Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 165
  • Home
  • Print this page
  • Email this page

 Table of Contents  
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 287-294

Effectiveness of A Traditional Training Method in Increasing Long-Term End-of-Life Care Perception and Clinical Competency among Oncology Nurses: A Pilot Clinical Trial

1 School of Nursing and Midwifery, Iranshahr University of Medical Sciences, Iranshahr, Iran
2 Nursing Research Center, Razi School of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran

Date of Submission02-Dec-2019
Date of Acceptance17-Apr-2020
Date of Web Publication27-Jun-2020

Correspondence Address:
BScN, MScN, PhD Parvin Mangolian Shahrbabaki
Nursing Research Center, Razi School of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/apjon.apjon_15_20

Rights and Permissions

Objective: Patients with cancer face numerous problems at the end of their lives, which makes palliative care necessary for a peaceful death. Considering the important role nurses play in the provision of end-of-life care, the present study was conducted to study the effect of a traditional training method on nurses' perception of and clinical competency in providing end-of-life care to patients with cancer in a hospital in Southeastern Iran. Methods: This was a pilot clinical trial in which the nurses in an oncology ward were allocated to two groups, experimental (n = 24) and control (n = 33), using a table of random numbers. The experiment group received three sessions of workshop training. The nurses' perception and clinical competency were measured before and 3 months postintervention. Results: The results showed the perception scores in the experimental and control groups to be 171.75 ± 19.54 and 170.03 ± 17.03 before education and 176.16 ± 19.54 and 176.12 ± 16.12 postintervention, respectively. The scores of clinical competency were 98.71 ± 10.24 and 99.58 ± 12.17 before education and 101.5 ± 14.67 and 104.97 ± 12 postintervention in the experimental and control groups, respectively. According to the findings, neither of the groups showed a significant difference between pre- and post-intervention in terms of perception of or clinical competency in end-of-life care. Conclusions: A traditional training method such as workshop training cannot cause long-term improvement in nurses' end-of-life care perception or clinical competency. It seems that nurses would benefit from acquiring cognitive and behavioral skills and knowledge through a more continuous form of instruction delivered through modern blended educational methods.

Keywords: Cancer, clinical competency, end-of-life care, perception, traditional training

How to cite this article:
Omidi K, Dehghan M, Shahrbabaki PM. Effectiveness of A Traditional Training Method in Increasing Long-Term End-of-Life Care Perception and Clinical Competency among Oncology Nurses: A Pilot Clinical Trial. Asia Pac J Oncol Nurs 2020;7:287-94

How to cite this URL:
Omidi K, Dehghan M, Shahrbabaki PM. Effectiveness of A Traditional Training Method in Increasing Long-Term End-of-Life Care Perception and Clinical Competency among Oncology Nurses: A Pilot Clinical Trial. Asia Pac J Oncol Nurs [serial online] 2020 [cited 2021 Jun 17];7:287-94. Available from: https://www.apjon.org/text.asp?2020/7/3/287/287571

  Introduction Top

Patients with cancer are afflicted by different physical and psychological complications in the course of the disease, which can pose a challenge to their end-stage quality of life. Scholars believe that the most difficult aspect of cancer in most people is not the thought of death itself, but the prospect of a painful death.[1] The experience of these problems in patients with cancer negatively affects their quality of life, especially in their final days.[2] Consequently, palliative care is introduced as a range of services for improving end-of-life experience.[3]

End-of-life care has been rapidly developing since the late 1960s with the primary aim of catering to the needs of dying patients with end-stage diseases.[4] These types of care do not intend to accelerate death, but are performed to enhance the patient's quality of life using various therapeutic interventions and forms of care.[5] The dynamic relationship between patients and nurses renders end-of-life care one of the most significant roles nurses play in their patients' lives. However, nurses may not be able to provide basic and effective care for end-stage patients due to the painful conditions they live in at the end of their lives.[6] A study reported that most nurses feel doubt and stress in the provision of end-of-life care and reported that only one out of every nine nurses in England is willing to offer end-of-life care to end-stage patients.[7] Because nurses spend more time with patients with cancer, they must have an accurate understanding of end-of-life care and be sufficiently motivated to provide optimal care for end-stage patients.[8]

