Background
Methods
Study design, area and period
Subjects
Sample size
Sampling technique
Data collection instrument and technique
Data collection and quality control
Statistical analysis
Operational definition
Ethical consideration
Result
Socio-demographic characteristics of nurses
Characteristics | Frequency | Percentage |
---|---|---|
No (341) | % (100) | |
Institution | ||
Black Lion | 176 | 51.6 |
St Paul | 88 | 25.8 |
Hayat | 31 | 9.1 |
Betel | 46 | 13.5 |
Age | ||
20-30 years | 216 | 63.3 |
31-40 years | 67 | 19.6 |
41-50 years | 44 | 12.9 |
>50 years | 14 | 4.1 |
Level of education | ||
Diploma | 170 | 49.9 |
Degree | 171 | 50.1 |
Ward | ||
Medical | 84 | 24.4 |
Surgical | 93 | 27.3 |
Oncology | 10 | 2.9 |
Pediatric | 94 | 27.6 |
Out patient | 66 | 17.6 |
Working experience | ||
Less than 5 years | 182 | 53.4 |
5-10 years | 70 | 20.5 |
11-15 years | 36 | 10.6 |
>20 years | 53 | 15.5 |
Experience in caring terminally ill patient | ||
Daily | 186 | 54.5 |
Once per week | 70 | 20.5 |
Once per month | 27 | 7.9 |
Few times per year | 33 | 9.7 |
Never | 25 | 7.3 |
Training | ||
Yes | 74 | 21.7 |
No | 267 | 78.3 |
How long | ||
1-2 weeks | 54 | 15.8 |
6 month | 20 | 5.9 |
Never | 267 | 78.3 |
Nurses’ knowledge towards PC
No | Characteristic | Yes N (%) | No N (%) | Don’t Know N (%) |
---|---|---|---|---|
1 | Do you know the definition palliative care? | 237 (69.5) | 30 (8.8) | 74 (21.7) |
2 | Palliative care is only appropriate in situations of a downhill trajectory or deterioration in conditions. | 280 (82.1) | 45 (13.2) | 16 (4.7) |
3 | The extent of the disease determines the method of pain treatment. | 290 (85) | 43 (12.6) | 8 (2.3) |
4 | Adjuvant therapies are important in managing pain. | 237 (69.5) | 30 (8.8) | 74 (21.7) |
5 | Drug addiction is a major problem when morphine is used on a long-term basis for the management of pain. | 280 (82.1) | 45 (13.2) | 16 (4.7) |
6 | The provisions of palliative care require emotional detachment. | 142 (41.6) | 160 (46.9) | 39 (11.4) |
7 | During the terminal stages of an illness, drugs that can cause respiratory depression are appropriate for the treatment of severe dyspnea. | 81 (23.8) | 181 (53.1) | 79 (23.2) |
8 | The philosophy of palliative care is compatible with that of aggressive treatment. | 112 (32.8) | 156 (45.7) | 73 (21.4) |
9 | The use of placebos is appropriate in the treatment of some types of pain. | 204 (59.8) | 61 (17.9) | 76 (22.3) |
10 | Meperidine (Demerol®) is not an effective analgesic for the control of chronic pain. | 97 (28.4) | 117 (34.3) | 127 (37.2) |
11 | The accumulation of losses renders burnout Inevitable for those who work in palliative care. | 150 (44) | 76 (22.3) | 115 (33.7) |
12 | Manifestations of chronic pain are different from those of acute pain. | 297 (87.1) | 34 (10) | 10 (2.9) |
13 | Terminally ill patients have the right to choose “Do not resuscitate” (DNR). | 225 (66) | 86 (25) | 30 (8.8) |
14 | Terminally ill patients should be encouraged to have hope against all odds. | 244 (71.6) | 67 (19.6) | 30 (8.8) |
Distribution of nurse’s attitude according to degree of agreement towards items of FATCOD
No | Statement | SD (%) | D (%) | U (%) | A (%) | SA (%) |
---|---|---|---|---|---|---|
1 | Palliative care is given only for dying patient. | 168 (49.) | 103 (30.2) | 13 (3.8) | 35 (10.3) | 17 (5) |
