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  1. Demmer, Craig EdD, CHES


A questionnaire was completed by 197 nurses working in AIDS care facilities to examine the experiences and attitudes of AIDS nursing staff. Correlations (Pearson r) showed a statistically significant relationship between personal death-related experience and death anxiety and attitudes toward dying patients. CNAs reported higher death anxiety scores and rated the negative aspects of caring for dying patients higher than did licensed practical nurses and registered nurses. The evidence supports the development of appropriate training and support programs in death and dying issues that are tailored to meet the needs of different levels of nursing staff in AIDS care facilities.


The latest evidence suggests that AIDS deaths are declining (Centers for Disease Control and Prevention, 1997). This is largely attributable to advances in HIV treatment therapies (Rabkin & Ferrando, 1997). However, these treatments are not effective for everyone and there is still no cure for AIDS (Kalichman, Ostrow, & Ramachandran, 1998). The reality is that people continue to die of complications from AIDS and nursing staff must continue to develop ways to cope when caring for dying patients. Since the beginning of the AIDS pandemic in 1981, a primary stressor for nurses caring for patients with AIDS has been dealing with the death of patients (Bennett, 1992; Dunkel & Hatfield, 1986; Jue, 1987; Ryan, 1988; Wiener & Siegel, 1990). Several studies indicate that people who choose to work with patients with AIDS need to confront their feelings about illness, pain, death, and personal mortality (Glass & Hastings, 1992). Dane and Miller (1992) suggested that most health workers caring for patients with AIDS are uncomfortable with discussing death. Lockhard (1989) asserted that workers who continually care for dying persons have just as much difficulty accepting the reality and finality of death as do others. For many workers, death is associated with feelings of loneliness, fear, loss of identity, and a sense of rootlessness (Dane & Miller, 1992). Bartnoff (1988) reported that health workers caring for patients with AIDS may experience phobias of death and dying, dying young, protracted wasting, and diminished quality of life.


Health workers' attitudes toward death and dying are likely to influence their work with dying patients (Cochrane et al., 1991; Field & Howells, 1986). According to Dane and Miller (1992), the readiness of workers in AIDS settings to face their mortality may hinder or deepen their practice. By increasing awareness of their attitudes toward death and toward caring for dying patients, AIDS health workers may be better able to respond to the death of patients. Workers uncomfortable discussing death may become insensitive to the needs of patients and deprive them the opportunity to deal with their mortality. In response to the anxiety caused by working with dying patients, nurses may develop a professional detachment that enables them to avoid pain by emotionally withdrawing from patients (Miles, 1980). Avoidance might seriously impair the worker's capacity to deliver empathic care (Taerk et al., 1993; Field & Howells, 1986). Servaty, Krejci, and Hayslip (1996) found that nursing and premedical students with lower death anxiety reported less apprehension about talking with dying people. In a study of nursing staff in nursing homes for the elderly, a significant relationship was found between death anxiety and attitudes toward the elderly (Eakes, 1985). Nursing staff with high death anxiety displayed more negative attitudes toward the elderly than those with low death anxiety. A recommendation was made that future studies assess the relationship between death anxiety and attitudes toward caring for other patient populations.


Although several studies have examined death attitudes and anxiety among nurses in general (Bennett, 1992; Brent et al., 1993; Hainsworth, 1996; Hare & Pratt, 1989; Johansson & Lally, 1991; Mallet et al., 1991; Miles, 1980; Thompson, 1986), few studies to date have focused on the relationship between death-related experiences and attitudes among nurses caring for patients with AIDS (Hoffman, 1996). The current study was designed to explore this relationship.