Background
Methods
Study aims
Study design
Sample and setting
Data collection
Instruments
General characteristics
Knowledge
Attitude
Confidence and educational needs
Data analyses
Results
Participant characteristics
Characteristic | n (%) | Mean ± SD | Median (range) |
---|---|---|---|
Sex | |||
Women | 98 (96.1) | ||
Men | 4 (3.9) | ||
Age (years) | 32.4 ± 7.1 | 30.0 (23.0–52.0) | |
Marital status | |||
Unmarried | 61 (59.8) | ||
Married | 40 (39.2) | ||
Other | 1 (1) | ||
Educational background | |||
Associate (College) | 9 (8.8) | ||
Bachelors (University) | 77 (75.5) | ||
Masters | 16 (15.7) | ||
Religious affiliation | |||
None | 55 (53.9) | ||
Catholic | 16 (15.7) | ||
Protestant | 29 (28.4) | ||
Buddhism | 2 (2.0) | ||
Main disease group | |||
CHF | 26 (25.5) | ||
Stroke | 26 (25.5) | ||
ESRD | 25 (24.5) | ||
ESLD | 25 (24.5) | ||
Work environment | |||
General ward | 47 (46.1) | ||
ICU | 55 (53.9) | ||
Clinical experience (months) | |||
Current (in present working department) | 67.6 ± 50.9 | 50.0 (3–240) | |
Total† | 107.3 ± 86.2 | 65.5 (12–375) | |
Position | |||
Staff nurse | 80 (78.4) | ||
Charge nurse | 19 (18.6) | ||
Head nurse | 3 (2.9) | ||
Certificate of nurse practitioner | |||
Yes | 9 (8.8) | ||
No | 93 (91.2) | ||
Received hospice, palliative, and EOL care education‡ | |||
Yes | 43 (42.2) | ||
≤ 8 h | 35 (83.3) | ||
9–16 h | 7 (16.7) | ||
No | 58 (56.9) |
Knowledge
Knowledge (Range) | Total (N = 102) | CHF (n = 26) (a) | Stroke (n = 26) (b) | ESRD (n = 25) (c) | ESLD (n = 25) (d) | F(p) | ||
Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | ||||
Total (0–20) | 9.73 ± 2.10 | 9.35 ± 1.74 | 9.27 ± 2.32 | 9.52 ± 2.33 | 10.80 ± 1.66 | 3.13 (.029) (b < d) | ||
Philosophy and principle (0–4) | 1.58 ± 0.83 | 1.62 ± 0.90 | 1.23 ± 0.77 | 1.72 ± 0.79 | 1.76 ± 0.78 | 2.29 (.084) | ||
Pain and symptom management (0–13) | 6.39 ± 1.65 | 5.96 ± 1.54 | 6.27 ± 1.78 | 6.04 ± 1.65 | 7.32 ± 1.31 | 3.99 (.010) (a, c < d) | ||
Psychosocial aspects of care (0–3) | 1.75 ± 0.84 | 1.77 ± 0.86 | 1.77 ± 0.71 | 1.76 ± 0.93 | 1.72 ± 0.89 | 0.02 (.996) | ||
Item No | Subdomain | Item (answer) | Response (%) | |||||
CHF (n = 26) | Stroke (n = 26) | ESRD (n = 25) | ESLD (n = 25) | Total (N = 102) | ||||
Correct (incorrect) | Correct (incorrect) | Correct (incorrect) | Correct (incorrect) | Correct (incorrect) | ||||
1 | Philosophy and principle | Palliative care is appropriate only in situations where there is evidence of a downhill trajectory or deterioration (F) | 18.6 (6.9) | 18.6 (6.9) | 17.6 (6.9) | 19.6 (4.9) | 74.5 (25.5) | |
9 | Philosophy and principle | The provision of palliative care requires emotional detachment (F) | 5.9 (19.6) | 3.9 (21.6) | 7.8 (16.7) | 8.8 (15.7) | 26.5 (73.5) | |
12 | Philosophy and principle | The philosophy of palliative care is compatible with that of aggressive treatment (T) | 12.7 (12.7) | 8.8 (16.7) | 14.7 (9.8) | 14.7 (9.8) | 51.0 (49.0) | |
17 | Philosophy and principle | The accumulation of losses renders burnout inevitable for those who seek work in palliative care (F) | 3.9 (21.6) | 0.0 (25.5) | 2.0 (22.5) | 0.0 (24.5) | 5.9 (94.1) | |
2 | Pain and symptom management | Morphine is the standard used to compare the analgesic effect of other opioids (T) | 3.9 (21.6) | 7.8 (17.6) | 8.8 (15.7) | 10.8 (13.7) | 31.4 (68.6) | |
