1

Chapter I

THE PROBLEM

Background of the Study

Death is a natural occurrence in the health care setting. Though effects are extended in

controlling the progress of a disease and in restoring the well-being of a patient, there are diseases

which pass beyond the stage of being curable. Since nurses play a vital role in providing direct

patient care, a patient’s death may bring a sense of loss and grief which could eventually affect

the way health care services are appropriately and adequately provided to other patients.

However, the degree of nurses’ grief as a reaction to patient death may vary in intensity. This

variation may be influenced by several factors present in both the nurse and the nurse-patient

relationship. This study looks into these factors that may affect the level of grief that nurses

experience upon the death of their patient, and investigates the degree of correlation between

these variables and the level of nurses’ grief.

“Grief is a phenomenon that every human being will eventually experience” (Brunelli,

2005). As healthcare providers who are in close contact with dying patients, nurses are vulnerable

to the experience of grief. However, the emotional aspect of nurses’ responses to the death of

their patients has barely been explored. Most of the studies related to patients’ death focus on the

patients’ relatives and significant others. Other researches explore the nurse’s role as one who

offers emotional support to the grieving family. This leaves the nurse’s own emotional needs

unaddressed. Although the nature of their profession demands that they maintain a certain degree

of emotional detachment from their patients, nurses may still feel that the death of their patient is

their personal loss. For example, it may be close to impossible not to be emotionally attached to

patients, especially if the patient was a child whose death was due to a terminal illness such as

cancer that has experienced much pain and suffering prior to his/her death. In addition to this,

limited studies in this area of nursing experience presents a problem on how nurses manage and
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cope with their grief, since little is known about the factors that affect it and the degree to which

these factors influence their grief level. Due to the demands of their profession, nurses may have

to suppress their grief to respond to duty’s call. This prevents them from undergoing the normal

grieving process, which results to a range of consequences from burnout to potentially harmful

addictions (Brosche, 2003). This gives rise to the need to study and investigate not only the level

of grief elicited in the nurse by the death of their patient, but also the factors that affect the

intensity of their grief, in order to have a more definite target for interventions addressing

emotional stress management.

Theoretical Framework

According to George Engel, grief is a common reaction that nurses experience, especially

when their parents die. Some nurses get emotionally attached to their patients and when a

particular patient dies, some nurses go through a process of grieving and utilize several strategies

as ways of maintaining composure in the light of professional responsibilities of providing

optimum care to other patients who are still in need of their services. In some instances, though

the death of a patient is somewhat expected, the nurses would still grieve when the patient dies.

The grieving process as described by George Engel delineates the normal stages of

mourning. The first step is defined as shock and disbelief, which may manifest as denial or an

overtly intellectual acceptance of the reality of the loss as an initial response to the death. The

second step is defined as developing awareness wherein the grieving person becomes aware of a

sense of loss. This manifests as crying or anger. In the case of nurses, anger may be directed at

themselves as a result of their grief regarding the patient’s death (Quint, 1996). The third phase is

restitution where aggression is reduced to a minimum. Resolving the loss is the fourth phase in

which the grieving party attempts to deal with the awareness of the loss. The final stage is

idealization, which is characterized by recurring thoughts and reminiscences about the deceased,
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and idealization, wherein the grieving identifies with the dead person by taking for himself

certain admired qualities and attributes.

However, due to the nature of the nurse-patient relationship considered in this study, the

nurse is not expected to go through the “normal stages of mourning” as defined by Engel due to a

number of reasons; a) the nurse-patient relationship is primarily b) the relationship has been

fostered in a relatively short period of time, making the attachment somewhat insufficient for the

nurse to go through each of the stages of mourning described; c) as a professional, the death of

the patient is somehow expected by the nurse, and therefore does not elicit a very intense degree

shock and disbelief. Thus, for the purpose of this study, the nurses’ grief level will be measured

based on their responses within 24 hours after the patient’s death. This should be sufficient for the

nurse to be aware of feeling a certain level of grief that can be rated in the scale even when he/she

does not go through the normal or expected grieving process.

According to Thess Thompson, grief is normal or complicated-- not a medical diagnosis.

If the experiences that comprise grief are not a medical diagnosis, then it raises some questions

about the validity of these theories.

Various theories about grief and the grieving process look only at the emotional aspects

that a person goes through from different perspectives. Elizabeth Kubler Ross would have us

believe that there are five stages of grief - denial, anger, bargaining, depression, and

acceptance that overlap each other.

John Bowlby and Colin Parkes define the grieving process differently, but in almost

similar words in four phases: shock and numbness, yearning and searching, disorganization and

despair, and reorganization. J. W. Worden emphasizes the four aspects of grief/mourning

as accepting the reality of the loss, experiencing the pain, adjusting to a life without your loved

one, and finally being able to reorganize and carry on with life.

Grief is what we feel inside us when we are engulfed with an intense feeling of sadness

and sorrow and feel it difficult to come to terms with the changed situation. Any grief theory
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must necessarily take into account why the grieving process is actually different for every

individual.

Cognition plays an important role in the level of the emotional distress that we pass through when

we lose a dear one due to death or separation. Cognition is the psychological result of perception,

learning, and reasoning. The manner in which we react during a loss depends upon our cognitive

abilities. The manner in which we perceive life is instrumental in the mood swings that we

experience during grief. A person with a positive mental attitude may not go through any of the

stages or phases of grief mentioned above. At the most, he may have momentary emotional

responses to the circumstances.

Grief is also dependent upon other factors such as the relationship with the deceased, the

circumstances of death, the amount of financial loss that is suffered, and issues like the amount of

hurdles expected to be faced due to the loss. The death of an aging grandparent on a life support

system is bound to cause less stress as we are prepared for the eventuality. Many times, even a

huge financial loss does not lead to what is normally termed as complicated grief because we feel

we will be able to bear it if we work hard enough.

There can be no complete list of emotions that one feels during a grieving process. They

differ according to how the brain processes the information while managing emotions and does

not follow a set pattern. It is dependent upon many factors that include societal and physical

factors as well as cognitive abilities. Grief theories are derived from experiment and observation

rather than theory. It is not only about mood and emotion but also about situations,

overall emotional health, and attitude.

Statement of the Problem

The study aims to determine the relationship between the nurses’ personal characteristics

or variables and their grief level towards the death of patients.

Specifically, it seeks to answer the following questions:

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1. What is the socio-demographic characteristics of the nurses in Abra Provincial Hospital

in terms of the following:

a. Civil status

b. Age

c. Gender

d. Ward

e. Number of years as RN

f. Experienced patients death within the last 10 months

g. Number of patient’s death handled

h. Duration of patient-nurse interaction

2. What is the attitude of nurses in Abra Provincial Hospital with regards to the death of

their patients?

3. What is the level of grief of the nurses in Abra Provincial Hospital towards the death of

their patients?

4. Is there a significant relationship between the attitude of the nurses in Abra Provincial

Hospital towards the death of their patients and each of the aforementioned independent

variables?

5. Is there a significant relationship between the level of grief of the nurses of Abra

Provincial Hospital l towards the death of their patients and their personal characteristics?

