Preferred Presentation Format: Seminar Research Theme: End-of-Life Issues
Objective: The purpose of this study was to describe the factors associated with retention of new hospice volunteers. The primary focus was the relationship between general self-efficacy, death-specific self-efficacy and a new hospice volunteer’s retention in that role. Secondly, the relationships between personal factors, agency and training variables, and volunteer retention were also explored.
Design: The design was a prospective cohort study of new hospice volunteers.
Population, Sample, Setting: This study consisted of a total of 181 new hospice volunteers from twenty hospice agencies in a major metropolitan region of the northeast United States who participated in training between May, 2000 and November, 2000. Hospice agencies varied in size, profit status, and format of training.
Concepts/Variables: The independent variables in this study included: 1. Cognitive components: Individual’s general and death-specific self-efficacy. 2. Behavioral components: Previous volunteer activity and motivations for volunteering. 3. Personal components: Demographic characteristics, including age, gender, marital status, educational level, employment status and family income. 4. Environmental components: Characteristics of the hospice agencies, including size, profit status, number and length of service of present volunteers, and form of volunteer training (length, number of trainers, their background and experience as trainers).
The dependent variable in this study was the activity status of hospice volunteers six months after completion of training.
Methods: Characteristics of the Hospice Agency were assessed through two surveys, one addressing the agency and the second assessing the hospice training approaches. Individual characteristics were assessed using a demographic survey, The General Self-efficacy Scale (Sherer, 1982), and The Death Self-efficacy Scale (Robbins, 1991). Six months after the conclusion of training, the researcher contacted the hospice volunteer coordinator to ascertain the activity status of study participants. A sample of the subjects, both active and inactive, were contacted by phone after six months and were surveyed about their volunteer experiences.
Findings: Retention as a hospice volunteer did nor correlate with the level of Death Self-efficacy. Scores on the General Self-efficacy Scale were inversely related to retention, with inactive volunteers having a higher score on this scale. Logistic regression revealed that three motivations to volunteer, (“to help others”, “resolve sadness of a death” and “religious beliefs”) are important in predicting volunteer activity. Logistic regression also disclosed that volunteers at larger agencies were more likely to be active; volunteers with more than four trainers were more likely to be inactive. Twelve of the twenty agencies had greater than 75% volunteer retention. These agencies were more likely to use the National Hospice Organization Handbook as a syllabus for training, serve more than 300 patients annually, have a large existing volunteer group with long lengths of service and have less than 17 hours of hospice training.
Conclusions: Individual characteristics were not significantly related to retention as a hospice volunteer. Characteristics of the agency and the hospice volunteers training appeared to be very important factors in retention of new hospice volunteers.
Implications: In order to meet the increased demands for hospice care, agencies must be able to identify the most effective means to orient new staff to the hospice philosophy. While this study dealt with hospice volunteers, several implications arise for nurses and other providers of hospice care. The results suggest that the differences in agencies and training are more important in volunteer retention than individual characteristics. The fact that twelve agencies had greater than 75% retention indicates that the organizations had developed effective methods to orient individuals to hospice. Certain competencies must be mastered for an individual to successfully work with dying patients. The teaching methods that most successfully help individuals to achieve this mastery must be identified for agencies to train and retain staff, including volunteers. The higher retention in agencies with fewer trainers may indicate that the opportunity to develop a personal relationship with the trainer aids in the orientation process. The support experienced in such a relationship accomplishes two goals. A supporting relationship may allow individuals to verbalize fears and concerns about working with the dying and, equally important, provides the mentoring and role modeling needed to master end-of-life care.
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