Graduation Year


Document Type




Degree Granting Department


Major Professor

Susan McMillan, Ph.D .


Anxiety, Attitude, Nurses, Pediatric, Hospice


To lose a child is a profoundly emotional experience. Even if it is not your own, the experience involves deeply held beliefs about death, the quality of death, ethics, and perhaps personal experience. Left unexplored, these beliefs and the anxiety they may produce, can become barriers to providing quality end-of-life care for children with life limiting conditions and their families. The purpose of this study was to explore the relationship between hospice nurses' attitudes toward providing pediatric hospice care and the level of anxiety they may experience related to pediatric hospice care. A self administered questionnaire was completed by 30 hospice nurses. The 20-item state anxiety questionnaire from the state-trait anxiety inventory was used to rate the nurses' level of anxiety related to pediatric hospice care. The nurses' attitudes toward pediatric hospice care were measured using a modified version of attitudes about care at the end of life among clinicians scale.

State-anxiety refers to the reaction or process taking place at a given time and the level of intensity related to the situation. the possible range of scores was 20-80 with the higher score indicating greater levels of anxiety. The actual range was 20-65, with a mean of 35.9 (SD = 12.1). The possible range of scores for the total attitude score was 12-60, with a higher score indicating a more positive attitude toward pediatric hospice. The total attitude score had a mean of 31.0 (SD=5.2). Attitude was further divided into three attitude subscales: comfort in discussing pediatric hospice with parents, perceived benefit of pediatric hospice and attitude toward physician involvement in pediatric hospice. The possible range for each subscale was 4-20, again with higher scores indicating a positive attitude. The comfort subscale had a mean of 8.3 (SD=2.8). The benefit subscale had a mean of 9.3 (SD=2.5). The physician involvement subscale had a mean of 13.7 (SD=2.1).

The results suggested the presence of some amount of anxiety experienced with pediatric hospice. The total score on the attitude portion of the survey indicated a generally positive attitude toward pediatric hospice in general. Additionally, the subscales of comfort in discussing pediatric hospice, the benefit of pediatric hospice and the attitude toward physician involvement demonstrated a positive attitude as well. While there was no significant relationship found between the total attitude score and anxiety or between the comfort and benefit subscales, there was a significant relationship (p <.01) found between the physician subscale and anxiety. This may indicate a desire for more physician involvement or the belief that physician involvement decreases anxiety. This study revealed self-knowledge and pediatric specific hospice training as areas for future research and education.