6. Is there a significant relationship between the attitude of nurses of Abra Provincial

Hospital and their level of grief towards the death of their patients?

Research Hypotheses

The researchers posited the following hypotheses which here tested at the 0.05 level of

significance:
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1. There is a significant relationship between the attitude of the nurses in Abra Provincial

Hospital towards the death of their patients and each of the aforementioned independent

variables.

2. There is a significant relationship between the level of grief of the nurses of Abra

Provincial Hospital towards the death of their patients and their personal characteristics.

3. There is a significant relationship between the attitude and level of grief of the nurses of

Abra Provincial Hospital towards the death of their patients.

Significance of the Study

This study will be beneficial to the nurses and student nurses in providing a baseline data

for the formulation of interventions that will address the variables or factors that are associated

with the level of grief among nurses who have experienced the death of a patient they have

handled.

It is also beneficial to the researchers because it serves as a motivation and challenge for

them to improve their role as student nurses.

The result of this study will also be of great help for future researches aimed to dig

further about grief and grieving.

Scope and Delimitation

This study assessed the relationship between the nurses’ personal characteristics and their

level of grief towards the death of their patients for the improvement of the strategies as ways of

maintaining composure in the life of professional responsibility of providing optimum care of the

patients who are still in needs of their services. Though the death of a patient is somewhat

expected, the nurses would still grieve when the patient dies.
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The respondents of this study were the staff nurses of Abra Provincial Hospital. Abra

Provincial Hospital was selected because of the large number of patients served by the nurses in

the area considering it is a public hospital.

Definition of Terms

Civil Status – refers to whether the nurse is Single, Married or a single parent.

○ Single – refers to a state of being unmarried

○ Married – refers to the state of being united or living together with another

person with or without the legal bounds of marriage.

Death – refers to the loss of all physiologic functions of a patient due to any kind of disease.

Duration of Interaction – the length of time the patient was under the care of the nurse.

Grief – refers to the nurse’s subjective response to the death of the patient he/she has handled;

for the purpose of this study, grief and bereavement have been used interchangeably.

Grief Level – refers to the measured psychological and emotional responses of nurses with

regards to the death of a patient. refers to a registered nurse currently practicing at the Abra

Provincial Hospital; may or may not have any specialization as long as he/she has handled

and experienced patient(s’) death within the last 10 months.

Attitude towards death – refers to the nurse’s outlook and response towards the subject of

death and/or dying; based on the Death Attitude

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Chapter II

METHODS and PROCEDURES

This chapter presents the research design, population and sample, data gathering

procedure, data gathering tool, and statistical treatment of data.

Research Design

This study utilized the descriptive research employing comparative and correlation

method. The relationship between the nurses’ personal characteristics and their level of grief

towards the death of their patients was assessed from the staff nurses of Abra Provincial Hospital.

Population and Sample

This design was selected to represent the population of nurses in APH through quota

sampling (N=30) of all available staff nurses who fit the following criteria: currently working in

APH; has handled at least 1 patient, regardless of the type of disease who died in her/his care;

should be presently working in the shift at the time of death of his/her patient; must have

experienced the death of the patient within the last 5 months from the day of data gathering;

The respondents for the research were selected after a preliminary survey using a

checklist indicating the 4 inclusion criteria stated above. From the total population of 57, we have

arrived with the total population of the sample using the Slovin’s Formula:

n= N

1 + N (e)2

N – total population
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e – margin of error (0.05)

The total respondents of this study were 57.

Table 1 shows the distribution of respondents. The random sampling was done to

determine the sample size in every ward.

WARDS TOTAL POPULATION SAMPLE

ER 15 6
MEDICAL 15 6
PEDIA 9 6
OB 7 6
ORTHO- SURG 11 6
TOTAL 57 30

Data Gathering Procedure

Before data is to be collected, permission was obtained from the chief nurse of the APH

service wards where the target population is situated.

A preliminary survey was conducted by performing a brief interview to identify the eligible

respondents in the study. Consistency of screening was insured by asking the nurse if he/she has

experienced the death of a patient he/she has handled within the past 5 months. This question was

asked in a standardized manner: “Nakaranas po ba kayong mamatayan ng pasyente simula noong

Enero 2010 hanggang Oktubre 2010?”

After identifying 30 nurses who fit the criteria and gave verbal consent, the 3-part tool

(described in the previous section) was given to each respondent. The survey was done in a quiet

room to improve recall of the grief experience. The researcher supervised the nurse respondent

while answering the questionnaires to be available for any clarification. This will ensure the

correct interpretation of the items in the tool. Each respondent is expected to finish answering the

questionnaires for no more than 30 minutes since the time of both the respondent and researcher

is taken into consideration.

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Data Gathering Tool

The researchers used questionnaire as their main tool in gathering data needed in

conducting study. The questionnaire consisted of three parts: Part I was on the Profile of the

Respondents; Part II was on the Death Attitude Profile; and Part III was on the Level of Grief

towards their patients.

The questionnaires were of likert or summated type of checklist using 5- point rating.

Scale interpreted as follows:

Descriptive Ranking for Value Means in the Attitude of nurses in Abra Provincial Hospital
Towards the death of their patients.
STATISTICAL LIMIT DESCRIPTIVE RATING SYMBOLS
4.20-5.00 STRONGLY DISAGREE SD
3.40- 4.19 DISAGREE D
2.60- 3.59 UNCERTAIN U
1.80- 2.59 AGREE A
1.0- 1.79 STRONGLY AGREE S

Descriptive Ranking for Value Means in the level of grief Towards the death of their
patients.
STATISTICAL LIMIT STATISTICAL LIMIT SYMBOLS
4.20-5.00 ALWAYS A
3.40- 4.19 OFTEN O
2.60- 3.59 SOMETIMES S
1.80- 2.59 SELDOM S
1.0- 1.79 NEVER N

Statistical Treatment of Data

The data gathered was coded and tabulated. The following are the method used:

1. Frequency counts and percentage was used to determine the profile of the nurses in Abra

Provincial Hospital.
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2. Weighted mean was used to determine the profile of the nurses in Abra Provincial

Hospital between the nurses’ attitude towards the death of their patients and the level of

grief towards the death of their patients.

3. Simple Linear regression Analysis was used to determine the following:

● Characteristics of the nurses in Abra Provincial Hospital between the nurses attitude

towards the death of their patients.

● The nurses’ personal characteristics between the level of grief towards the death of

their patients.

● The nurses’ attitude towards the death of their patient between the level of grief

towards the death of their patients.

The Pearson-Product Moment Coefficient of Correlation using the formula:

rxy=

[ ∑ (x-x)2] [ ∑ (y-y)2 ]

Where: rxy = the correlation coefficient for variable x & y

x = an individual score for variable x

x= the mean score for variable x

y = an individual score for variable y

y = the mean score for variable y

∑ = the sum of

Point Biserial coefficient of Correlation

rpb=x1-x2√n0n1

SD

Where:
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X1= mean of those who scored 1 in the distribution

X0= mean of those who scored 0 in the distribution

SD= standard deviation

n0= frequency of those who scored 0 in the distribution

n0= frequency of those who scored 1 in the distribution

Chapter III

PRESENTATION, ANALYSIS and INTERPRETATION of DATA

This chapter presents the findings from the assessment of the relationship between the

nurses’ personal characteristics and their level of grief towards the death of their patients.
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Findings of the study are presented in the form of tables with corresponding analysis and

interpretation.