Perception is the complex process of becoming aware of and understanding sensory information and also the regulation and interpretation of environmental conception and understanding.[9] Researchers have reported that nurses' perception and attitude influence their behavior in providing care to patients with cancer. It is evident that understanding nurses' perception of their roles as caregivers is necessary for discussing the concept of end-of-life care.[10] Inadequate perception of end-of-life care negatively influences patients and their families and also causes confusion, stress, and mental and physical fatigue and eventually, occupational burnout in nurses.[11] On the other hand, accurate perception of end-of-life care can improve nurses' clinical competency.[12]

Clinical competency is the combination of the knowledge and skills necessary for achieving certain objectives. Clinical competency ensures the nurses' capabilities and performance, and improving it is a legal and ethical undertaking aimed at benefiting recipients through providing adequate care.[13] One study reported that, in many cases, lack of competency in the provision of end-of-life care results from lack of knowledge about death and the care necessary for end-stage patients, which is why educational interventions are of utmost importance[14] as poor skills on the part of nurses can lead to irreparable suffering in patients.[15]

Education is an intervention through which information and messages are communicated; the level of knowledge and awareness is augmented; and finally, skills, performance, and attitude are altered and improved.[15] Conducting face-to-face workshops is a teacher-centered approach that, despite the emergence of newer techniques and the expansion of knowledge, remains a popular teaching method among educators.[16] Despite the emergence of novel ways of teaching, lecturing is still a common way of providing information. Some experts believe that lecturing is a passive method and is therefore not suitable for the training in mental skills.[17]

A review of literature demonstrates the importance of attending to end-of-life patients with cancer and developing programs for improving nurses' performance in offering care to end-stage patients. In addition, end-of-life care is largely influenced by culture, customs, and even religious beliefs, and few studies have been conducted on it in developing countries. The researcher's experience shows that, despite the educational workshops held for nurses, end-stage patients continue to be neglected, and patients may suffer due to inaccurate perception of their conditions and inadequate skills in providing end-of-life care on part of the nurses. Therefore, this study aimed to determine the effects of education on nurses' perception of and clinical competency in end-of-life care in patients with cancer.

  Methods Top

Study design

This was a pilot randomized clinical trial aiming to determine the effects of education on nurses' perception of and clinical competency in providing end-of-life care to patients with cancer.

Sample and setting

The research setting was the adult oncology ward of Shahid Bahonar Hospital, affiliated with Kerman University of Medical Sciences. This hospital is the main center of provision of specialized services to patients with cancer in Southeastern Iran.

Power analysis calculations with G*Power software (Department of Experimental Psychology, Heinrich-Heine-University, 40225 Dsseldorf, Germany) indicate that 64 participants would be needed per group to detect an effect size of 0.5 (power = 80%, P = 0.05). As there was a limited number of oncology nurses in the study setting, all eligible nurses were taken as our potential sample (the census method). Of the total 103 nurses who were deemed eligible, 70 participated in this study and were allocated to the two groups of experimental (n = 35) and control (n = 35) using a random number table. Two nurses in the control group and eleven in the experimental group left the study, reducing the number of nurses assigned to the control and the experimental groups to 33 and 24, respectively [Figure 1]. The sampling list was collected from the hospital by the first researcher, and the samples were assigned to the experimental and control groups by a researcher outside the research team. The researcher was blind to the placement of the samples. Factors affecting education, such as demographic and background variables including age and years of work, were equal between the groups, and no significant difference was observed between the groups in terms of the variables associated with training [Table 1]. The inclusion criteria consisted of having a high-school diploma or a higher degree in nursing and having experienced providing end-of-life care. The exclusion criterion was nonparticipation of nurses in more than one training session.
Figure 1: The flowchart of participants' selection

Click here to view
Table 1: Comparison of participants' characteristics between the experimental and control groups

