Emergency Nurses’ Perceptions of Supportive Behaviors and Burdens in Providing End-Of-Life Care
Abstract
The high mortality rate in the Emergency Department (ED) is consistent with the high demand for the end of life (EOL) care. However, ED work system required to live-saving quickly and precisely. It affects the quality of EOL care. The purpose of this study was to determine nurses’ perceptions in ED related to supportive behaviors (SB) and burdens in providing EOL care to dying patients. The descriptive-quantitative method was used with a cross-sectional approach in 50 nurses Emergency Department at one of the tertiary hospitals in Indonesia. The samples were chosen using the total sampling technique. Data collection used emergency nurse perceptions of end of life care questionnaire. Data were analyzed using univariate analysis in the form of distribution, frequency, and mean. The result of the study showed that the three largest obstacles in EOL care were: ED nurses’ work loads (mean=10.626), intra-family disagreements (mean=9.802), and deal with angry of family members (mean=9.472). The three largest supportive behaviors were teaching families how to act (mean=11.962), allowing family members adequate time with the patient after a patient died (mean=11.09), and good collaboration from health professionals (mean=10.886). According to this research, further studies are needed to minimize obstacles and improve supportive behaviors related to the nurse’s workload, the provision of spiritual teams, special training for the nurse and the provision of special rooms for EOL patients and their families.
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Ajzen, I. (2005). Attitude, Personality and behavior. In T. Manstead (Ed.) (2nd ed.). New York: USA: Open. University Press.
Attia, A. K., Abd-Elaziz, W. W., & Kandeel, N. A. (2013). Critical Care Nurses’ Perception of Barriers and Supportive Behaviors in End-of-Life Care. American Journal of Hospice and Palliative Medicine, 30(3), 297–304. https://doi.org/10.1177/1049909112450067
Bailey, C., Murphy, R., & Porock, D. (2010). Trajectories of End-of-Life Care in the Emergency Department. YMEM, 57(4), 362–369. https://doi.org/10.1016/j.annemergmed.2010.10.010
Beckstrand, R. L., Collette, J., Callister, L., & Luthy, K. E. (2012). Oncology Nurses’ Obstacles and Supportive Behaviors in End-of-Life Care: Providing Vital Family Care. Oncology Nursing Forum, 39(5), E398–E406. https://doi.org/10.1188/12.ONF.E398-E406
Beckstrand, R. L., Rawle, N. L., Callister, L., & Mandleco, B. L. (2010). Pediatric nurses’ perceptions of obstacles and supportive behaviors in end-of-life care. American Journal of Critical Care, 19(6), 543–552. https://doi.org/10.4037/ajcc2009497
Beckstrand, R. L., Rohwer, J., Luthy, K. E., Macintos, J. L. B., & Rasmussen, R. J. (2015). Rural Emergency Nurses’ End-Of-Life Care Obstacle Experiences:Stories From The Last Frontier. YMEN, 1–9. https://doi.org/10.1016/j.jen.2015.08.017
Beckstrand, R. L., Smith, M. D., Heaston, S., & Bond, A. E. (2008). Emergency Nurses’ Perceptions of Size, Frequency, and Magnitude of Obstacles and Supportive Behaviors in End-of-Life Care. Journal of Emergency Nursing, 34(4), 290–300. https://doi.org/10.1016/j.jen.2007.09.004
Chan, Z. C. Y., & Lai, W.-F. (2010). A Hong Kong perspective on ways to improve nurse retention. Nursing Standard : Official Newspaper of the Royal College of Nursing, 24(35), 35–40. https://doi.org/10.7748/ns2010.05.24.35.35.c7750
Decker, K., Susan, L., & Julia, M. (2015). The experiences of emergency nurses in providing end-of-life care to patients in the emergency department. Australasian Emergency Nursing Journal, 18(2), 68–74. https://doi.org/10.1016/j.aenj.2014.11.001
Departmen of Health. (2008). End of Life Care Strategy : Promoting High Quality Care For All Adults At The End Of Life. Retrieved from http://www.cpa.org.uk/cpa/End_of_Life_Care_Strategy.pdf
Effendy, N. (1998). Dasar-Dasar Keperawatan Kesehatan Masyarakat (2nd ed.). Jakarta: EGC.