Table I reveals the personal characteristics of the nurses of the Abra Provincial

Hospital. Some of the personal characteristics considered in this study were age, civil

status, number of years as registered nurse, gender, ward of assignment, if they have

experienced that their patient died within the last 10 months, the number of patients died

handled, and the duration of patient- nurse interaction.

On Age. It is revealed from table that a greater number (15 or 50%) of the nurses of Abra

Provincial Hospital considered as a respondents of this study belong to the age bracket of 21-25.

This means that at this age of time in the life of nurses of Abra, they are engaging themselves to

help the sick people of their own province. This might perhaps the reason why one- half of the

total respondents belong to this age bracket. Meanwhile, less than one- fourth of the respondents

(5 or 17%) belong to the age bracket of below 20 years of age. This manifest that only a few

number of nurses of Abra enters the job at this age for some reasons such as preparing themselves

for the review of nursing Licensure examination. This is a manifestation also that only some if

not a few examinees passed the examination for the least number of nurses employed at the Abra

Provincial Hospital who belongs to this age bracket.

On Civil Status. As seen from the table, a greater number of respondents (20 or 67%) of

them were single. This suggests that the nurses of the Abra Provincial Hospital enjoy life being

single. Perhaps, most of them have plans in life like going abroad to look for an opportunity that’s

why they are preserving themselves to be single. On the other hand, only one0 third (10 or 33%)

of the respondents are married.

Table I
Personal Characteristics of the Nurse in APH

Socio- demographic Profile (f) (%)

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AGE
26 above 10 33
21-25 15
20 below 10 50
17
TOTAL 30 100
CIVIL STATUS
Single 20 67
Married 10
33
TOTAL 30 100
Number of years as RN
15 years and above 1 3
11-14 0 0
6-10 3 10
5 below 26 87
TOTAL 30 100
GENDER
male 13 43
female 17
57
TOTAL 30 100
WARD
Pedia 6 20
Medical 6
Ortho 6 20
OB 6 20
ER 6 20
20
TOTAL 30 100
EXPERIENCED DEATH WITHIN LAST 10 MONTHS
Yes 30 100
No 0
0
TOTAL 30 100
NUMBER OF PATIENT’S DEATH HANDLED
11 above 0 0
6-10 7
5 below 23 23
77
TOTAL 30 100
DURATION OF PATIENT-NURSE INTERACTION W/ THAT PATIENT?
21 hours above 16 53
16-20 2 7
11-15 2 7
6-10 0 0
5 below 10 33
TOTAL 30 100

On the number of years as a registered nurse. The table unveils that majority of the

nurses in Abra Provincial Hospital (26 or 87% of them) are registered nurses for 5 years and

below. This suggests that the nurses of the Abra Provincial Hospital are still young in the service.

It is significant to note that only one which consists of three percent of the population
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experienced to be a registered nurse for a span of 15 years and above. This implies that after

nurses served the province for quite some years, they tended to look for a greener pasture in some

other places.

On gender. Up to this point of time, the course for nursing was still dominated by

females as a result of this study. This was evidenced by the larger number of respondents (17 or

57%) of this study who were females consisted of greater than a half of the respondents. This

suggests that at this time, it shows that nursing is still a course intended for females.

On ward. Another characteristic which pertains to the nurses of the Abra Provincial

Hospital considered on this study was the ward where they are working. The researchers decided

to have the same number of respondents from each ward. They got 6 respondents from each ward

which was chosen purposively. The researchers have distributed the same number of respondents

from each ward for their convenience for at this point in time, they think that they still lack some

qualities of researchers such as financial assistance, time constraints, effort and as well as the

expertise needed.

On experiencing death of their patients within the last 10 months. It was found out in

this study that there was no variation in the responses of the respondents. This means that

hundred percent (30 or 100%) of the nurses of Abra Provincial hospital experienced that some of

their patients for within the last 10 months have died.

On the number of patients died handled. A little bit greater than three-fourths (23 or

77%) of the nurses of Abra Provincial Hospital considered as respondents of this study have

experienced to have handled 5 and below cases within the last 10 months wherein their patients

died under their care. This manifests that majority of the nurses of Abra Provincial Hospital

experienced a minimal number of death cases as evidenced in the table. It is also significant to

note that only 7 or less than one- fourth which consisted of twenty three percent have experienced

to have a span of 6-10 cases were their patients died.

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On the duration of patient-nurse interaction. With regards to the number of hours

were the nurses of Abra provincial Hospital had interacted with their patients who had died, it is

very interesting to note that a little bit greater than one- half of them (16 or 53%) had interacted

with their patients for a number of 21 hour and above. This manifests that the nurses cared so

much for their patients for they were patiently interacting with their patients for almost a day. It is

also significant to note that only a few of the respondents (2 or 7%) of them have cared for their

patients for a span of 11-15 hours and 16-20 hours.

The nurses of the Abra Provincial Hospital attitudes towards the Death of their patients

were also considered in this study. The summary of the responses of the respondents was

presented in Table 2. Generally, the nurses of the Abra Provincial Hospital had an

“AGREE” level attitude towards the death of their patient. This was evidenced by their

weighted mean of 2.46. This suggests that the respondents of this study viewed death

positively that this is a natural occurrence in the health setting.

With the different items considered as indicators to measure the respondent’s

attitude towards the death of their patients, it was found out that in this study, nurses

viewed that death was a natural aspect of this life. This was viewed by the weighted mean

of 1.4 which belongs to the “Strongly Agree” attitude. In fact, this statement garnered the

lowest computed weighted mean. On the other hand, the statements “Death provides an

escape from this terrible world“ garnered the highest weighted mean respectively, ( x=

3.4) which falls on “Disagree” Attitude. This means that the respondents do not view

death as a means or as a solution to end their lives to escape from troubles, problems,

hardships and difficulties in life. According to them also, this was not an avenue for them

to end life just to leave the world that is full of negative phenomena.
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TABLE II
Attitude Towards the Death of their Patient