Click here to view


To achieve the goals of the study, a demographic information questionnaire, a nurses' perception of end-of-life care questionnaire, and a nurses' clinical competency in end-of-life care questionnaire were used. The demographic questionnaire for nurses included age, sex, marital status, position, type of shift, work experience in oncology, background end-of-life information, and resources for obtaining information. The oncology nurses' perception of end-of-life care questionnaire was developed by Ghaljeh et al. in 2016.[15] Its content, face, and construct validity were confirmed in a validation study based on the opinions of nursing experts and scholars, and its reliability was determined to be 0.9 (Cronbach's alpha). This questionnaire has 42 items scored on a 5-point Likert scale ranging from “totally agree” to “totally disagree,” scored from 1 to 5, in the same order, resulting in a total score ranging from 42 to 210. Scores below 98 indicate poor perception, 98–154 moderate perception, and 154–210 good perception. The Nurses' Competency in the Provision of Palliative Care was developed by Montagnini et al.[18] in the USA to examine the clinical competency of nurses in providing end-of-life care. This scale includes 28 questions. Responses are scored on a 5-point Likert scale ranging from “totally disagree” to “totally agree,” scored from 1 to 5. The minimum score is 28 and the maximum score is 140; scores below 65 are reported as poor, those between 6 and 105 as moderate, and those above 105 as good. This questionnaire has acceptable content validity based on the opinion of experts and a good reliability of 0.92 (Cronbach's alpha).

Data collection and intervention

After obtaining the clinical trial code (IRCT20170116031972N5) and ethics code (IR.KMU.REC.1396.2393), the researcher visited the research setting (Shahid Bahonar Hospital affiliated with Kerman University of Medical Sciences) and acquired the permission for conducting the study from the hospital dean, manager of nursing services, and the oncology ward. Then, the researcher visited the ward and randomly selected nurses based on the inclusion criteria and allocated them to the experimental or control group. Written informed consent for participation was obtained before intervention, and nurses were ensured that their information would remain confidential. Demographic information, perception, and clinical competency in end-of-life care were obtained using the respective questionnaires from both groups. No intervention was offered in the control group, whereas the experimental group received the educational program. The educational program comprised of an educational workshop consisting of group education, questions and answers, discussion, and educational handouts. This program was implemented by the researcher between working shifts and in a quiet setting over three sessions, each 30–45 min long in the hospital's conference hall. The educational content included information on the importance of and the required clinical competency for providing adequate end-of-life care (awareness, attitude, performance, decision-making, spiritual care, continuation of care, communication, mental support for patients and families, and sign and symptom management). At the end of the course, an educational handout was given to the nurses to help them remember the educational content and for use in the clinical setting. The content of the education program was developed based on the most recent articles and books[19],[20],[21],[22],[23],[24] and approved by seven experts. In the next step, to determine the long-term effectiveness of the educational program on perception and clinical competency, these factors were assessed in both groups 3 months after the educational course. According to studies, the most suitable posttraining assessment to determine the impact of training is a 3-month follow-up.[25],[26],[27]

Data analysis

In this study, data were analyzed using SPSS 19 (SPSS Inc., Chicago, Ill., USA). Data were described using number, percentage, central tendency, and dispersion indices. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used to describe the variables. The two groups were compared in terms of demographic and background variables using the Mann–Whitney U-test, Fisher's exact test, and the Chi-square test. To compare the mean scores of perception and clinical competence both before and 3 months after the intervention, within and between groups, paired-samples t-test and independent samples t-test were run.

  Results Top

The demographic results are presented in [Table 1]. No significant difference was observed between the two groups in terms of the examined variables.

Based on the results, before and after mean differences in the experimental and control groups were 1.73 ± 7.40 and 1.63 ± 10.27 for holistic care, 0.55 ± 3.73 and 3.23 ± 1.38 for family-centered care, 1.21 ± 4.43 and 0.71 ± 4.26 for growth with suffering and confrontation, and 2.61 ± 6.05 and 1.71 ± 11.11 for structural and physical challenges. The mean scores of overall perception of end-of-life care in the experimental group before and after intervention were 6.1 ± 14.32 and 4.42 ± 22.09, respectively. In terms of the variable of overall perception and its dimensions, no significant difference was observed between the two groups before and 3 months after intervention [Table 2].
Table 2: Comparison of nurses' score of end-of-life care and its dimensions in control and experimental groups

Click here to view

Concerning the dimensions of clinical competency of nurses, before–after mean differences of in the experimental and control groups were 0.22 ± 0.4 and 0.06 ± 0.5 for knowledge, 0.14 ± 0.59 and 0.04 ± 0.72 for attitudes, 0.19 ± 0.71 and 0.18 ± 0.72 for behavior, 0.12 ± 0.66 and 0.11 ± 0.74 for decision-making, 18 ± 0.65 and 0.12 ± 0.74 for communication, 0.26 ± 0.77 and 0.33 ± 0.85 for continuous care, 0.16 ± 0.65 and 0.05 ± 0.98 for affective support, 0.28 ± 0.59 and 0.1 ± 0.49 for symptom management, 0.03 ± 1.29 and –0.21 ± 1.1 for spiritual support, and 0.2 ± 0.81 and 0.08 ± 0.86 for employee affective support. Before–after mean differences of overall clinical competency of nurses for end-of-life care in the experimental and control groups were 5.39 ± 13.29 and 2.79 ± 12.41, respectively. Moreover, the scores of none of the dimensions of end-of-life care competency showed a significant difference between the two groups before and 3 months after intervention [Table 3].
Table 3: Comparison of clinical competency before and 3 months after the intervention

