16] | 徐旭东, 金奕, 李淑兰, 等. 天津市8家三级甲等医院急诊科护士死亡态度现状及影响因素研究[J]. 中国护理管理, 2016, 16(3):340-344. |
| [17] | 康璇, 徐春艳, 张翠萍. 肿瘤医院护士死亡态度及其影响因素分析[J]. 中华现代护理杂志, 2018, 24(7):756-759. |
| [18] | 韩舒, 崔岩, 卢晓虹, 等. 三级甲等医院护士死亡态度现状及影响因素研究[J]. 护理管理杂志, 2018, 18(3):185-188. |
| [19] | 高冉, 蔡英杰, 李艳娇, 等. 护士生命意义感对死亡态度影响的研究[J]. 中国护理管理, 2018, 18(4):461-465. |
| [20] | 张慧影, 武礼琴. 新疆临床护士死亡态度对其临终照护态度的影响研究[J]. 全科护理, 2018, 16(11):1291-1294. |
| [21] | Wang LP, Li CX, Zhang QL, et al. Clinical nurses’ attitudes towards death and caring for dying patients in China[J]. Int J Palliat Nurs, 2018, 24(1):33-39. |
| [22] | 吕爱华. 患者死亡对急诊科护士心理影响的合众化研究[D]. 杭州: 浙江中医药大学, 2018. |
| [22] | Lyu AH. A unified study on the psychological influence of patient death on nurses in emergency department[D]. Hangzhou: Zhejiang Chinese Medical University, 2018. |
| [23] | 刘英. 湖南省急诊科护士对死亡的态度与临终关怀态度的现况调查[D]. 长沙: 湖南师范大学, 2019. |
| [23] | Liu Y. Investigation on the attitude of emergency nurses towards death and hospice care in Hunan Province[D]. Changsha: Hunan Normal University, 2019. |
| [24] | 管秋蓉. 妇科肿瘤科护理人员死亡态度现状及影响因素调查[J]. 全科护理, 2019, 17(14):1765-1767. |
| [25] | Guo QH, Zheng RS. Assessing oncology nurses’ attitudes towards death and the prevalence of burnout:a cross-sectional study[J]. Eur J Oncol Nurs, 2019, 42:69-75. |
| [26] | 徐旭东, 金奕, 赵媛, 等. 急诊科护士死亡态度与工作敬业度及组织公民行为的相关性研究[J]. 中国实用护理杂志, 2019, 35(29):2290-2294. |
| [27] | 丁传琦, 金静芬. 急诊科护士死亡态度对其临终照护态度影响的研究[J]. 中华护理教育, 2020, 17(3):275-278. |
| [27] | Ding CQ, Jin JF. The influence of death attitude on hospice care attitude among emergency nurses[J]. Chin J Nurs Educ, 2020, 17(3):275-278. |
| [28] | 杜华, 吴萌, 潘玉芹, 等. 安徽省肿瘤科护士安宁疗护态度现状及其影响因素[J]. 护理实践与研究, 2020, 17(15):1-6. |
| [29] | 罗金玲, 春晓, 叶倩仪, 等. 331名ICU护士的死亡态度水平分析[J]. 护理学报, 2020, 27(9):42-47. |
| [29] | Luo JL, Chun X, Ye QY, et al. Analysis of death attitude level of 331 ICU nurses[J]. J Nurs(China), 2020, 27(9):42-47. |
| [30] | 勾小华. 肿瘤内科护士对死亡态度的调查及对临终护理质量的影响[J]. 实用医院临床杂志, 2020, 17(4):163-166. |
| [30] | Gou XH. Death attitude of nurses in oncology department and its influences on quality of hospice nursing[J]. Pract J Clin Med, 2020, 17(4):163-166. |
| [31] | 杜华, 吴萌, 潘玉芹, 等. 安徽省三级甲等医院肿瘤科护士死亡态度现状及其影响因素研究[J]. 全科护理, 2020, 18(11):1285-1291. |
| [32] | 黄家丽, 孙丽, 顾道琴, 等. 肿瘤科护士生命意义感现状及影响因素分析[J]. 护理研究, 2020, 34(20):3594-3600. |
| [33] | 吴运玲, 张家旭. 新入职护士对待临终关怀及死亡态度的调查研究[J]. 当代护士(上旬刊), 2020, 27(11):33-34. |
| [34] | Li LJ, Lv JM, Zhang LL, et al. Association between attitude towards death and spiritual care competence of Chinese oncology nurses:a cross-sectional study[J]. BMC Palliat Care, 2021, 20(1):150. |