ITEMS MEAN (x) DR

1.Death is no doubt a grim experience 2 Agree
2.The prospect of my own death arouses anxiety 2.8 Uncertain
3. I avoid death thoughts at all cost. 2.6 Uncertain
4.believe that I will be in heaven after I die 2.5 Agree
5. Death will bring an end to all my troubles. 3.4 Disagree
6. Death should be viewed as natural, undeniable and unavoidable 2.2 Agree
event.
7. I am disturbed with the finality of death. 2.8 Uncertain
8. Death is an entrance of intimate satisfaction. 2.9 Uncertain
9. Death provides an escape from this terrible world. 3.4 Disagree
10. Death is deliverance from pain and suffering 3.1 Uncertain
11. I always try not to think about death. 2.5 Agree
12. Death is a promise of a good and eternal life. 2.6 Uncertain
13. Whenever the thought of death enters my mind I try to push it 2.1 Agree
away.
14.I believe that heaven is a much better place than this world. 2.2 Agree
15. I would neither fear death nor welcome it. 2.5 Agree
16. Death is a natural aspect of this life. 1.4 Strongly agree
17.I have an intense fear of death 2.7 Uncertain
18. I avoid thinking about death altogether. 2.1 Agree
19. Death is a union of God and eternal bliss. 2.1 Agree
20. Death is a promise of a good and eternal life. 1.9 Agree
21. The subject of life after death troubles me greatly. 2.4 Agree
22. I look forward to a reunion with my loved ones after I Die 2.6 Uncertain
23. The fact that death will mean the end of everything as I know it 2.1 Agree
frightens me.
24. Death is simple a part of the process of life. 2.5 Agree
25. I see death as a passage to an eternal and blessed place. 2.1 Agree
TOTAL 2.46 AGREE

LEGEND:
4.20-5.00 STRONGLY DISAGREE
3.40-4.19 DISAGREE
2.60-3.59 UNCERTAIN
1.80-2.59 AGREE
1.00-1.79 STRONGLY AGREE

Another aspect which was looked into the study was the Level of Grief of Nurses

of the Abra Provincial Hospital towards the Death of Their Patients. The summary of the

respondents answers were tabulated and presented in Table 3.

TABLE III
Level of Grief Towards the Death of their Patient

TITLE MEA DR
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N
1. Do you experience images of the event surrounding the patient’s death? 1.9 Seldom
2. Do thoughts of the patient come into your mind whether you wish it or 1.8 Seldom
not?
3. Do thoughts of the patient make you feel distressed? 2 Seldom
4. Do you think about the patient? 2.3 Seldom
5.Do images of the patient make you feel distressed 2.0 Seldom
6. Do you find yourself preoccupied with images or memories of patient? 1.6 Never
7. Do you find yourself thinking of reunion with the patient? 1.8 Seldom
8. Do you find yourself missing the patient? 1.8 Seldom
9. Are you reminded by familiar objects (photos, possessions, rooms, etc.) 1.9 Seldom
of the patient?
10. Do you find yourself pining for/yearning for the patient? 2.2 Seldom
11. Do you find yourself looking for the patient in familiar places? 2.1 Seldom
12. Do you feel distress/pain if for any reason you are confronted with the 1.8 Seldom
reality that the patient is not coming back?
13. Do reminders of the patient such as photos, situations, music, places, 2.2 Seldom
etc. cause you to feel longing for the patient?
14. Do reminders of the patient such as photos, situations, music, places, 1.9 Seldom
etc. cause you to feel loneliness?
15.Do reminders of the patient such as photos, situations, music, places 2 Seldom
etc. cause you to cry about him/her?
16. Do reminders of the patient such as photos, situations, music, places, 1.8 Seldom
etc. cause you to feel sadness?
17. Do reminders of the patient such as photos, situations, music, places, 2.1 Seldom
etc. cause you to feel loss of enjoyment?
TOTAL 1.95 SELDOM
MILD

LEGEND:
4.20-5.00 ALWAYS = severe
3.40-4.19 OFTEN = moderate
2.60-3.39 SOMETIMES = moderate
1.80-2.59 SELDOM = mild
1.00-1.79 NEVER = mild

Above Table unveils that the nurses of the Abra Provincial Hospital have a

general mean of 1.95 which falls on descriptive rating of “Mild grieving”. This means

that the respondents have a gentle and moderate, not severe or extreme grieving towards

the death of their patients this implies that when the patients of these nurses dies, they

mildly grief to show that they were not fully affected by the incident that may also affect

their performance in their work and in their service rendered in the place where they were

working.
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As to the different items considered as indicators to measure the level of grief of

the nurses of Abra Provincial Hospital towards the death of their patients, it was found

out that the respondent seldom thinks about the patient. This was evidenced by their

weighted mean of 2.3. This means that the respondents of the study do not always think

about their patients who died for them to work better in their service. This is a way for

them to show that death is only but a natural situation that may happen in life. Based

from the table, the above mentioned statement garnered the highest mean level.

Meanwhile, the statement “Do you find yourself preoccupied with images or

memories of patient” had the lowest mean 1.6 which was integrated as “NEVER”. This

means that the nurses of the Abra Provincial Hospital considered as the respondent of the

study found them not thinking the images or picture or memories of their patients who

had died.

The relationship between the nurses’ attitude towards the death of their patients

and their personal characteristics is presented in table 4. To carry out this purpose, the

researcher made use of the simple linear regression analysis specifically the person

product moment of correlation and the point bi-serial coefficient of correlation.

On Civil Status. It was found out in this study that there is no significant relationship

between the nurses’ attitude towards the death of their patients and their civil status. This

means that whatever status the nurse was, that is, single or married, it does not affect their

attitude. This suggests that single nurses and married nurses have tended to have a likely

the same attitude towards the death of their patients.

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Above finding was contrary to what was found out by Evangelista (1981) that in

her review, Popoff and nursing (1975) revealed that when patient brings up the topic of

death, unmarried nurses were much more likely to feel uncomfortable as compared to the

married ones.

TABLE IV

Coefficient of Correlation Showing the Significant Relationship between Abra

Provincial Nurses Attitude towards the Death of their Patient and their Personal
Characteristics

Personal Characteristics r- Value

Civil Status -0.018

Age -0.166

Gender -0.001

Ward -0.06

Number of Years as RN -0.115

Number of patients’ death handled -0.077

Duration of patient-nurse interaction 0.154

Experience death within last 10 months *

On Civil Status. It was found out in this study that there is no significant

relationship between the nurses’ attitude towards the death of their patients and their civil

status. This means that whatever status the nurse was, that is, single or married, it does

On age. The nurses of the APH do not have any bearing on their attitude towards

the death of their patients. This means that age is not a factor to consider in determining

the attitude of the nurses. This implies that in this study, there was no significant
 21

relationship found out between the nurses’ attitude towards the death of their patients and

their age. This suggests that whatever age bracket a nurse belongs, their attitude towards

the death of their patients were likely the same.

Above findings contraindicated the findings of Gow and Williams (1977) in

Evangelista (1981) where the latter indicated that age was an important determinant in

nurses’ perceptions of death and dying, It was also contrary to what was found out by

Kasmarik (1974) and was pointed out by Evangelista (1981) that increase in age was

associated with favorable attitudes toward death and dying.

On gender. There was no significant relationship between the nurses of APH

attitude towards the death of their patients and their gender. This means that whatever

characteristic a nurse belongs, male or a female, it does not affect their attitude. It further

implies that male and female nurses have more or less the same attitude towards the death

of their patients. The findings of this study regarding gender does not agree to what was

found out by Spilka (1969) in Atnel (1988) where the latter found out that women

expressed stronger beliefs than males about death leading to afterlife. Again, it was also

contrary to Walsh, in which gender was considered an important variable that dictates

grief in relation to patient’s death.