General Medical Council. (2010). Treatment and care towards the end of life: good practice in decision making. General Medical Council, 1–85. https://doi.org/978-0-901458-46-9
Hanratty, B., Holmes, L., Lowson, E., Grande, G., Addington-hall, J., Payne, S., & Seymour, J. (2012). Older Adults ’ Experiences of Transitions Between Care Settings at the End of Life in England : A Qualitative Interview Study. Journal of Pain and Symptom Management, 44(1), 74–83. https://doi.org/10.1016/j.jpainsymman.2011.08.006
Heaston, S., Beckstrand, R. L., Bond, E., Palmer, S. P., Provo, & Utah. (2006). Emergency Nurses’ Perceptions of Obstacles and Supportive Behaviors in End-of-Life Care, (December). https://doi.org/10.1016/j.jen.2006.07.013
Hendianti, G. N. (2012). Gambaran Beban Kerja Perawat Pelaksana Unit Instalasi Gawat Darurat Rumah Sakit Muhammadiyah Bandung. Students E-Journal, 1(1), 31.
International Council of Nurses. (2012). The Code of Ethics for Nurses. The Michigan Nurse, 74(2), 9–10. https://doi.org/10.1111/j.0028-1425.2007.ethics.x
Ka-Ming Ho, J. (2016). Resuscitation versus end-of-life care: Exploring the obstacles and supportive behaviors to providing end-of-life care as perceived by emergency nurses after implementing the end-of-life care pathway. Applied Nursing Research, 29, e7–e13. https://doi.org/10.1016/j.apnr.2015.05.014
Menteri Kesehatan RI. (2009). Keputusan Menteri Kesehatan Republik Indonesia Nomor 856 / Menkes / SK / IX / 2009 Tentang Standar Instalasi Gawat Darurat ( IGD ) Rumah Sakit. Retrieved October 9, 2017, from http://sardjitohospital.co.id/sardjitowp/wp-content/uploads/2015/12/kepmenkes-856-thn-2009-standar-IGD.pdf
National Health Service. (2015). End of life care. Retrieved February 5, 2017, from https://www.nhs.uk/Planners/end-of-life-care/Pages/what-it-involves-and-when-it-starts.aspx
Ose, M. I., Ratnawati, R., & Lestari, R. (2016). Studi Fenomenologi Pengalaman Perawat Instalasi Gawat Darurat (Igd) Dalam Merawat Pasien Terlantar Pada Fase End Of Life Di Rsud Dr. Saiful Anwar Malang, 4(2).
Smith, A. K., McCarthy, E., Weber, E., Cenzer, I. S., Boscardin, J., Fisher, J., & Covinsky, K. (2012). Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Affairs, 31(6), 1277–1285. https://doi.org/10.1377/hlthaff.2011.0922
Stoppelenburg, A. B., Rietjens, J. A. C., & Heide, A. Van Der. (2014). The effects of advance care planning on end-of-life care : A systematic review, (Erasmus MC). https://doi.org/10.1177/0269216314526272
Warnes, G., Blackburn, K., & Hooper, J. (2017). Wiltshire ’ s End of Life Care Strategy For Adults 2017 to 2020.
Ajzen, I. (2005). Attitude, Personality and behavior. In T. Manstead (Ed.) (2nd ed.). New York: USA: Open. University Press.
