Nurses' practices and their influencing factors in palliative care

Evaluating ICU nurses' education, practice, and competence in palliative and end-of-life care in Saudi Arabia: A cross-sectional study

Background

In palliative and end-of-life (PEOL) care, especially within intensive care units (ICUs), nurses' unique skills are critical, yet their expertise remains under-explored, particularly in Saudi Arabia.

Objective

This study aimed to evaluate the education, practice, and perceived competence of adult ICU nurses in Saudi Arabia regarding PEOL care and to pinpoint key factors that influence this aspect of healthcare delivery.

Methods

A cross-sectional design was utilized in this study. Participants were recruited from five public hospitals and one specialized center in Hail, Saudi Arabia. Data were gathered in September 2023 using the PEOL Care Index, which measures various care dimensions on a Likert scale in Arabic and English. IBM SPSS Statistics 29.0 was used for statistical analysis, particularly to conduct ANOVA, t-test, and multiple regression.

Results

142 out of the targeted 171 ICU nurses completed the survey, yielding a response rate of 83.04%. Although 81% of the nurses had experience caring for dying patients, only 30.3% had received in-service PEOL care training. Those with this training demonstrated significantly higher scores in education, clinical practice, and perceived competence than their counterparts (p <0.05). Mean scores across these areas were 69.67, 71.01, and 71.61, respectively. In-service training positively correlated with these metrics (p <0.05). Multiple regressions also revealed that in-service training, job satisfaction, and communication authority are strong influencers, explaining 21.6% of the variation in clinical practice and 16.9% in perceived competence.

Conclusion

The study highlighted the proficiency of ICU nurses in PEOL care, emphasizing that in-service training, job satisfaction, and the authority to communicate effectively with patients and their families significantly improved clinical practice and nurses' competence in PEOL care. This underlines the critical need for healthcare institutions to acknowledge and address these key factors to optimize patient care outcomes.

Status and influencing factors of knowledge, attitude and self-reported practice regarding hospice care among nurses in Hainan, China: A cross-sectional study

AIM

This study is to investigate the current status of knowledge, attitude and self-reported practice in hospice care among nurses in Hainan, China, and then to analyse its influencing factors and mediating effects. This provides a basis for formulating scientific and standardized hospice care training programmes for nurses.

METHODS

This cross-sectional study investigated knowledge, attitude and self-reported practice in hospice care among 1819 nurses in Hainan, China. Convenience sampling was used to select participants from 45 hospitals and nursing homes in 14 cities and counties from October to December 2021. A scale of knowledge, attitude and self-reported practice of healthcare providers in hospice care (Chinese version) was administered to collect data during the study period. Statistical analyses, including t-tests, one-way ANOVA, post-hoc analysis and multiple linear regression, assessed the status of knowledge, attitude and self-reported practice of hospice care in nurses and identified influencing factors. The PROCESS macro program model 4.0 was employed to explore the mediating effect of attitude on knowledge and self-reported practice in hospice care.

RESULTS

Nurses in Hainan displayed low knowledge (mean = 7.68, SD = 3.53), moderate attitudes (mean = 88.13, SD = 12.10) and self-reported practice (mean = 51.81, SD = 9.82) in hospice care. Current employment and willingness to engage in hospice care were significant factors influencing knowledge, attitude and self-reported practice in hospice care. Attitude partially mediated the relationship between knowledge and self-reported practice.

PATIENT OR PUBLIC CONTRIBUTION

This study focuses on nurses' knowledge, attitude and self-reported practice in hospice care and does not directly involve patients or the public. However, the findings enhance hospice care provided to patients and the broader community by improving nurses' knowledge and skills. This study informs evidence-based training programmes and interventions, benefiting those in need of hospice care services.

Registered Nurses' beliefs about end-of-life care: A mixed method study

AIMS

To examine registered nurses' (RNs) behavioural, normative and control beliefs about end-of-life care for patients who are diagnosed with advanced and life-limiting illnesses; and to identify the barriers and facilitators they experience when providing end-of-life care.

DESIGN

A sequential explanatory mixed methods study.

METHOD

An online cross-sectional survey was conducted using the Care for Terminally Ill Patient tool among 1293 RNs working across five hospitals in the Kingdom of Saudi Arabia. Online individual semi-structured interviews with a subgroup of survey respondents were then undertaken. Data were collected between October 2020 to February 2021.

RESULTS

A total of 415 RNs completed the online survey, with 16 of them participating in individual interviews. Over half of the participants expressed the belief that end-of-life care is most efficiently delivered through multidisciplinary team collaboration. The majority of participants also believed that discussing end-of-life care with patients or families leads to feelings of hopelessness. Paradoxically, the study revealed that more than half of the participants held the negative belief that patients at the end of life should optimally receive a combination of both curative and palliative care services. The results showed that nurses' beliefs were significantly associated with their age, religion, ward type, level of education and frequency of providing end-of-life care. Data from the qualitative interviews identified four themes that explored RNs' beliefs and its related factors. The four themes were 'holistic care', 'diversity of beliefs', 'dynamics of truth-telling' and 'experiences of providing end-of-life care.'

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Wherever possible, patients at the end-of-life should be cared for in specialist settings by multidisciplinary teams to ensure effective, high-quality care. Where this is not possible, organisations should ensure that teams of multidisciplinary staff, including nurses, receive education and resources to support end-of-life care in non-specialist settings. Hospitals that employ foreign-trained nurses should consider providing targeted education to enhance their cultural competence and reduce the impact of different beliefs on end-of-life care.