On ward. There was no literature found correlating nurses’ attitude towards death

of their patients and also the ward where they belong to. But it is interesting to note that

in this study, it was found out that there was no existed relationship between the nurses of

APH attitude towards the death of their patients and the ward where they are rendering

their services. This suggests that wherever ward nurses were belonged to, their attitude

towards the death of their patients were likely to have the same levels.
 22

On number of years as a registered nurse. This variable considered in the study

was found out to have no significant relationship to the nurses’ attitude towards the death

of their patients. This means that young nurses in the service and the old nurses in the

service may tend to have the same level of attitude.

Above result contradicts to what was found out by Feudtuer (2007) where he

pointed out that the number of years in nursing practice is significantly correlated with

comfort working with dying children and families.

On number of patients’ death handled. The number of patients’ death handled

by the nurses of APH was also considered as a nurse characteristic of this study. It was

found out that there was no significant relationship between the nurses’ attitude towards

the death of their patients and the number of patients’ death they handled. This means

that the number of death cases nurses have handled does not affect their attitude.

Moreover, a nurse who had handled a less number of death cases and a nurse who had

handled a more number of death cases tended to have the same attitude.

Findings of this study contraindicated the findings of Arthur Engler (2004) who

had an implication that there is a direct relationship between years in nursing practice and

number of patients’ death experienced.

On duration of patient-nurse interaction. In this study, it was also found out

that there was no significant relationship between the nurses’ attitude towards the death

of their patients and the duration of their interaction with their patients. This means that

the length of time they spent together with their patients who died does not have any

bearing towards their attitude. This implies that those nurses who stayed in a long period
 23

of time and those nurses who stayed in a short period of time together with their patients

have tended to have more or less equally the same attitude.

Above findings contraindicated the findings of Papadatou (2002) where he

stressed that the care of a patient with whom they had a longstanding relationship

triggered intense in opposition to physicians who were less distressed.

On experiencing patients’ death within last 10 months. On this study, the

relationship between the nurses’ attitude towards the death of their patients was not

established to that in their experience to have death of their patients within the last 10

months. This was due to the fact that there was no variations in the responses of the

respondents for all of them have experience that some of their patients had died for

within 10 months.

Another important aspect which was looked into this study is the relationship

between the nurses Abra Provincial Hospital level of grief towards the death of their

patients and their personal characteristics. The simple linear regression analysis was

utilized to carry out the purpose.

On Civil Status. One of the personal characteristics of the respondents

considered in this study was their marital status. According to the statistical

computations, it was found out that this characteristic has no relationship towards the

level of grief of the respondents. This implies that whatever category a nurse may belong,

it does not affect his level of grief. It further suggests that a married and unmarried nurse

TABLE V
Coefficient of Correlation Showing the Significant Relationship between Abra
Provincial Hospital nurses Level of grief towards the death of their
 24

patients and their Personal Characteristics

Personal Characteristics r- Value

Civil Status 0.099

Age -0.503**

Gender -0.094

Ward -0.189

Number of Years as RN 0.011

Number of patients’ death handled 0.006

Duration of patient-nurse interaction 0.100

Experience death within last 10 months *

have more or less equally the same level of grief towards the death of their patients.

This finding of the study was not in consonance to what was revealed from the

findings of Evangelista (1981) where his findings corroborated to what was found out by

Pop off and Nursing75 (1975) that when patient brings up to the topic of his death,

unmarried nurses were much more likely to feel uncomfortable as compared to the

married.

On Age. There existed a significant relationship between the nurses of the Abra

Provincial Hospital level of grief towards the death of their patients and theie age. This

manifests that age has something to do with the level of grief of the nurses. This implies

that older aged nurses tended to have a higher level of grief towards the death of their

patients.
 25

This finding corroborated with the findings of Evangelista (1981) as evidenced

from the study conducted by Gow and Williams (1977) where the former indicated that

age was an important determinant in nurses’ perceptions of death and dying.

On Gender. It was found out in this study that this characteristic of the nurses has

nothing to do with their level of grief towards the death of their patients. This means that

there is no significant relationship between the nurses’ level of grief towards the death of

their patients and their gender. This implies that a male nurse and a female nurse have

almost the same level of grief towards the death of their patients.

Above findings contradict the findings of Spilka (1969) in Atuel (1988) where

they found out that women expressed stronger beliefs than males about death. And in the

study of Walsh, men were found to have higher grief scores thanwomen, although their

extent of grief is reversed after nine months.

On Ward. Regarding to the division where the nurses were destined to work,

nurses who were designated to Pedia, Medical, Ortho, OB and ER tended to have the

same level of grief towards the death of their patients. This finding was evidenced by the

none significance an the relationship between the nurses grief and the ward where they

were assigned to. This implies that a ward was not a factor to have a higher or a lower

level of grief towards the death of patients.

On number of years as a Registered Nurse. There was no significant

relationship found out between the nurses of the Aba Provincial Hospital level of grief

towards the death of their patients and the number of years as a registered nurse. This

implies that number of years in the service is not a contributory factor to the nurse’s level
 26

of grief towards the death of their patients. A young and older nurse in the service seems

to have likely the same level of grief.

This finding does not support the findings of the study made by Feudtner (2007)

where he found out that the number of years in nursing practice is significantly correlated

with the comfort working with dying patient and their families. Above findings also

contradicted what was found out by Arthur Engler (2004) that in his study, it implies that

there is a direct relationship between years in nursing practice and number of patient

death experience.

On number of patients’ death handled. There existed no significant relationship

between nurses of Abra Provincial Hospital level of grief towards the death of their

patients and the number of patient’s death they handled. This means that the number of

patients death handled was not a determinant to their level of grief. This implies that

nurses who handled a lesser number of dead patients and those who handled a more

number of dead patients have equally the same level of grief towards the death of their

patients.

On duration of patient-nurse interaction. Regarding the length of time where

nurses were giving comfort to their patients, it had no significant bearing to the nurse’s

level of grief of the Abra Provincial Hospital. It means that there existed no significant

relationship between the nurses’ level of grief towards the death of their patients and the

duration of patient-nurse interaction. This further implies that the length of time intended

by the nurses to their patients did not yield any effect on their level of grief.

But on the study made by Papadatou (2002), above findings of the study was

contradicted. He pointed out in his study that the care of a patient with whom they had a
 27

longstanding relationship triggered intense distress, in opposition to physicians who were

less distressed. Perlsin (1997) showed also that caring for dying patients and their

families is the most stressful and painful situation for nurses who must constantly attend

to the patients unlike other health care providers who visit the patient and then walk

away.

On experiencing patients death within 10 months. Due to inappropriate

variances found in the responses of the respondents considered in the study, the

relationship was not established. This was because of the fact that hundred percent

(100%) of the respondents have experienced that some of their patients died for within 10

months.

Finally, the establishment of the relationship between the attitude of the nurses

and the level of their grief towards the death of their patients was also determined. To

carry out this purpose, the simple linear regression analysis specifically the pearson

product moment of correlation was utilized. The summary of the computation was

presented in table 6.