Click here to view

The nurses in the control group had considerable improvement in knowledge compared to the experimental group. Concerning the significant increase in the clinical competence score in the control group, the possible causes mentioned for the increase in the perception score of the control group (sample attrition in the experimental group and acquisition of knowledge in the control group) may also apply here.

  Discussion Top

The present study aimed to determine the effects of a traditional training method, holding workshops, on nurses' perception of and clinical competency in the provision of end-of-life care. The results of the present study revealed that after the provision of education on end-of-life care, both groups showed an increase in their perception and clinical competency scores. Moreover, neither of the groups showed a significant difference in terms of perception and dimensions of clinical competency. It seems that the workshop failed to exert a persistent effect on the perception and clinical competency of nurses in the provision of end-of-life care in the long term. As this ineffectiveness may be attributed to the small sample size, it is suggested that future studies use a larger sample.

As a result, a revision of educational courses and the use of hybrid methods such as psychological interventions together with new educational methods may bring about a greater improvement in nurses' perception of and clinical competency in the provision of end-of-life care. Our results are consistent with another study concluding that the provision of education only in the form of theory teaching has less effect and efficiency on perception and performance in the target group than the use of blended methods and clinical education does.[28] A study titled “The effect of two educational methods on the performance, knowledge, and awareness of nurses in long-term learning” showed that multimedia-based teaching methods have a longer effect than traditional teaching methods[29] do. It seems that it is not possible to increase nurses' clinical competence only through traditional methods such as use of workshops, making use of more recent methods of learning necessary. Another study demonstrated that planned interventions led to significant increases in all dimensions related to palliative care, i.e., knowledge, attitude, and beliefs, thereby improving the performance of nurses in the provision of supportive and palliative care.[30] The researchers concluded that after offering simulated education, the perception and attitude of participants on end-of-life care improved, and even those who felt uncomfortable when visiting end-stage patients felt better with regard to care, after intervention.[31]

The results of this study suggest that a three-session training workshop is not sufficient to improve nurses' perception and clinical competency, so providing in-service and continuous training may prove more effective in achieving these goals. In agreement with these results, the researchers of one study reported that in the 1st month after the provision of continuous education, the obstacles to the provision of care for end-stage patients were reduced among the nursing personnel, and in the 6th month, all the obstacles were eliminated. In addition, the professional competency of nurses considerably increased in the provision of care to these patients. The physicians, however, showed an opposite trend. The researchers concluded that the provision of continuous education and the continuation of clinical activity enhance the professional competency of nurses, but as physicians perform care in the short term, their education must be repeated and continued.[32]

End-of-life care is a stressful situation. Nurses' stressful work conditions may cause dramatic psychophysiological responses, mood disturbance, and exhaustion and fatigue and may also adversely affect their perception and clinical competency. Therefore, it seems that nurses need to acquire stress management skills and problem-solving techniques in addition to knowledge in order to provide effective care. In support of this, a study found that cognitive-behavioral interventions, along with other interventions, reduce stress in nurses.[33] Nurses' anxiety and their workload should be reduced through group interventions so that they can make the right decision in sensitive situations.[34]

The present study was limited by some factors. For instance, the small sample size of oncology nurses in the control and intervention groups was a limitation. Therefore, it is suggested that a larger sample be used in future studies, and that the results of this study be generalized with caution. It seems that the study results and suggestions can be presented to nurses and used for the implementation of more efficient instruction methods using new educational technologies in this hospital. The data on the perception and clinical competency of nurses were of the self-report type; thus, conducting a study using data collected through direct observation of nurses' clinical competency may yield more reliable results. Another limitation of this study was that nurses in the experimental and control groups worked together, making the exchange of information possible. In addition, as the training program was short, it is suggested that such training programs be studied for a longer period of time.

