Exploring the Relationships of Spiritual Health, Life Attitude, and Attitude Toward Do-Not-Resuscitate of the Nurses

Sunday, 22 July 2018

Shao-Po Huang, MSN, RN, NP
National Taiwan University Hospital Hsin-Chu Branch, Hsin chu, Taiwan
Li-Chueh Weng, PhD, RN
School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
Yi-Wen Wang, PhD, RN
School of Nursing,Chang Gung University, Tao-Yuan, Taiwan


This study was to explore the relationships among spiritual health, life attitude and attitude towards Do-Not-Resuscitate of the clinical nurses in Taiwan.


This study was a descriptive correlational research design. Convenience sampling and the cross-sectional survey were used. A total of 177 clinical nurses were recruited from a regional teaching hospital at northern Taiwan. The data collection tools included: basic demographic data questionnaire, work-related information questionnaire, life attitude scale (5 sub-scales), spiritual health scale-short from (24-items), and attitude towards Do-Not-Resuscitate scale etc.


The findings showed that nurses in this study had moderate/high spiritual health, postive life attitue, and positive attitude towards Do-Not-Resuscitate. The results of hierarchial multiple linear regression showed that nurses who had ever care patients who signed DNR would have positive attitude towards Do-Not-Resuscitate (p <0.001). The nurses who perceive themselves as being in a poor health condition would have a more postive attitude towards Do-Not-Resuscitate than the others who were in an acceptable or good health status (p <0.001). The nurses in the age group 41-50 also would have a more positive attitude towards Do-Not-Resuscitate than in the age group under 31 (p < 0.05). Life attitude were also positive predictors of Do-Not-Resuscitate attitute (p <0.001). The model of mediation variable analysis (mediated regression) show that spiritual health had significant effect on life attitudes and attitude towards Do-Not-Resuscitate in the model 1 (β=0.490, p<0.01; β=0.201, p<0.01); spiritual heath had no prediction on the attitude towards Do-Not-Resuscitate (β=0.026, p>0.05) when life attitudes entered into the model 2 and then could positively and significantly influence the attitude towards Do-Not-Resuscitate (β=0.357, p<0.001). Life attitudes could predict 13.7% of attitude towards Do-Not-Resuscitate (F=13.838, p<0.001; △R2: 9.7%). In this study, the model could predict 45.5% of attitude towards Do-Not-Resuscitate in clinical nurse (F=4.305, p<0.001).


Although spiritual health do not have the explanatory power for DNR attitude in hierarchial multiple linear regression, the results of this study and the past literature show that they are positively correlated with each other among spiritual health, life attitudes and the attitude towards Do-Not-Resuscitate. According to Baron and Kenny's statistical theory, the completed mediation effect is noticed and it means that spiritual health has no directly predictive power,but it still effect DNR attitude through life attitude. It is called” indirect effect”. Thus, we discuss attitude towards Do-Not-Resuscitate in the future, it will be impossible to ignore the significance or influence of spiritual health.

The study suggested that the attitude and abilities of spiritual health care may improve by sharing experience in nursing practice. Knowledge and skills of spiritual care should include into the on job training programs to improve nurses’ spiritual health,and then it will also help them to explore the meaning and value of life. It will be helpful to be a reference framework in policy making and education program establishment of hospice care in the future.