| [35] | 罗蕾, 李放, 张健, 等. 安宁疗护专科护士的死亡态度与死亡教育需求现状及其相关性分析[J]. 中国护理管理, 2021, 21(2):195-201. |
| [36] | 胡少芬, 杨士来. 泉州市基层医院护士死亡态度现状及影响因素分析[J]. 职业与健康, 2021, 37(5):653-656. |
| [37] | 王丽华. 南昌市3所三甲医院肿瘤科护士死亡应对能力现状调查及影响因素分析[D]. 南昌: 南昌大学, 2021. |
| [37] | Wang LH. Investigation on death coping ability of oncology nurses in three 3A hospitals in Nanchang and analysis of influencing factors[D]. Nanchang: Nanchang University, 2021. |
| [38] | 罗明琴, 潘世琴. 青海省护理人员安宁疗护知识与死亡态度的现状调查研究[J]. 青海医药杂志, 2021, 51(10):19-21. |
| [39] | 唐晨曦, 李晓华, 何丽, 等. 三级综合医院护士临终关怀与死亡态度及其影响因素分析[J]. 医学信息, 2021, 34(15):71-75. |
| [39] | Tang CX, Li XH, He L, et al. Analysis of nurses’ hospice care and attitude towards death and its influencing factors in tertiary general hospitals[J]. Med Inf, 2021, 34(15):71-75. |
| [40] | 田凡立, 李惠玲, 马文霞, 等. 抗疫一线护理人员生命态度及影响因素调查[J]. 中国医学伦理学, 2021, 34(10):1347-1352. |
| [41] | 徐英华, 高巧丽, 王荣芽, 等. 临床护士死亡态度对其临终关怀态度影响的研究[J]. 护理管理杂志, 2021, 21(11):795-800. |
| [42] | Zhang JL, Tao HM, Mao JD, et al. Correlation between nurses’ attitudes towards death and their subjective well-being[J]. Ann Palliat Med, 2021, 10(12):12159-12170. |
| [43] | 蔡柳. ICU护士对待患者的死亡态度现状及影响因素分析[D]. 沈阳: 中国医科大学, 2022. |
| [43] | Cai L. Status quo and influencing factors of ICU nurses’ attitude towards patients’ death[D]. Shenyang: China Medical University, 2022. |
| [44] | 林毅, 高巧丽, 谢冬静, 等. 三级医院护士死亡态度现状分析与灵性教育实施探讨[J]. 上海护理, 2022, 22(3):38-43. |
| [45] | 李琳玉, 孙畅, 陈晓飞, 等. 新生儿重症监护室护士对死亡态度与安宁疗护教育需求的相关性分析[J]. 中华急危重症护理杂志, 2022, 3(5):431-436. |
| [45] | Li LY, Sun C, Chen XF, et al. Correlation analysis between death attitude and hospice education needs of the nurses in neonatal intensive care unit[J]. Chin J Emerg Crit Care Nurs, 2022, 3(5):431-436. |
| [46] | 钟美霞, 胡建萍, 郑月, 等. 规范化培训护士的死亡态度与死亡应对能力现状及其相关分析[J]. 职业与健康, 2022, 38(23):3245-3250. |
| [46] | Zhong MX, Hu JP, Zheng Y, et al. Current situation of death attitude and death coping ability of standardized training nurses and analysis on their correlation[J]. Occup Health, 2022, 38(23):3245-3250. |
| [47] | Zheng RS, Guo QH, Dong FQ, et al. Death self-efficacy,attitudes toward death and burnout among oncology nurses:a multicenter cross-sectional study[J]. Cancer Nurs, 2022, 45(2):E388-E396. |
| [48] | He SJ, Zhao H, Wang HP, et al. The mediating effects of attitude toward death and meaning of life on the relationship between perception of death and coping with death competence among Chinese nurses:a cross-sectional study[J]. BMC Nurs, 2023, 22(1):87. |
| [49] | 罗丹丹. 监护室护士对死亡态度以及安宁疗护教育需求的现状调查[J]. 全科护理, 2023, 21(12):1712-1715. |
| [50] | 杨红梅, 赵丹, 钟海燕, 等. 湖南省急诊科护士死亡态度与死亡教育需求现状及其相关性分析[J]. 重庆医学, 2023, 52(8):1219-1224. |