Attia, A. K., Abd-Elaziz, W. W., & Kandeel, N. A. (2013). Critical Care Nurses’ Perception of Barriers and Supportive Behaviors in End-of-Life Care. American Journal of Hospice and Palliative Medicine, 30(3), 297–304. https://doi.org/10.1177/1049909112450067
Bailey, C., Murphy, R., & Porock, D. (2010). Trajectories of End-of-Life Care in the Emergency Department. YMEM, 57(4), 362–369. https://doi.org/10.1016/j.annemergmed.2010.10.010
Beckstrand, R. L., Collette, J., Callister, L., & Luthy, K. E. (2012). Oncology Nurses’ Obstacles and Supportive Behaviors in End-of-Life Care: Providing Vital Family Care. Oncology Nursing Forum, 39(5), E398–E406. https://doi.org/10.1188/12.ONF.E398-E406
Beckstrand, R. L., Rawle, N. L., Callister, L., & Mandleco, B. L. (2010). Pediatric nurses’ perceptions of obstacles and supportive behaviors in end-of-life care. American Journal of Critical Care, 19(6), 543–552. https://doi.org/10.4037/ajcc2009497
Beckstrand, R. L., Rohwer, J., Luthy, K. E., Macintos, J. L. B., & Rasmussen, R. J. (2015). Rural Emergency Nurses’ End-Of-Life Care Obstacle Experiences:Stories From The Last Frontier. YMEN, 1–9. https://doi.org/10.1016/j.jen.2015.08.017
Beckstrand, R. L., Smith, M. D., Heaston, S., & Bond, A. E. (2008). Emergency Nurses’ Perceptions of Size, Frequency, and Magnitude of Obstacles and Supportive Behaviors in End-of-Life Care. Journal of Emergency Nursing, 34(4), 290–300. https://doi.org/10.1016/j.jen.2007.09.004
Chan, Z. C. Y., & Lai, W.-F. (2010). A Hong Kong perspective on ways to improve nurse retention. Nursing Standard : Official Newspaper of the Royal College of Nursing, 24(35), 35–40. https://doi.org/10.7748/ns2010.05.24.35.35.c7750
Decker, K., Susan, L., & Julia, M. (2015). The experiences of emergency nurses in providing end-of-life care to patients in the emergency department. Australasian Emergency Nursing Journal, 18(2), 68–74. https://doi.org/10.1016/j.aenj.2014.11.001
Departmen of Health. (2008). End of Life Care Strategy : Promoting High Quality Care For All Adults At The End Of Life. Retrieved from http://www.cpa.org.uk/cpa/End_of_Life_Care_Strategy.pdf
Effendy, N. (1998). Dasar-Dasar Keperawatan Kesehatan Masyarakat (2nd ed.). Jakarta: EGC.
General Medical Council. (2010). Treatment and care towards the end of life: good practice in decision making. General Medical Council, 1–85. https://doi.org/978-0-901458-46-9
Hanratty, B., Holmes, L., Lowson, E., Grande, G., Addington-hall, J., Payne, S., & Seymour, J. (2012). Older Adults ’ Experiences of Transitions Between Care Settings at the End of Life in England : A Qualitative Interview Study. Journal of Pain and Symptom Management, 44(1), 74–83. https://doi.org/10.1016/j.jpainsymman.2011.08.006
Heaston, S., Beckstrand, R. L., Bond, E., Palmer, S. P., Provo, & Utah. (2006). Emergency Nurses’ Perceptions of Obstacles and Supportive Behaviors in End-of-Life Care, (December). https://doi.org/10.1016/j.jen.2006.07.013
Hendianti, G. N. (2012). Gambaran Beban Kerja Perawat Pelaksana Unit Instalasi Gawat Darurat Rumah Sakit Muhammadiyah Bandung. Students E-Journal, 1(1), 31.
International Council of Nurses. (2012). The Code of Ethics for Nurses. The Michigan Nurse, 74(2), 9–10. https://doi.org/10.1111/j.0028-1425.2007.ethics.x
Ka-Ming Ho, J. (2016). Resuscitation versus end-of-life care: Exploring the obstacles and supportive behaviors to providing end-of-life care as perceived by emergency nurses after implementing the end-of-life care pathway. Applied Nursing Research, 29, e7–e13. https://doi.org/10.1016/j.apnr.2015.05.014
Menteri Kesehatan RI. (2009). Keputusan Menteri Kesehatan Republik Indonesia Nomor 856 / Menkes / SK / IX / 2009 Tentang Standar Instalasi Gawat Darurat ( IGD ) Rumah Sakit. Retrieved October 9, 2017, from http://sardjitohospital.co.id/sardjitowp/wp-content/uploads/2015/12/kepmenkes-856-thn-2009-standar-IGD.pdf
National Health Service. (2015). End of life care. Retrieved February 5, 2017, from https://www.nhs.uk/Planners/end-of-life-care/Pages/what-it-involves-and-when-it-starts.aspx
Ose, M. I., Ratnawati, R., & Lestari, R. (2016). Studi Fenomenologi Pengalaman Perawat Instalasi Gawat Darurat (Igd) Dalam Merawat Pasien Terlantar Pada Fase End Of Life Di Rsud Dr. Saiful Anwar Malang, 4(2).
Smith, A. K., McCarthy, E., Weber, E., Cenzer, I. S., Boscardin, J., Fisher, J., & Covinsky, K. (2012). Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Affairs, 31(6), 1277–1285. https://doi.org/10.1377/hlthaff.2011.0922
Stoppelenburg, A. B., Rietjens, J. A. C., & Heide, A. Van Der. (2014). The effects of advance care planning on end-of-life care : A systematic review, (Erasmus MC). https://doi.org/10.1177/0269216314526272
Warnes, G., Blackburn, K., & Hooper, J. (2017). Wiltshire ’ s End of Life Care Strategy For Adults 2017 to 2020.