2 | As a patient nears death; the nurse should withdraw from his/her involvement with the patient. | 227 (66.6 | 72 (21.1) | 4 (1.2) | 30 (8.8) | 8 (2.3) |
3 | Giving nursing care to the chronically sick patient is a worthwhile learning experience. | 38 (11.1) | 41 (12) | 37 (109) | 139 (40.8) | 86 (25.2) |
4 | It is beneficial for the chronically sick person to verbalize his/her feelings. | 27 (7.9) | 22 (6.5) | 28 (8.2) | 154 (45.2) | 110 (33) |
5 | Family members who stay close to a dying person often interfere with a professionals' job with the patient. | 49 (13.5) | 95 (27.9) | 44 (12.9) | 123 (36.1) | 33 (9.7) |
6 | The length of time required to give nursing care to a dying person would frustrate me. | 97 (28.4) | 108 (31.7) | 50 (14.7) | 68 (19.9) | 17 (5) |
7 | Families should be concerned about helping their dying member make the best of his/her remaining life. | 30 (8.8) | 20 (5.9) | 19 (5.6) | 174 (51) | 98 (28.7) |
8 | Family should maintain as normal an environment as possible for their dying member. | 21 (6.2) | 35 (10.3) | 27 (7.9) | 187 (54.8) | 71 (20.8) |
9 | The nurse should not be the one to talk about death with the dying person. | 74 (21.7) | 86 (25.2) | 35 (10.3) | 103 (30.2) | 43 (12.6) |
10 | The family should be involved in the physical care of the dying person. | 43 (12.6) | 46 (13.5) | 36 (10.6) | 133 (39) | 83 (24.3) |
11 | It is difficult to form a close relationship with the family of a dying member. | 65 (19.1) | 102 (29.9) | 55 (16.1) | 85 (24.9) | 34 (10) |
12 | There are times when death is welcomed by the dying person. | 30 (8.8) | 37 (10.9) | 19 (5.6) | 141 (41.3) | 114 (33.4) |
13 | Nursing care for the patient's family should continue throughout the period of grief and bereavement. | 41 (12.0) | 59 (17.3) | 42 (123) | 139 (40.8) | 60 (17.6) |
14 | The dying person and his/her family should be the in-charge decision makers. | 25 (7.3) | 38 (11.1) | 36 (10.6) | 170 (49.9) | 72 (21.1) |
15 | Addiction to pain relieving medication should not be a nursing concern when dealing with a dying person. | 111 (32.6) | 99 (29) | 23 (6.7) | 74 (21.7) | 34 (10) |
16 | Nursing care should extend to the family of the dying person. | 59 (17.3) | 66 (19.4) | 33 (9.7) | 128 (37.5) | 47 (13.8) |
17 | When a patient asks, “Nurse am I dying?'I think it is best to change the Subject to something cheerful. | 43 (12.6) | 73 (21.4) | 56 (16.4) | 123 (36.1) | 46 (13.5) |
18 | I am afraid to become friends with chronically sick and dying patients. | 110 (32.5) | 131 (38.4) | 22 (6.5) | 61 (17.9) | 17 (5) |
19 | I would be uncomfortable if I entered the room of a terminally ill person and found him/her crying. | 93 (27.3) | 102 (29.9) | 24 (6.5) | 93 (27.3) | 29 (8.5) |
20 | I would be uncomfortable talking about impending death with the dying Person. | 65 (19.1) | 91 (26.7) | 36 (10.6) | 103 (30.2) | 46 (13.5) |
21 | It is possible for nurses to help patients prepare for death. | 68 (19.9) | 58 (17) | 38 (10.6) | 134 (39.3) | 43 (12.6) |
22 | Death is not the worst thing that can happen to a person. | 91 (26.7) | 101 (29.6) | 36 (10.6) | 69 (20.2) | 44 (12.9) |
23 | I would feel like running away when the person actually died. | 132 (38.7) | 101 (29.6) | 29 (8.5) | 55 (16.1) | 24 (7) |
24 | I would not want to be assigned to care for a dying person. | 121 (35.5) | 103 (30.2) | 34 (10) | 58 (17) | 25 (7.3) |