3 | Pain and symptom management | The extent of the disease determines the method of pain treatment (F) | 9.8 (15.7) | 10.8 (14.7) | 10.8 (13.7) | 6.9 (17.6) | 38.2 (61.8) | |
4 | Pain and symptom management | Adjuvant therapies are important in managing pain (T) | 25.5 (0.0) | 24.5 (1.0) | 21.6 (2.9) | 24.5 (0.0) | 96.1 (3.9) | |
6 | Pain and symptom management | During the last days of life, the drowsiness associated with electrolyte imbalance may decrease the need for sedation (T) | 2.0 (23.5) | 4.9 (20.6) | 2.9 (21.6) | 2.9 (21.6) | 12.7 (87.3) | |
7 | Pain and symptom management | Drug addiction is a major problem when morphine is used on a long-term basis for the management of pain (F) | 5.9 (19.6) | 9.8 (15.7) | 7.8 (16.7) | 9.8 (14.7) | 33.3 (66.7) | |
8 | Pain and symptom management | Individuals who are taking opioids should also follow a bowel regimen (T) | 22.5 (2.9) | 21.6 (3.9) | 20.6 (3.9) | 23.5 (1.0) | 88.2 (11.8) | |
10 | Pain and symptom management | During the terminal stages of an illness, drugs that can cause respiratory depression are appropriate for the treatment of severe dyspnoea (T) | 4.9 (20.6) | 8.8 (16.7) | 3.9 (20.6) | 9.8 (14.7) | 27.5 (72.5) | |
13 | Pain and symptom management | The use of placebos is appropriate in the treatment of some types of pain (F) | 2.0 (23.5) | 1.0 (24.5) | 2.9 (21.6) | 0.0 (24.5) | 5.9 (94.1) | |
14 | Pain and symptom management | In high doses, codeine causes more nausea and vomiting than morphine (T) | 9.8 (15.7) | 6.9 (18.6) | 6.9 (17.6) | 13.7 (10.8) | 37.3 (62.7) | |
15 | Pain and symptom management | Suffering and physical pain are synonymous (F) | 18.6 (6.9) | 14.7 (10.8) | 17.6 (6.9) | 18.6 (5.9) | 69.6 (30.4) | |
16 | Pain and symptom management | Demerol is not an effective analgesic in the control of chronic pain (T) | 10.8 (14.7) | 16.7 (8.8) | 14.7 (9.8) | 18.6 (5.9) | 60.8 (39.2) | |
18 | Pain and symptom management | Manifestations of chronic pain are different from those of acute pain (T) | 19.6 (5.9) | 18.6 (6.9) | 14.7 (9.8) | 20.6 (3.9) | 73.5 (26.5) | |
20 | Pain and symptom management | The pain threshold is lowered by anxiety or fatigue (T) | 16.7 (8.8) | 13.7 (11.8) | 14.7 (9.8) | 19.6 (4.9) | 64.7 (35.3) | |
5 | Psychosocial and spiritual care | It is crucial for family members to remain at the bedside until death occurs (T) | 24.5 (1.0) | 24.5 (1.0) | 23.5 (1.0) | 24.5 (0.0) | 97.1 (2.9) | |
11 | Psychosocial and spiritual care | Men generally reconcile their grief more quickly than women (F) | 12.7 (12.7) | 6.9 (18.6) | 10.8 (13.7) | 9.8 (14.7) | 40.2 (59.8) | |
19 | Psychosocial and spiritual care | The loss of a distant or contentious relationship is easier to resolve than the loss of one who is close or intimate (F) | 7.8 (17.6) | 13.7 (11.8) | 8.8 (15.7) | 7.8 (16.7) | 38.2 (61.8) |
Attitude
Attitude (30–120) | Total (N = 102) | CHF (n = 26) (a) | Stroke (n = 26) (b) | ESRD (n = 25) (c) | ESLD (n = 25) (d) | F(p) |
Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | ||
87.97 ± 6.93 | 87.08 ± 5.54 | 86.19 ± 5.98 | 87.40 ± 8.65 | 91.32 ± 6.47 | 2.87 (.040) (b < d) | |
Item No | Item (range: 1–4) | Mean ± SD | ||||
1 | Giving nursing care to the dying person is a worthwhile learning experience. | 3.14 ± 0.53 | ||||
2 | Death is not the worst thing that can happen to a person. | 2.36 ± 0.78 | ||||
3† | I would be uncomfortable talking about impending death with the dying person. | 1.72 ± 0.57 | ||||