It is revealed on the table that there was no significant relationship existed

between the attitude of the nurses and the level of their grief towards the death of their

patients. This means that the attitude of the nurses toward the death of their patients does

not have any bearing and it has nothing to do with the nurses’ level of grief towards the

death of their patients. Further, attitude was not a factor to determine the grief of the

nurses. Moreover, attitude of the nurses towards the death of their patients was not a

determinant on the nurses’ level of grief towards the death of their patients.
 28

TABLE VI

Coefficient of Correlation Showing the Significant Relationship between Abra

Provincial Hospital Nurses Attitude and the Level of Grief towards
the Death of their Patients

Attitude towards death r- Value

Level of grief -0.087

The findings of this study contraindicated the findings of study conducted by

Anderson, Seecharan and Toce (2004) where they pointed out that nurses’ attitude

towards death could have a significant on how they handle grief towards the death of

their patients. According to them, to compare the perceptions towards death of doctors

and nurses who cared for one patient, both health care providers agreed on their

perceptions although the physicians was said to generally have a more positive view.

Chapter IV

SUMMARY, CONCLUSIONS and RECOMMENDATIONS

 29

This chapter presents the summary, conclusions and the recommendations based on the

findings.

SUMMARY

The purpose of the study was to determine the relationship between the nurses’ personal

characteristics and their level of grief towards the death of their patients.

Specifically to answer the following questions were sought:

1. What is the socio-demographic characteristics of the nurses in Abra Provincial Hospital

in terms of the following:

a. Civil status

b. Age

c. Gender

d. Ward

e. Number of years as RN

f. Experienced patients death within the last 10 months

g. Number of patient’s death handled

h. Duration of patient-nurse interaction

2. What is the attitude of nurse in Abra Provincial Hospital with regards to the death of their

patients?

3. What is the level of grief of the nurses in Abra Provincial Hospital towards the death of

their patients?

4. Is there a significant relationship between the attitude of the nurses in Abra Provincial

Hospital towards the death of their patients and each of the aforementioned independent

variables?

5. Is there a significant relationship between the Abra Provincial Hospital nurses level of

grief towards the death of their patients and their personal characteristics?
 30

6. Is there a significant relationship between the attitude towards the death of their patients

of the nurses in Abra Provincial Hospital and their level of grief towards the death of

their patients?

Respondents of the study were 30 selected nurses in Abra Provincial Hospital. On the

treatment of data, the researcher made used of the descriptive method wherein a questionnaire

was prepared. The questionnaire consisted of three parts, aside from questionnaires; data was

also gathered through observations. The reliability of the instruments was measured using the

formula frequency counts and percentage. Weighted mean was used to determine the

profile of the nurses in Abra Provincial Hospital between the nurse’s attitude towards

the death of their patients and the level of grief towards the death of their patients.

And, Simple Linear regression Analysis was used to determine the following:

● Characteristics of the nurses in Abra Provincial Hospital between the nurses attitude

towards the death of their patients.

● The nurses personal characteristics between the level of grief towards the death of their

patients.

● The nurses attitude towards the death of their patient between the level of grief towards

the death of their patients.

FINDINGS

Based on the data gathered, the salient findings are as follows:

1. The profile of the respondents in terms of age revealed that a greater number (15

or 50%) of the nurses considered as a respondents of this study belong to the age bracket of 21-25

This means that at this age of time in the life of nurses of Abra, they are engaging themselves to

help the sick people of their own province. Meanwhile, less than one- fourth of the respondents (5

or 17%) belong to the age bracket of below 20 years of age. This manifest that only a few number
 31

of nurses of Abra enters for the review of nursing Licensure examination ers the job at this age

for some reasons such as preparing themselves. As of gender, it was seen that a greater number of

respondents (20 or 67%) of them were single. This suggests that the nurses of the Abra Provincial

Hospital enjoy life being single. Perhaps, most of them have plans in life like going abroad to

look for an opportunity that’s why they are preserving themselves to be single. On the other hand,

only one0 third (10 or 33%) of the nurses were married. As on experiencing death of their

patients within the last 10 months, it was found out in this study that there was no variation in the

responses of the respondents. These means that hundred percent (30 or 100%) of the nurses. As

on the number of patients died handled, 23 or 77% of the nurses considered as respondents of this

study have experienced to have 5 and below cases where their patients died for the span of within

the last 10 months. This manifests that majority of the nurses experienced a minimal number of

death case. Lastly, the survey conducted shows that with regards to the number of hours were the

nurses had interacted with their patients who had died, it is very interesting to note that 16 or 53%

had interacted with their patients for a number of 21 hour and above. This shows that the nurses

cared so much for their patients for they were patiently interacting with their patients for almost a

day.

2. The attitude of the nurses towards the death of their patients had an “AGREE” level

attitude towards the death of their patient. This was evidenced by their weighted mean of

2.46. This suggests that the respondents of this study viewed death positively that this is a

natural occurrence in the health setting.

With the different items considered as indicators to measure the respondent’s

attitude towards the death of their patients, it was found out that in this study, nurses

viewed that death was a natural aspect of this life. This was viewed by the weighted mean

of 1.4 which belongs to the “Strongly Agree” attitude. In fact, this statement garnered the

lowest computed weighted mean. On the other hand, the statements “Death provides an
 32

escape from this terrible world“ garnered the highest weighted mean respectively, ( x=

3.4) which falls on “Disagree” Attitude. This means that the respondents do not view

death as a means or as a solution to end their lives to escape from troubles, problems,

hardships and difficulties in life. According to them also, this was not an avenue for them

to end life just to leave the world that is full of negative phenomena

3.The level of grief towards the death of their patients unveils that the nurses a

general mean of 1.95 which falls on descriptive rating of “Mild grieving”. This means

that the respondents have a gentle and moderate, not severe or extreme grieving towards

the death of their patients this implies that when the patients of these nurses dies, they

mildly grief to show that they were not fully affected by the incident that may also affect

their performance in their work and in their service rendered in the place where they were

working.

As to the different items considered as indicators to measure the level of grief of

the nurses of Abra Provincial Hospital towards the death of their patients, it was found

out that the respondent seldom thinks about the patient. This was evidenced by their

weighted mean of 2.3. This means that the respondents of the study do not always think

about their patients who died for them to work better in their service. This is a way for

them to show that death is only but a natural situation that may happen in life. Based

from the table, the above mentioned statement garnered the highest mean level.

Meanwhile, the statement “Do you find yourself preoccupied with images or

memories of patient” had the lowest mean 1.6 which was integrated as “NEVER”. This

means that the nurses of the Abra Provincial Hospital considered as the respondent of the
 33

study found them not thinking the images or picture or memories of their patients who

had died.

4. Relationship between Nurses Attitude towards the death of their patient and

their personal characteristics found out that there was no significant relationship between

the nurses attitudes towards the death of their patients and their personal characteristics.