| [50] | Yang HM, Zhao D, Zhong HY, et al. Current situation and correlation analysis of attitude towards death and demands for death education among emergency nurses in Hunan Province[J]. Chongqing Med, 2023, 52(8):1219-1224. |
| [51] | 杨玉丽, 梁晓艳. 银川市肿瘤科护士死亡态度现状及影响因素分析[J]. 循证护理, 2023, 9(2):278-282. |
| [52] | Han HW, Ye Y, Zhuo HX, et al. Death attitudes and associated factors among health professional students in China[J]. Front Public Health, 2023, 11:1174325. |
| [53] | Cybulska AM, ?o?nowska MA, Schneider-Matyka D, et al. Analysis of nurses’ attitudes toward patient death[J]. Int J Environ Res Public Health, 2022, 19(20):13119. |
| [54] | Duran S, Polat S. Nurses’ attitudes towards death and its relationship with anxiety levels[J]. Omega(Westport), 2022:302228211065963. |
| [55] | 王云岭. 死亡教育纳入国民教育体系探究[J]. 科学与社会, 2020, 10(3):1-13,65. |
| [55] | Wang YL. Exploration on integrating death education into the national education system[J]. Sci Soc, 2020, 10(3):1-13,65. |
| [56] | Han HW, Ye Y, Xie YH, et al. The impact of death attitudes on death education needs among medical and nursing students[J]. Nurse Educ Today, 2023, 122:105738. |
| [57] | 李阳. 大闹一场悄然离去——论医学生生死教育教学探索[J]. 中国医学人文, 2023, 9(9):66-69. |
| [58] | 黄成利, 胡超. 死亡意识的恐惧管理和悲伤管理[J]. 心理学报, 2023, 55(2):318-335,I0004. |
| [58] | Huang CL, Hu C. The terror management and sorrow management of death consciousness[J]. Acta Psychol Sin, 2023, 55(2):318-335,I0004. |
| [59] | 杨红, 李攀, 胡茂荣. 论死亡的认知与接纳[J]. 医学与哲学, 2023, 44(5):54-58. |
| [59] | Yang H, Li P, Hu MR. The cognition and acceptance of death[J]. Med Philos, 2023, 44(5):54-58. |
| [60] | Wang YW, Tang SY, Hu X, et al. Gender differences in attitudes toward death among Chinese college students and the implications for death education courses[J]. Omega(Westport), 2022, 85(1):59-74. |
| [61] | Qian Y, Qian ZC. Work,family,and gendered happiness among married people in urban China[J]. Soc Indic Res, 2015, 121(1):61-74. |
| [62] | 卿石松. 性别角色观念、家庭责任与劳动参与模式研究[J]. 社会科学, 2017(11):91-100. |
| [62] | Qing SS. Gender role attitudes,family responsibilities and female-male labor force participation patterns[J]. J Soc Sci, 2017(11):91-100. |
| [63] | Chiou RJ, Tsai PF, Han DY. Exploring the impacts of a coffin-lying experience on life and death attitudes of medical and nursing students:preliminary findings[J]. BMC Med Educ, 2023, 23(1):1-11. |
| [64] | Chua JYX, Shorey S. Effectiveness of end-of-life educational interventions at improving nurses and nursing students’ attitude toward death and care of dying patients:a systematic review and meta-analysis[J]. Nurse Educ Today, 2021, 101:104892. |
/
| 〈 |
|
〉 |