Ajzen, I. (2005). Attitude, Personality and behavior. In T. Manstead (Ed.) (2nd ed.). New York: USA: Open. University Press.
Attia, A. K., Abd-Elaziz, W. W., & Kandeel, N. A. (2013). Critical Care Nurses’ Perception of Barriers and Supportive Behaviors in End-of-Life Care. American Journal of Hospice and Palliative Medicine, 30(3), 297–304. https://doi.org/10.1177/1049909112450067
Bailey, C., Murphy, R., & Porock, D. (2010). Trajectories of End-of-Life Care in the Emergency Department. YMEM, 57(4), 362–369. https://doi.org/10.1016/j.annemergmed.2010.10.010
Beckstrand, R. L., Collette, J., Callister, L., & Luthy, K. E. (2012). Oncology Nurses’ Obstacles and Supportive Behaviors in End-of-Life Care: Providing Vital Family Care. Oncology Nursing Forum, 39(5), E398–E406. https://doi.org/10.1188/12.ONF.E398-E406
Beckstrand, R. L., Rawle, N. L., Callister, L., & Mandleco, B. L. (2010). Pediatric nurses’ perceptions of obstacles and supportive behaviors in end-of-life care. American Journal of Critical Care, 19(6), 543–552. https://doi.org/10.4037/ajcc2009497
Beckstrand, R. L., Rohwer, J., Luthy, K. E., Macintos, J. L. B., & Rasmussen, R. J. (2015). Rural Emergency Nurses’ End-Of-Life Care Obstacle Experiences:Stories From The Last Frontier. YMEN, 1–9. https://doi.org/10.1016/j.jen.2015.08.017
Beckstrand, R. L., Smith, M. D., Heaston, S., & Bond, A. E. (2008). Emergency Nurses’ Perceptions of Size, Frequency, and Magnitude of Obstacles and Supportive Behaviors in End-of-Life Care. Journal of Emergency Nursing, 34(4), 290–300. https://doi.org/10.1016/j.jen.2007.09.004
Chan, Z. C. Y., & Lai, W.-F. (2010). A Hong Kong perspective on ways to improve nurse retention. Nursing Standard : Official Newspaper of the Royal College of Nursing, 24(35), 35–40. https://doi.org/10.7748/ns2010.05.24.35.35.c7750
Decker, K., Susan, L., & Julia, M. (2015). The experiences of emergency nurses in providing end-of-life care to patients in the emergency department. Australasian Emergency Nursing Journal, 18(2), 68–74. https://doi.org/10.1016/j.aenj.2014.11.001
Departmen of Health. (2008). End of Life Care Strategy : Promoting High Quality Care For All Adults At The End Of Life. Retrieved from http://www.cpa.org.uk/cpa/End_of_Life_Care_Strategy.pdf
Effendy, N. (1998). Dasar-Dasar Keperawatan Kesehatan Masyarakat (2nd ed.). Jakarta: EGC.
General Medical Council. (2010). Treatment and care towards the end of life: good practice in decision making. General Medical Council, 1–85. https://doi.org/978-0-901458-46-9
Hanratty, B., Holmes, L., Lowson, E., Grande, G., Addington-hall, J., Payne, S., & Seymour, J. (2012). Older Adults ’ Experiences of Transitions Between Care Settings at the End of Life in England : A Qualitative Interview Study. Journal of Pain and Symptom Management, 44(1), 74–83. https://doi.org/10.1016/j.jpainsymman.2011.08.006
Heaston, S., Beckstrand, R. L., Bond, E., Palmer, S. P., Provo, & Utah. (2006). Emergency Nurses’ Perceptions of Obstacles and Supportive Behaviors in End-of-Life Care, (December). https://doi.org/10.1016/j.jen.2006.07.013
Hendianti, G. N. (2012). Gambaran Beban Kerja Perawat Pelaksana Unit Instalasi Gawat Darurat Rumah Sakit Muhammadiyah Bandung. Students E-Journal, 1(1), 31.