  Conclusion Top

The results of this study revealed that traditional training methods such as holding workshops failed to affect the nurses' perception of end-of-life care or even their clinical competency in the long term. Of course, it was a pilot study and is needed for further studies to confirm the results. Due to the importance of end-of-life care for patients, especially those with cancer, it seems that nurses require motivation such as continuous acquisition of knowledge so that they can improve their clinical competency, simultaneously achieving a deep perception of the status quo and enhancing it. It is suggested that health-care planners make persistent changes in nurses' clinical competency through planning and implementation of blended interventions such as continuous in-service education together with cognitive and behavioral interventions with the aid of efficient instructors and modern educational technologies.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

An E, Wennberg E, Nissim R, Lo C, Hales S, Rodin G. Death talk and relief of death-related distress in patients with advanced cancer. BMJ Support Palliat Care 2017;2017:bmjspcare-2016-001277.  Back to cited text no. 1
Nouhi E, Jahani Y. The study of palliative care and its relationship with quality of life in patients with chronic heart failure. in 2014-2015. J Clin Nurs Midwifery 2017;5:35-46.  Back to cited text no. 2
Salehi S, Tajvidi M, Ghasemi V, Raee Z. Investigating the effect of nurses' supportive and educative care on the quality of life in breast cancer patients referred for radiotherapy in Seyedoshohada hospitals in Isfahan in 1392. J Clin Nurs Midwifery 2016;5:26-34.  Back to cited text no. 3
Irajpour A, Alavi M, Izadikhah A. Situation analysis and designing an interprofessional curriculum for palliative care of the cancer patients. Iran J Med Educ 2015;14:1047-56.  Back to cited text no. 4
Pool MK, Nadrian H, Pasha N. Effects of a self-care education program on quality of life after surgery in patients with esophageal cancer. Gastroenterol Nurs 2012;35:332-40.  Back to cited text no. 5
Wang SY, Hall J, Pollack CE, Adelson K, Bradley EH, Long JB, et al. Trends in end-of-life cancer care in the Medicare program. J Geriatr Oncol 2016;7:116-25.  Back to cited text no. 6
Hendricks-Ferguson VL, Akard TF, Madden JR, Peters-Herron A, Levy R. Contributions of advanced practice nurses with a DNP degree during palliative and end-of-life care of children with cancer. J Pediatr Oncol Nurs 2015;32:32-9.  Back to cited text no. 7
Mikaili P. Evaluation of the effect of chemotherapy on functional scales of quality of life of patient with breast cancer. Iran Q J Breast Dis 2014;6:26-34.  Back to cited text no. 8
Ghaljeh M, Rezaee N, Imanigoghari Z, Rafati F. End of life holistic care for cancer patients: A qualitative study. J Clin Diagnostic Res 2019;13:6-9.  Back to cited text no. 9
Iranmanesh S, Axelsson K, Häggström T, Sävenstedt S. Caring for dying people: Attitudes among Iranian and Swedish nursing students. Indian J Palliat Care 2010;16:147.  Back to cited text no. 10
[PUBMED]  [Full text]  
Granek L, Ben-David M, Nakash O, Cohen M, Barbera L, Ariad S, et al. Oncologists' negative attitudes towards expressing emotion over patient death and burnout. Support Care Cancer 2017;25:1607-14.  Back to cited text no. 11
Garrido MM, Balboni TA, Maciejewski PK, Bao Y, Prigerson HG. Quality of life and cost of care at the end of life: The role of advance directives. J Pain Symptom Manage 2015;49:828-35.  Back to cited text no. 12
Liu M, Yin L, Ma E, Lo S, Zeng L. Competency inventory for registered nurses in Macao: Instrument validation. J Adv Nurs 2009;65:893-900.  Back to cited text no. 13
Glover TL, Garvan C, Nealis RM, Citty SW, Derrico DJ. Improving end-of-life care knowledge among senior baccalaureate nursing students. Am J Hosp Palliat Care 2017;34:938-45.  Back to cited text no. 14
Ghaljeh M, Iranmanesh S, Nayeri ND, Tirgari B, Kalantarri B. Compassion and care at the end of life: Oncology nurses' experiences in South-East Iran. Int J Palliat Nurs 2016;22:588-97.  Back to cited text no. 15