5.The relationship between the nurses level of grief towards the death of their

patients and their personal characteristics found out that this characteristic has no

relationship towards the level of grief of the respondents. This implies that whatever

category a nurse may belong, it does not affect his level of grief. It further suggest that a

nurse who is unmarried and a married nurse have more or less equally the same level of

grief towards the death of their patients. On age, there is existed significant relationship

between the nurses level of grief towards the death of their patients and their age. This

manifests that age has something to do with the level of grief of the nurses. This implies

that older aged nurses tended to have a higher level of grief towards the death of their

patients. On gender, it was found out in this study that this characteristic of the nurses

has nothing to do with their level of grief towards the death of their patients. This means

that there is no significant relationship between the nurses level of grief towards the death

of their patients and their gender. This implies that a male nurse and a female nurse have

almost the same level of grief towards the death of their patients. Regarding to the

division where the nurses were destined to work, nurses who were designated to Pedia,

Medical, Ortho, OB and ER tended to have the same level of grief towards the death of

their patients. This finding was evidenced by the none significance an the relationship

between the nurses grief and the ward where they were assigned to. This implies that a
 34

ward was not a factor to have a higher or a lower level of grief towards the death of

patients. On number of years as a registered nurse, there was no significant relationship

found out between the nurses of the Aba Provincial Hospital level of grief towards the

death of their patients and the number of years as a registered nurse. This implies that

number of years in the service is not a contributory factor to the nurse’s level of grief

towards the death of their patients. A young and older nurse in the service seems to have

likely the same level of grief. On number of patients death handled there was no

significant relationship between nurses of Abra Provincial Hospital level of grief towards

the death of their patients and the number of patient’s death they handled. This means

that the number of patients death handled was not a determinant to their level of grief..On

duration of patient-nurse interaction, regarding the length of time where nurses were

giving comfort to their patients, it had no significant bearing to the nurse’s level of grief

of the Abra Provincial Hospital.On experiencing patients death within 10 months, found

out that due to inappropriate variances found in the responses of the respondents

considered in the study, the relationship was not established. This was because of the fact

that hundred percent (100%) of the respondents have experienced that some of their

patients died for within 10 months. Finally, the establishment of the relationship between

the attitude of the nurses and the level of their grief towards the death of their patients

was also determined.

6. On the relationship between the nurses’ attitude towards death and the level of

grief towards the death of their patients found out that there was no significant

relationship existed between the attitude of the nurses and the level of their grief towards

the death of their patients. This means that the attitudes of the nurses toward the death of
 35

their patients do not have any bearing and it has nothing to do with the nurses’ level of

grief towards the death of their patients. Further, attitude was not a factor to determine

the grief of the nurses. Moreover, attitude of the nurses towards the death of their patients

was not a determinant on the nurse’s level of grief towards the death of their patients.

CONCLUSIONS

Based on the findings the following conclusions were drawn out:

1. Majority of the respondents are female and single. The result of the study also showed

that the most of them are at the age bracket of 21- 25 years old. This means that they are fresh

graduates or newly registered nurses as supported by the longest period of service or number of

years as registered nurses which is 5 years and below. The study also revealed that the nurses

handled their patients for 21 hours and beyond, at most.

2. The relationship between the nurses’ attitude towards the death of their patients

viewed death positively that this is a natural occurrence in the health care setting. This

means that the respondents do not view death as a means or as a solution to end their

lives to escape from troubles, problems, hardships and difficulties in life. According to

them also, this was not an avenue for them to end life just to leave the world that is full of

negative phenomena.

3. The level of grief towards the death of their patients unveils that the nurses have a

mild grief level, this means that the respondents have a gentle and moderate, not severe

or extreme grieving towards the death of their patients this implies that when the patients

of these nurses dies, they mildly grief to show that they were not fully affected by the

incident that may also affect their performance in their work and in their service rendered

in the place where they were working.

 36

4. Relationship between nurses’ attitude towards the death of their patient and

their personal characteristics found out that there was no significant relationship between

the nurses’ attitudes towards the death of their patients and their personal characteristics.

Means that the nurses must render good attitude towards their patient even if it’s dying.

They have to give care until the last minute of the life of their patients.

5. The relationship between the nurses’ level of grief towards the death of their

patients and their personal characteristics found out that this characteristic has no

relationship towards the level of grief of the respondents. Age, gender, civil status and

other variables did not affect the level of grief of their patients.

6. There is no significant relationship between the nurses’ attitude and the level of

grief towards the death of their patients. This refuted the previous study conducted by

Dunn, Ten and Stephens(2005) , means that nurses attitude towards death have no direct

effect on their level of grief they experienced towards the death of their patients.

RECOMMENDATIONS

The following recommendations of the researchers have been gathered from the result of

the study.

Because nurses work so closely with dying patients, they must have intimate care

to the whole person including physical, emotional, and spiritual care, sharing in

conversation the patient’s fears and concern. They must have to expose themselves and

their personal feelings. When patients die, they must seldom allow themselves to

adequately acknowledge their own losses, or to fully comprehend the intimacy of their

relationships with clients. Too often they think that they are to be "pillars of strength" in

times of crisis or death.

 37

In order to offer compassionate care for the critically sick and for the dying, as

nurses they must be able give themselves without being destroyed in the process. For self

preservation, they may resort to ineffective coping mechanisms such as withdrawal,

psychological numbing, and avoidance of personal involvement with patients. Failure to

work through the grieving process leads to potential burnout.

As nurses, they must strive more to provide compassionate care, sharing in the

grief, loss, and fear experienced by dying patients and their families. We want to do more

than just go through the motions, becoming numb to the pain of others.

It is important that they see their selves as humans and recognize the emotional

reactions that traumatic events evoke in them. Acknowledgment of their vulnerability to

tragedy is a fundamental factor in the way each of them handles the senseless losses they

are faced with every day in their professional lives. And,

A parallel and follow- up study should be conducted to strengthen the relationship

between the attitude of the nurses and their level of grief towards the death of their patients. Other

factors should also be included to have better understanding of the possible indicators in nurses’

attitude and its relationship to the level of grief towards the death of their patients.

BIBLIOGRAPHY

A. BOOKS
 38

Feudtner, C., Haney, J., and Dimmer, M.A. (January 1, 2003). Spiritual Care Needs of
Hospitalized Children and their Families: A National Survey of Pastoral Care
Providers’Perceptions. Pediatrics, 3(1),e67-72.

Moss, M.S., Moss, S.Z., Rubinstein, R.L., and Black, H.K. (2003). The Metaphor of “Family”
in Staff Communication about Dying and Death. The Gerontological Society of
America. 58:290-296.

Spilker, B., Zwartjen, W.J., Zwartjen, G.M. (1991). The Role of Religion in Coping with
Childhood Cancer. Pastoral Psychol, 39:295-304.

B. JOURNAL

Brunelli, Tina, RN, BSN. (October-December 2005). Concept Analysis: The Grieving Process for
Nurses. Nursing Forum, 40(4), 123.

Engler, A.J. (2004). Neonatal Staff and Advanced Practice: Nurses’ Perceptions of
Bereavement/End-of-Life Care of Families of Critically Ill and/or Dying Infants. American
Journal of Critical Care. 13:489-498.