Knowledge aspect of practice of nurses towards PC
No | Characteristics | Multiple response | Frequency | Percentage |
---|---|---|---|---|
Yes n (%) | No n (%) | |||
1 | Initiate palliative care discussion: | During diagnosis | 186 (54.5) | 155 (45) |
When the disease progress | 128 (37.5) | 213 (62.5) | ||
At the end of life | 57 (16.7) | 284 (83.3) | ||
2 | Do you inform terminally ill patient about their diagnosis? | Yes | 167 (49) | 174 (51) |
No | 69 (20.2) | 272 (79.8) | ||
Depending on family’s wish | 96 (28.2) | 245 (71.8) | ||
Inapplicable | 11 (3.2) | 330 (96.8) | ||
3 | Factors considered when dealing with terminally ill patient: | Spiritual | 172 (50.4) | 169 (49.6) |
Medical situation | 149 (43.7) | 192 (56.3) | ||
Cultural | 69 (20.2) | 272 (79.8) | ||
Psychological | 124 (36.4) | 217 (63.6) | ||
4 | Address spiritual issue: | Connect with spiritual counselor | 177 (51.9) | 164 (48.1) |
Listen with empathy | 133 (39) | 208 (61) | ||
Impose your own view | 320 (94.7) | 18 (5.3) | ||
Understand patient reaction | 74 (21.7) | 267 (78.3) | ||
5 | Cultural assessment during patient care should include: | Truth telling and decision making | 148 (43.4) | 193 (56.6) |
Preference regarding disclosure of information | 55 (16.1) | 286 (83.9) | ||
Dietary preference | 65 (19.1) | 276 (80.9) | ||
Language, family communication | 158 (46.3) | 183 (53.7) | ||
Perspective on death, suffering & grieving | 42 (12.3) | 299 (87.7) | ||
6 | Addressing psychological: | Emotional support | 180 (52.8) | 161 (47.2) |
Counseling the patient | 159 (46.6) | 182 (53.4) | ||
Hiding the truth | 285 (83.6) | 56 (16.4) | ||
7 | Whom do you involve in decision making? | Patient | 205 (60.1) | 136 (39.9) |
Family | 111 (32.6) | 230 (67.4) | ||
My own | 27 (7.9) | 314 (92.1) | ||
Other health professional | 47 (13.8) | 294 (86.2) | ||
8 | How do you perceived terminally ill patient concern or question? | Patient right | 273 (80.1) | 68 (19.9) |
Treat | 336 (96.8) | 11 (3.2) | ||
Doubting your professionalism | 25 (7.3) | 316 (92.7) | ||
Attention seeking behavior | 307 (90) | 34 (10.0) | ||
9 | Communication to the family of terminally ill patient depends on: | Family’s ability to assimilate | 230 (67.7) | 111 (32.6) |
Their involvement in decision making | 206 (60.4) | 135 (39.6) | ||
Your willingness to disclose information | 36 (10.6) | 305 (89.4) | ||
10 | Commonly use medication in your practice for severe pain? | Paracetamol/Ibuprofin | 207 (60.7) | 134 (39.3) |
Codeine | 41 (12) | 300 (88) | ||
Morphine | 108 (31.7) | 233 (68.3) | ||
11 | How do you assess patient pain? | Grade with face | 201 (58.8) | 140 (41.1) |
Intensity | 122 (35.8) | 219 (64.2) | ||
Location | 34 (10) | 307 (90) | ||
Quality | 39 (11.4) | 302 (88.5) |
Association between socio-demographic variables and nurses attitude towards PC
Characteristic | Attitude | P value (x2) | COR 95(CI) | AOR 95(CI) | ||
---|---|---|---|---|---|---|
Good n(%) | Poor n(%) | |||||
Institution | Black lion | 137 (40.2) | 39 (11.4) | 0.009* (11.477) | 1.00 | 1.00 |
St. Paul | 71 (20.8) | 17 (5) | 1.189 (0.628,2.25) | 1.395 (0.703,2.767) | ||
Hayat | 16 (4.7) | 15 (4.4) | 0.304* (0.138,0.668) | 0.285* (0.121,0.669) | ||
Betel | 35 (10.3) | 11 (3.2) | 0.906 (0.421,1.947) | 0.96 (0.416,2.15) | ||