International Council of Nurses. (2012). The Code of Ethics for Nurses. The Michigan Nurse, 74(2), 9–10. https://doi.org/10.1111/j.0028-1425.2007.ethics.x
Ka-Ming Ho, J. (2016). Resuscitation versus end-of-life care: Exploring the obstacles and supportive behaviors to providing end-of-life care as perceived by emergency nurses after implementing the end-of-life care pathway. Applied Nursing Research, 29, e7–e13. https://doi.org/10.1016/j.apnr.2015.05.014
Menteri Kesehatan RI. (2009). Keputusan Menteri Kesehatan Republik Indonesia Nomor 856 / Menkes / SK / IX / 2009 Tentang Standar Instalasi Gawat Darurat ( IGD ) Rumah Sakit. Retrieved October 9, 2017, from http://sardjitohospital.co.id/sardjitowp/wp-content/uploads/2015/12/kepmenkes-856-thn-2009-standar-IGD.pdf
National Health Service. (2015). End of life care. Retrieved February 5, 2017, from https://www.nhs.uk/Planners/end-of-life-care/Pages/what-it-involves-and-when-it-starts.aspx
Ose, M. I., Ratnawati, R., & Lestari, R. (2016). Studi Fenomenologi Pengalaman Perawat Instalasi Gawat Darurat (Igd) Dalam Merawat Pasien Terlantar Pada Fase End Of Life Di Rsud Dr. Saiful Anwar Malang, 4(2).
Smith, A. K., McCarthy, E., Weber, E., Cenzer, I. S., Boscardin, J., Fisher, J., & Covinsky, K. (2012). Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Affairs, 31(6), 1277–1285. https://doi.org/10.1377/hlthaff.2011.0922
Stoppelenburg, A. B., Rietjens, J. A. C., & Heide, A. Van Der. (2014). The effects of advance care planning on end-of-life care : A systematic review, (Erasmus MC). https://doi.org/10.1177/0269216314526272
Warnes, G., Blackburn, K., & Hooper, J. (2017). Wiltshire ’ s End of Life Care Strategy For Adults 2017 to 2020.
Ajzen, I. (2005). Attitude, Personality and behavior. In T. Manstead (Ed.) (2nd ed.). New York: USA: Open. University Press.
Attia, A. K., Abd-Elaziz, W. W., & Kandeel, N. A. (2013). Critical Care Nurses’ Perception of Barriers and Supportive Behaviors in End-of-Life Care. American Journal of Hospice and Palliative Medicine, 30(3), 297–304. https://doi.org/10.1177/1049909112450067
Bailey, C., Murphy, R., & Porock, D. (2010). Trajectories of End-of-Life Care in the Emergency Department. YMEM, 57(4), 362–369. https://doi.org/10.1016/j.annemergmed.2010.10.010
Beckstrand, R. L., Collette, J., Callister, L., & Luthy, K. E. (2012). Oncology Nurses’ Obstacles and Supportive Behaviors in End-of-Life Care: Providing Vital Family Care. Oncology Nursing Forum, 39(5), E398–E406. https://doi.org/10.1188/12.ONF.E398-E406
Beckstrand, R. L., Rawle, N. L., Callister, L., & Mandleco, B. L. (2010). Pediatric nurses’ perceptions of obstacles and supportive behaviors in end-of-life care. American Journal of Critical Care, 19(6), 543–552. https://doi.org/10.4037/ajcc2009497
Beckstrand, R. L., Rohwer, J., Luthy, K. E., Macintos, J. L. B., & Rasmussen, R. J. (2015). Rural Emergency Nurses’ End-Of-Life Care Obstacle Experiences:Stories From The Last Frontier. YMEN, 1–9. https://doi.org/10.1016/j.jen.2015.08.017
Beckstrand, R. L., Smith, M. D., Heaston, S., & Bond, A. E. (2008). Emergency Nurses’ Perceptions of Size, Frequency, and Magnitude of Obstacles and Supportive Behaviors in End-of-Life Care. Journal of Emergency Nursing, 34(4), 290–300. https://doi.org/10.1016/j.jen.2007.09.004
Chan, Z. C. Y., & Lai, W.-F. (2010). A Hong Kong perspective on ways to improve nurse retention. Nursing Standard : Official Newspaper of the Royal College of Nursing, 24(35), 35–40. https://doi.org/10.7748/ns2010.05.24.35.35.c7750
Decker, K., Susan, L., & Julia, M. (2015). The experiences of emergency nurses in providing end-of-life care to patients in the emergency department. Australasian Emergency Nursing Journal, 18(2), 68–74. https://doi.org/10.1016/j.aenj.2014.11.001
Departmen of Health. (2008). End of Life Care Strategy : Promoting High Quality Care For All Adults At The End Of Life. Retrieved from http://www.cpa.org.uk/cpa/End_of_Life_Care_Strategy.pdf
Effendy, N. (1998). Dasar-Dasar Keperawatan Kesehatan Masyarakat (2nd ed.). Jakarta: EGC.