Parkes, C.M. (1998). Coping with Loss: The Dying Child.

http://www.bmj.com/cgi/content/full/316/7141/1376

Parkes, C.M. (1996). Bereavement: Studies of Grief in Adult Life (3rd ed.). Rontledge, London.

Quint, J. (1968). Awareness of Death and Nurses’ Composure. Nursing Research.

Wong, P.T.P., Reker, G.T., and Gesser, G. (1994). Death Attitude Profile-Revised: A
multidimensional Measure of Attitudes toward Death. In R.A. Neimeyer (Ed.) Death Anxiety
Handbook (p. 121-148). Francis Taylor, Washington DC.

C. MULTIMEDIA

Papadatou, D., Papazoglou, I., Bellali, T., and Petraki, D. Greek Nurse and Physician Grief as a
Result of Caring for Children Dying of Cancer.
http://www.medscape.com/viewarticle/442676_print

ABRA VALLEY COLLEGES

Bangued, Abra

COLLEGE of NURSING
 39

KATHERINE F. CABUNOC,RN,MAN
Chief Nurse
Abra Provincial hospital

Ma’am:

We, the undersigned Bachelor of Science in Nursing BSN IV students of college

of Nursing of Abra Valley Colleges are presently undertaking a research study entitled “
The relationship Between the Nurses Personal Characteristics and their Level of
Grief Towards the Death of their Patients”:

In connection with this, we would like to float our questionnaires. Rest assured
that all information gathered will be kept confidential.

Hoping for your favorable response regarding this matter.

Thank you very much.

Very truly yours,

Jumel B. Blando

Leader

JUBERT S. GANNAPAO
Research instructor

Recommending Approval:

JOSEPHINE R. MANZANARES,RN,MAN
Dean College of Nursing

Approved by:

FRANCIS A, BORGOŇA,HD
President

ABRA VALLEY COLLEGES

Bangued, Abra

COLLEGE of NURSING
 40

GODOFREDO L. GAZA,MD,MHA
PHO
Abra Provincial hospital

Ma’am:

We, the undersigned Bachelor of Science in Nursing BSN IV students of college

of Nursing of Abra Valley Colleges are presently undertaking a research study entitled “
The relationship Between the Nurses Personal Characteristics and their Level of
Grief Towards the Death of their Patients”:

In connection with this, we would like to float our questionnaires. Rest assured
that all information gathered will be kept confidential.

Hoping for your favorable response regarding this matter.

Thank you very much.

Very truly yours,

Jumel B. Blando

Leader

JUBERT S. GANNAPAO
Research instructor

Recommending Approval:

JOSEPHINE R. MANZANARES,RN,MAN
Dean College of Nursing

Approved by:

FRANCIS A, BORGOŇA,HD
President

ABRA VALLEY COLLEGES

Bangued, Abra

COLLEGE of NURSING
 41

Respondents:

We, the undersigned Bachelor of Science in Nursing BSN IV students of college

of Nursing of Abra Valley Colleges are presently undertaking a research study entitled “
The relationship Between the Nurses Personal Characteristics and their Level of
Grief Towards the Death of their Patients”:

In connection with this, we would like to float our questionnaires. Rest assured
that all information gathered will be kept confidential.

Hoping for your favorable response regarding this matter.

Thank you very much.

Very truly yours,

Jumel B. Blando

Leader

JUBERT S. GANNAPAO
Research instructor

Recommending Approval:

JOSEPHINE R. MANZANARES,RN,MAN
Dean College of Nursing

Approved by:

FRANCIS A, BORGOŇA,HD
President

Sample Questionnaire

Part I: Socio- demographic Profile

DIRECTION: Please put a check in space provided. Answer honestly.
 42

Name: (optional) __________________________________

Age:
___ 26 above
___ 21-25
___ 20 below

Civil Status:
___ single ___ married
Gender:
___ male ___ female
Experienced patients death within the last 10 months?
___ yes ___ no
Number of patient’s death handled
___ 11 and above
___ 6-10
___ 5 and below
Duration of patient-nurse interaction
___ 21 hours and above
___ 16 hours-20 hours
___ 11 hours-15 hours
___ 5 hours and below

Part II: Death Attitude Profile

Please be guided on the following scale:

LEGEND:
5- STRONGLY DISAGREE
4- DISAGREE
3- UNCERTAIN
2- AGREE
1- STRONGLY AGREE

5 4 3 2 1
1.Death is no doubt a grim experience

2.The prospect of my own death arouses anxiety

3. I avoid death thoughts at all cost.

4.believe that I will be in heaven after I die

5. Death will bring an end to all my troubles.

6. Death should be viewed as natural, undeniable and unavoidable

event.
 43

7. I am disturbed with the finality of death.

8. Death is an entrance of intimate satisfaction.

9. Death provides an escape from this terrible world.

10. Death is deliverance from pain and suffering

11. I always try not to think about death.

12. Death is a promise of a good and eternal life.

13. Whenever the thought of death enters my mind I try to push it

away.

14.I believe that heaven is a much better place than this world.

15. I would neither fear death nor welcome it.

16. Death is a natural aspect of this life.

17.I have an intense fear of death

18. I avoid thinking about death altogether.

19. Death is a union of God and eternal bliss.

20. Death is a promise of a good and eternal life.

21. The subject of life after death troubles me greatly.

22. I look forward to a reunion with my loved ones after I Die

23. The fact that death will mean the end of everything as I know
it frightens me.

24. Death is simple a part of the process of life.

25. I see death as a passage to an eternal and blessed place.

Part III: Level of grief towards the death of their Patients

Please be guided in the following scale:

 44

LEGEND:
5- ALWAYS
4- OFTEN
3- SOMETIMES
2- SELDOM
1-NEVER

5 4 3 2 1
1.Do you experience images of the event surrounding
the patient’s death?

2.Do thoughts of the patient come into your mind

whether you wish it or not?

3.Do thoughts of the patient make you feel

distressed?

4.Do you think about the patient?

5.Do images of the patient make you feel distressed

6.Do you find yourself preoccupied with images or

memories of X?

7.Do you find yourself thinking of reunion with the

patient?

8.Do you find yourself missing the patient?

9.Are you reminded by familiar objects (photos,

possessions, rooms, etc.) of the patient?

10.Do you find yourself pining for/yearning for the

patient?

11.Do you find yourself looking for the patient in

familiar places?

12.Do you feel distress/pain if for any reason you are

confronted with the reality that the patient is not
coming back?

13.Do reminders of the patient such as photos,

situations, music, places, etc. cause you to feel
longing for the patient?

14.Do reminders of the patient such as photos,

situations, music, places, etc. cause you to feel
 45

loneliness?

15.Do reminders of the patient such as photos,

situations, music, places etc. cause you to cry about
him/her?

16.Do reminders of the patient such as photos,

situations, music, places, etc. cause you to feel
sadness?

17.Do reminders of the patient such as photos,

situations, music, places, etc. cause you to feel loss of
enjoyment?

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
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