Age | 20-30 years | 162 (47.5) | 54 (15.8) | 0.556 (2.08) | ||
31-40 years | 52 (15.2) | 15 (4.4) | ||||
41-50 years | 36 (10.6) | 8 (2.3) | ||||
> 50 years | 9 (2.6) | 5 (1.5) | ||||
Gender | Male | 90 (26.4) | 26 (7.6) | 0.709 (0.139) | ||
Female | 169 (49.6) | 56 (16.4) | ||||
Total | 259 (76) | 82 (24) | ||||
Level of education | Diploma | 117 (34.3) | 53 (15.5) | 0.003* (8.627) | 1.00 | |
Degree | 142 (41.6) | 29 (8.5) | 2.218* (1.326,3.711) | 2.415* (1.383,4.218) | ||
Total | 259 (76) | 82 (24) | ||||
Ward | Medical | 84 (24.6) | 10 (2.9) | 0.002* (14.547) | 3.6* (1.528,8.483) | 3.44* (1.41,8.398) |
Surgical | 70 (20.5) | 23 (6.7) | 1.304 (0.63,2.695) | 1.153 (0.535,2.484) | ||
Pediatric | 63 (18.5) | 31 (9.1) | 0.871 (0.433,1.754) | 0.297 (0.34,1.522) | ||
Out patient | 42 (12.3) | 18 (5.3) | 1.00 | 1.00 | ||
Working Experience | Less than5 years | 137 (40.2) | 45 (13.2) | 0.677 (2.320) | ||
5-10 years | 55 (16.1) | 15 (4.4) | ||||
11-15 years | 28 (8.2) | 8 (2.3) | ||||
> 20 years | 39 (11.4) | 14 (4.1) | ||||
Experience in caring terminally ill patient | Daily | 143 (41.9) | 43 (12.6) | 0.911 (0.537) | ||
Once per week | 50 (14.7) | 20 (5.9) | ||||
Once permonth | 23 (6.7) | 4 (1.2) | ||||
Few times per year | 24 (7) | 9 (2.6) | ||||
Never | 19 (5.6) | 6 (1.8) | ||||
Training | Yes | 64 (18.8) | 10 (2.9) | 0.025* (8.627) | 2.365* (1.151,4.851) | 2.218* (1.039,4.731) |
No | 195 (57.2) | 72 (21.1) | 1.00 | |||
How long | 1-2 weeks | 45 (13.2) | 9 (2.6) | 0.728 (0.121) | ||
1 month | 18 (5.3) | 2 (0.6) |
Association between socio-demographic variables and nurses knowledge towards PC
Characteristic | Knowledge | P value (x2) | COR 95(CI) | AOR 95(CI) | ||
---|---|---|---|---|---|---|
Good n(%) | Poor n(%) | |||||
Institution | Black lion | 55 (16.1) | 121 (35.5) | 0.717 (1.353) | ||
St. Paul | 27 (7.9) | 61 (17.9) | ||||
Hayat | 11 (3.2) | 20 (5.9) | ||||
Betel | 11 (3.2) | 35 (10.3) | ||||
Age | 20-30 years | 62 (18.2) | 154 (45.2) | 0.781 (1.084) | ||
31-40 years | 23 (6.7) | 44 (12.9) | ||||
41-50 years | 15 (4.4) | 29 (8.5) | ||||
> 50 years | 4 (1.2) | 10 (2.7) | ||||
Gender | Male | 34 (10) | 82 (24) | 0.732 (0.48) | ||
Female | 70 (20.5) | 155 (45.5) | ||||
Level of education | Diploma | 48 (14.1) | 122 (35.8) | 0.365 (0.620) | ||
Degree | 56 (16.4) | 115 (33.7) | ||||
Ward | Medical | 34 (10) | 60 (17.6) | 0.003* (13.784) | 3.833* (1.275,6.29) | 2.751* (1.223,6.18) |
Surgical | 38 (20.5) | 55 (16.1) | 3.445* (1.560,7.64) | 3.445* (1.537,7..72) | ||
Pediatric | 22 (6.5) | 72 (21.1) | 1.528 (0.666,3.504) | 1.515 (0.653,3.515) | ||
Out patient | 10 (2.9) | 50 (14.7) | 1 | 1 | ||
Working Experience | >5 years | 48 (14.1) | 134 (39.3) | 0.306 (3.617) | ||
5-10 years | 25 (7.3) | 45 (12.9) | ||||
11-15 years | 14 (4.1) | 22 (6.5) | ||||
> 20 years | 17 (5) | 36 (10.6) | ||||
Experience in caring terminally ill patient | Daily | 60 (17.6) | 126 (37.0) | 0.764 (1.847) | ||
Once/week | 17 (5) | 53 (15.5) | ||||
Once/month | 9 (2.6) | 18 (5.3) | ||||
Few times per year | 11 (3.2.) | 22 (6.5.) | ||||
Never | 7 (2.1) | 18 (5.3) | ||||
Training | Yes | 35 (11.1) | 39 (11.4) | 0.001* | 2.575* (1.512,4.38) | 3.023* (1.750,5.22) |
No | 69 (20.2) | 198 (58.1) | 1 | 1 | ||
How long | 1-2 weeks | 23 (31.1) | 31 (41.9) | 0.285 (1.145) | ||
1 month | 12 (16.2) | 8 (10.8) |