General Medical Council. (2010). Treatment and care towards the end of life: good practice in decision making. General Medical Council, 1–85. https://doi.org/978-0-901458-46-9
Hanratty, B., Holmes, L., Lowson, E., Grande, G., Addington-hall, J., Payne, S., & Seymour, J. (2012). Older Adults ’ Experiences of Transitions Between Care Settings at the End of Life in England : A Qualitative Interview Study. Journal of Pain and Symptom Management, 44(1), 74–83. https://doi.org/10.1016/j.jpainsymman.2011.08.006
Heaston, S., Beckstrand, R. L., Bond, E., Palmer, S. P., Provo, & Utah. (2006). Emergency Nurses’ Perceptions of Obstacles and Supportive Behaviors in End-of-Life Care, (December). https://doi.org/10.1016/j.jen.2006.07.013
Hendianti, G. N. (2012). Gambaran Beban Kerja Perawat Pelaksana Unit Instalasi Gawat Darurat Rumah Sakit Muhammadiyah Bandung. Students E-Journal, 1(1), 31.
International Council of Nurses. (2012). The Code of Ethics for Nurses. The Michigan Nurse, 74(2), 9–10. https://doi.org/10.1111/j.0028-1425.2007.ethics.x
Ka-Ming Ho, J. (2016). Resuscitation versus end-of-life care: Exploring the obstacles and supportive behaviors to providing end-of-life care as perceived by emergency nurses after implementing the end-of-life care pathway. Applied Nursing Research, 29, e7–e13. https://doi.org/10.1016/j.apnr.2015.05.014
Menteri Kesehatan RI. (2009). Keputusan Menteri Kesehatan Republik Indonesia Nomor 856 / Menkes / SK / IX / 2009 Tentang Standar Instalasi Gawat Darurat ( IGD ) Rumah Sakit. Retrieved October 9, 2017, from http://sardjitohospital.co.id/sardjitowp/wp-content/uploads/2015/12/kepmenkes-856-thn-2009-standar-IGD.pdf
National Health Service. (2015). End of life care. Retrieved February 5, 2017, from https://www.nhs.uk/Planners/end-of-life-care/Pages/what-it-involves-and-when-it-starts.aspx
Ose, M. I., Ratnawati, R., & Lestari, R. (2016). Studi Fenomenologi Pengalaman Perawat Instalasi Gawat Darurat (Igd) Dalam Merawat Pasien Terlantar Pada Fase End Of Life Di Rsud Dr. Saiful Anwar Malang, 4(2).
Smith, A. K., McCarthy, E., Weber, E., Cenzer, I. S., Boscardin, J., Fisher, J., & Covinsky, K. (2012). Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Affairs, 31(6), 1277–1285. https://doi.org/10.1377/hlthaff.2011.0922
Stoppelenburg, A. B., Rietjens, J. A. C., & Heide, A. Van Der. (2014). The effects of advance care planning on end-of-life care : A systematic review, (Erasmus MC). https://doi.org/10.1177/0269216314526272
Warnes, G., Blackburn, K., & Hooper, J. (2017). Wiltshire ’ s End of Life Care Strategy For Adults 2017 to 2020.
Ajzen, I. (2005). Attitude, Personality and behavior. In T. Manstead (Ed.) (2nd ed.). New York: USA: Open. University Press.
Attia, A. K., Abd-Elaziz, W. W., & Kandeel, N. A. (2013). Critical Care Nurses’ Perception of Barriers and Supportive Behaviors in End-of-Life Care. American Journal of Hospice and Palliative Medicine, 30(3), 297–304. https://doi.org/10.1177/1049909112450067
Ajzen, I. (2005). Attitude, Personality and behavior. In T. Manstead (Ed.) (2nd ed.). New York: USA: Open. University Press.
Attia, A. K., Abd-Elaziz, W. W., & Kandeel, N. A. (2013). Critical Care Nurses’ Perception of Barriers and Supportive Behaviors in End-of-Life Care. American Journal of Hospice and Palliative Medicine, 30(3), 297–304. https://doi.org/10.1177/1049909112450067
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DOI: https://doi.org/10.24198/jnc.v2i1.19023
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