Demographics and work-related characteristics
The mean age of the participants was 29.71 years. Most of the subjects were females (92.8%), with bachelor’s degrees (85.1%), no religious beliefs (53.1%), and single (83.0%). The mean length of service in nursing was 6.59 years. The largest proportion of the participants worked in ICU was 38.7%, no experience of caring for terminal friends or relatives (68.6%), no participation concerning DNR signature (72.7%), participated in education related to palliative care (88.1%) and DNR (77.3%). The mean frequency of caring for terminal patients was 3.47 (57.0%) (Table 1).
Knowledge, attitude, practice, mindfulness, self-efficacy, and dispositional resilience toward DNR signature of the terminal patient among nurses
The mean percentage of correct answer rate of knowledge toward the DNR signature of the terminal patient among nurses was 73.99 (SD= 9.9). The mean scores of attitude and practice toward the DNR signature of the terminal patient among nurses were 42.53 (SD=4.46), and 38.30 (SD=6.25), respectively. The mean scores of mindfulness, self-efficacy, and dispositional resilience were 66.84 (SD=9.87), 25.25 (SD=5.14), and 27.49(SD=5.10), respectively. Among dispositional resilience scores, nurses scored the highest in control and lowest in the challenges (Table 2).
Predictors of Knowledge, attitude, practice toward DNR signature of the terminal patient among nurses
As shown in Table 3, the significant predictors of the K-DNR among nurses were participation in DNR signature, and participation in education related to palliative care after adjustment for mindfulness, self-efficacy, dispositional resilience, demographics and work-related characteristics among nurses. Nurses who have participated in the DNR signature had a higher mean score for the K-DNR than those who had never participated in DNR signature by 3.88 points (95% CI=0.26~7.50, p=0.037). Nurses who have participated in education related to palliative care had a higher mean score for the K-DNR than those who had never participated in relevant education by 9.18 points (95% CI=3.73~14.64, p=0.001).
DNR knowledge, mindfulness, self-efficacy, dispositional resilience, religious belief were important predictors for the A-DNR after adjustment for DNR knowledge, mindfulness, self-efficacy, dispositional resilience, demographics and work-related characteristics among nurses. Nurses with higher DNR knowledge (β=0.10, 95% CI=0.03~0.16, p=0.004), mindfulness (β=0.08, 95% CI=0.01~0.14, p=0.019), self-efficacy (β=0.20, 95% CI=0.05~0.35, p=0.010), or lower dispositional resilience (β= -0.16, 95% CI= -0.32~ -0.01, p=0.039) had better attitude towards DNR. Nurses who have religious beliefs had a higher mean score for the A-DNR than those who had no religious belief by 2.23 points (95% CI=0.99~3.48, p=0.001).
DNR attitude, dispositional resilience, and male gender were important predictors for the P-DNR after adjustment for DNR knowledge, DNR attitude, mindfulness, self-efficacy, dispositional resilience, demographics and work-related characteristics among nurses. Nurses with higher DNR attitude (β=0.62, 95% CI=0.42~0.81, p<0.001), or dispositional resilience (β=0.24, 95% CI=0.04~0.44, p=0.023) had better practice towards DNR. Male nurses had a higher mean score for the P-DNR than female nurses by 4.10 points (95% CI=1.01~7.19, p=0.010).
Path modeling of knowledge, attitude, and practice toward DNR signature of the terminal patient caregiver among nurses
The path modeling demonstrated that self-efficacy, dispositional resilience, master/junior college, and religious beliefs directly affected practice. The relationships between self-efficacy (Coefficients=0.272, p < 0.001), dispositional resilience (Coefficients=0.202, p = 0.006), master/junior college (Coefficients=0.149, p = 0.040), and religious belief (Coefficients=0.155, p = 0.033) were significant by standardized coefficient estimates for the paths. The above data are shown in Table 4.