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Author ORCID Identifier



Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Lisa Chiodo

Second Advisor

Rachel Walker

Third Advisor

Daniel Gerber

Subject Categories

Other Nursing


Nurses are the cornerstones to provide safe patient care. Studies about nurses experiencing challenges while providing end-of-life care (EOLC) are limited. It is imperative to understand how nurses’ beliefs and attitudes influence their actions while providing EOLC. The aims of this study were to (a) explore the relationship of personal factors and nurse beliefs and attitudes on providing EOLC and (b) examine the relationship of nurse beliefs and attitudes on intention and performance to provide EOLC. These aims were explored in a convenience sample of nurses working in multiple adult patient settings. The Theory of Planned Behavior guided a cross-sectional correlational research design. The sample included 621 members of the Oncology Nurses Society and the American Association of Critical Care Nurses who completed a questionnaire. Constructs evaluated included EOLC behavioral, normative, and control beliefs, behavior intention, and past behavior performance, religiosity, personal and professional experience with death, and personal demographic variables. Behavioral, normative, and control beliefs were hypothesized to influence both intention to provide care for patients at end-of-life and actual care provided. Among the personal factors examined, only age and professional experience with death predicted either intention or performance. Although religiosity was a strong predictor of EOLC beliefs, it was not a significant predictor of either intention or performance. Behavioral, normative, and control beliefs were significant predictors of intention to communicate, but only behavioral vii beliefs and control beliefs significantly predicted intention to act. Actual communication performance was predicted by both behavioral beliefs and normative beliefs, but not control beliefs. Given the substantial involvement nurses have in providing EOLC, it is important to understand how their beliefs and attitudes about EOLC and death might influence their intention and actual behavioral performance. Guided by a psychosocial theory, these study results determined that religiosity was a strong predictor of behavioral, normative, and control beliefs, but when intention and performance are added to the multivariate regression analysis, faith gain and faith loss were no longer significant predictors. Nurses’ intentions to perform EOLC were related to their prior behavior performance. The results of this study provide insight into potential interventions to improve patient EOLC.


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Other Nursing Commons