Factors Associated With End-of-Life Care Competencies Among Nurses in Departments With a High Incidence of End-of-Life Cases: A Mixed-Methods Study

초록

Background Recent medical advances have led to longer lives, shifting end-of-life care from families to healthcare institutions. Despite the critical need to identify factors influencing end-of-life care competency among nurses in high-mortality departments, this area remains underexplored. Aim: This study aimed to determine the factors associated with end-of-life care competency among nurses in high-mortality departments, with a focus on preserving patient dignity and quality of life.DesignAn explanatory sequential mixed-methods design. Methods: A survey was administered to 204 nurses across three general hospitals in G City, Korea, from June 13 to July 11, 2024, and data were analyzed using hierarchical regression. Subsequently, focus group interviews were conducted with nine participants between August 21 and October 10, 2024, followed by thematic analysis. Results: Quantitative analysis revealed that the perception of shared decision-making (beta = 0.20, p = 0.002), ethical nursing competency (beta = 0.31, p < 0.001), and positive psychological capital (beta = 0.19, p = 0.030) significantly influenced end-of-life care competency among nurses working in high-mortality departments. The regression model demonstrated an explanatory power of 46.8% (F = 14.04, p < 0.001, R2 = 0.468, Adj-R2 = 0.435). Thematic analysis yielded five themes and twelve subthemes. Conclusion: This study identifies key factors to enhance end-of-life care competency among nurses in high-mortality departments. The findings provide specific evidence to improve care quality and optimize nurse deployment in high-demand settings. Implications for Nursing Management and Leadership: This study highlights important implications for nursing leadership in improving end-of-life care. Nurse managers play a key role by providing structured training and fostering an ethical, supportive organizational climate. They must also promote effective communication and shared decision-making within clinical teams. Especially in high-mortality settings, leaders should prioritize workforce development strategies that strengthen nurses' psychological resilience and reduce burnout.

키워드