Valutazione degli atteggiamenti degli infermieri nelle cure dei pazienti morenti: Survey in pronto soccorso
Authors: Matteo Giovanni , Guillari Assunta , Liccardo Rosa , Esposito Maria Rosaria 
Published: October 2018

The emergency-urgency area is a place of care in which patients are essentially unknown and potentially seriously ill or injured. The Accident & Emergency (A&E) nurse can also represent the driver of care and support for families. The process of providing end-of-life care for dying patients and support for their families is underestimated and there is little research available to support the contribution and actions of the emergency nurse towards the end of life1. On the other hand, sudden and shocking deaths, acute events or serious accidents, are part of the reality of these welfare settings in which death is not very far from the everyday life of an A&E nurse2-3. Furthermore, the attitudes of nurses to death and the dying can influence the quality of care provided during the critical or terminal phases of a person’s life4. Although death is a universal phenomenon that affects all human beings, regardless of their living conditions, it is still perceived as a feared event and therefore people are not inclined to talk about it4. Everyone has a subjective attitude towards death, has their own way of dealing with it and experiencing it. Health workers, especially nurses and nursing students, play an important and fundamental role in caring for and taking care of dying people and their families5. Patients at the end of their lives experience a variety of needs that include not only the physical needs and their clinical condition, but also spiritual needs and the need for emotional support6. Taking care of these people and their loved ones therefore becomes a great challenge for nursing because it requires emotional and professional skills and therefore good training in the approach taken towards the dying. Obviously this type of assistance has significant repercussions on the health workers involved. Indeed, some studies have revealed that assisting the dying patient raises negative emotions, such as feelings of impotence, fear, anguish and anxiety, in those who provide health and well-being. These emotions then inevitably have a negative impact on the assistance provided6. In a study conducted in Iran on 155 nurses, members of the oncology and intensive care units of 3 hospitals, a correlation emerged between the degree of autonomy of nurses and attitudes towards dying patients7. A higher level of nursing autonomy positively influences end-of-life care skills8. Another factor that affects the attitudes of nurses and, consequently, the assistance given to dying patients, is represented by the level of training. Adequate professional competence also implies the formation of positive welfare attitudes towards death, the patient and their family, even from first level university courses9. A good professional training guarantees a good approach and an adequate situational management in the choices and decisions of the patient’s family and in the mourning process10. It is possible to deduce how good a patient’s care is at the end of life is linked to a series of factors linked to each other and how indispensable they are for patients and their families. All this context is amplified and complicated considerably in A&E1 in which it does not always, almost never, leave room for relational, communicative and emotional support to patients. A&E, mistakenly, is considered a place in which the symptom is treated with emergency and not the patient, a place that leaves out the experiences of people because the priority is not the psycho-social state but exclusively the physio-pathological one. From the literature it emerges that the attitudes of nurses to caring for terminally ill patients can have an important influence on the care provided (Mastroianni, 2015). These studies examined the associations between personal attitudes toward death and the care of dying patients. Most of these studies have focused on the figure of the nurse11 or nursing students in the care of terminal cancer patients. To our knowledge, there are no studies in Italy and few at the international level1 that have investigated the attitudes of nurses and nursing students towards the end of life in the emergency-urgency areas and in particular in A&E. Such knowledge could help promote the adoption of positive attitudes in nurses and nursing students, in end-of-life care in A&E. The aim of the study is to describe the attitudes of nurses and nursing students in end-of-life care in A&E. A cross-sectional study was conducted, in the period between June and September 2017, with convenience sampling of nurses belonging to the A&E of the “Pineta Grande” PO (n.20) in the province of Caserta and to the AORN “A. Cardarelli “of Naples (no. 60). The sample of nursing students included all the students attending the 3rd year (no. 40) of the degree course in Nursing at the University of Rome “Tor Vergata”, home to Castel Volturno. The choice to include the 3rd year of the course was made considering that the part of the course with planned didactic activities and instruction on nursing in end of life care had been completed.