Çepni S, Şahin Ç. Effect of different teaching methods and techniques embedded in the 5E instructional model on students' learning about buoyancy force. Eurasian J Phys Chem Educ 2012;4:97-127.  Back to cited text no. 16
Malekan F, Hajimohammadi R. The relationship between Iranian ESP learners' translation ability and resilience in reading comprehension. Int J Educ Literacy Stud 2017;5:47-52.  Back to cited text no. 17
Montagnini M, Price D, Smith H, Strodtman L, Oldfield J, Policht T, et al. Assessment of self-perceived end-of-life care competencies of healthcare providers at a large academic medical center (S755). J Pain Symptom Manage 2017;53:440.  Back to cited text no. 18
Loscalzo MJ. Palliative care: An historical perspective. ASH Educ Program Book 2008;2008:465.  Back to cited text no. 19
Mallik M, Hall C, Howard D. Nursing Knowledge and Practice E-Book. United States: Elsevier Health Sciences; 2009.  Back to cited text no. 20
Thomas K, Lobo B, Detering K. Advance Care Planning in End of Life Care. England: Oxford University Press; 2017.  Back to cited text no. 21
Pace JC, Wholihan D. Palliative and End-of-Life Care, An Issue of Nursing Clinics of North America, E-Book: Elsevier Health Sciences; 2016.  Back to cited text no. 22
Chan RJ, Webster J, Bowers A. End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database Syst Rev 2016;12:1-32.  Back to cited text no. 23
Wachterman MW, Pilver C, Smith D, Ersek M, Lipsitz SR, Keating NL. Quality of end-of-life care provided to patients with different serious illnesses. JAMA Intern Med 2016;176:1095-102.  Back to cited text no. 24
Zelinski EM, Spina LM, Yaffe K, Ruff R, Kennison RF, Mahncke HW, et al. Improvement in memory with plasticity-based adaptive cognitive training: Results of the 3-month follow-up. J Am Geriatr Soc 2011;59:258-65.  Back to cited text no. 25
Gengoux GW, Berquist KL, Salzman E, Schapp S, Phillips JM, Frazier TW, et al. Pivotal response treatment parent training for autism: Findings from a 3-month follow-up evaluation. J Autism Dev Disord 2015;45:2889-98.  Back to cited text no. 26
Gibson J, Booth R, Davenport J, Keogh K, Owens T. Dialectical behaviour therapy-informed skills training for deliberate self-harm: A controlled trial with 3-month follow-up data. Behav Res Ther 2014;60:8-14.  Back to cited text no. 27
McCall K. Effects of Transformational Learning on Student Nurses' Perceptions and Attitudes of Caring for Dying Patients [Doctoral Dissertation]. Walden Dissertations and Doctoral Studies: Walden University; 2018.  Back to cited text no. 28
Pan HH, Wu LF, Hung YC, Chu CM, Wang KY. Long-term effectiveness of two educational methods on knowledge, attitude, and practice toward palliative care consultation services among nursing staff: A longitudinal follow-up study. Clin Nurs Res 2018;27:483-96.  Back to cited text no. 29
Kumar SP, Jim A, Sisodia V. Effects of palliative care training program on knowledge, attitudes, beliefs and experiences among student physiotherapists: A preliminary quasi-experimental study. Indian J Palliat Care 2011;17:47.  Back to cited text no. 30
[PUBMED]  [Full text]  
Lewis C, Reid J, McLernon Z, Ingham R, Traynor M. The impact of a simulated intervention on attitudes of undergraduate nursing and medical students towards end of life care provision. BMC Palliat Care 2016;15:67.  Back to cited text no. 31
Clausen C, Cummins K, Dionne K. Educational interventions to enhance competencies for interprofessional collaboration among nurse and physician managers: An integrative review. J Interprof Care 2017;31:685-95.  Back to cited text no. 32
Orly S, Rivka B, Rivka E, Dorit SE. Are cognitive–behavioral interventions effective in reducing occupational stress among nurses? Appl Nurs Res 2012;25:152-7.  Back to cited text no. 33
Konnert C, Dobson K, Stelmach L. The prevention of depression in nursing home residents: A randomized clinical trial of cognitive–behavioral therapy. Aging Ment Health 2009;13:288-99.  Back to cited text no. 34

  Authors Top

Parvin Mangolian Shahrbabaki


  [Figure 1]

  [Table 1], [Table 2], [Table 3]


Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded156    
    Comments [Add]    

Recommend this journal