4 | Nursing care for the patient’s family should continue throughout the period of grief and bereavement. | 3.38 ± 0.55 | ||||
5† | I would not want to be assigned to care for a dying person. | 2.39 ± 0.80 | ||||
6† | The nurse should not be the one to talk about death with the dying person. | 3.05 ± 0.71 | ||||
7† | The length of time required to give nursing care to a dying person would frustrate me. | 2.40 ± 0.69 | ||||
8† | I would be upset when the dying person I was caring for gave up hope of getting better. | 2.66 ± 0.65 | ||||
9† | It is difficult to form a close relationship with the family of the dying person. | 2.75 ± 0.64 | ||||
10 | There are times when death is welcomed by the dying person. | 2.77 ± 0.51 | ||||
11† | When a patient asks, “Nurse am I dying?,” I think it is best to change the subject to something cheerful. | 3.23 ± 0.58 | ||||
12 | The family should be involved in the physical care of the dying person. | 3.09 ± 0.65 | ||||
13† | I would hope the person I’m caring for dies when I am not present. | 2.59 ± 0.68 | ||||
14† | I am afraid to become friends with a dying person. | 2.71 ± 0.68 | ||||
15† | I would feel like running away when the person actually died. | 3.20 ± 0.75 | ||||
16 | Families need emotional support to accept the behavior changes of the dying person. | 3.58 ± 0.55 | ||||
17† | As a patient nears death, the nurse should withdraw from his/her involvement with the patient. | 2.81 ± 0.67 | ||||
18 | Families should be concerned about helping their dying member make the best of his/her remaining life. | 3.37 ± 0.54 | ||||
19† | The dying person should not be allowed to make decisions about his/her physical care. | 3.60 ± 0.57 | ||||
20 | Families should maintain as normal an environment as possible for their dying member. | 3.25 ± 0.59 | ||||
21† | It is beneficial for the dying person to verbalize his/her feelings. | 3.25 ± 0.59 | ||||
22 | Nursing care should extend to the family of the dying person. | 3.48 ± 0.58 | ||||
23 | Nurses should permit dying persons to have flexible visiting schedules. | 3.47 ± 0.52 | ||||
24 | The dying person and his/her family should be the in-charge decision makers. | 3.39 ± 0.57 | ||||
25 | Addiction to pain relieving medication should not be a concern when dealing with a dying person. | 2.80 ± 0.83 | ||||
26† | I would be uncomfortable if I entered the room of a terminally ill person and found him/ her crying. | 1.85 ± 0.53 | ||||
27 | Dying persons should be given honest answers about their condition. | 3.07 ± 0.62 | ||||
28† | Educating families about death and dying is not a nursing responsibility. | 3.02 ± 0.78 | ||||
29† | Family members who stay close to a dying person often interfere with the professionals job with the patient. | 2.47 ± 0.59 | ||||
30 | It is possible for nurses to help patients prepare for death. | 3.11 ± 0.49 |
Confidence and educational needs
Category | Theme | Confidence | Educational needs | ||||||||
Mean ± SD | Mean ± SD | ||||||||||
Pain and symptom management (1–4) | Pain and symptom assessment | 3.43 ± 0.76 | 2.87 ± 0.69‡ | ||||||||
Pain management (pharmacological, non-pharmacological) | 3.34 ± 0.74 | 2.99 ± 0.63‡ | |||||||||
Symptom management (confusion, delirium, dyspnoea, sleep disorder, nausea/vomiting, ascites) | 3.32 ± 0.71 | 3.02 ± 0.64‡ | |||||||||
Nutrition and excretion management | 3.13 ± 0.90 | 2.89 ± 0.67‡ | |||||||||
Lymphedema management | 2.60 ± 0.98 | 2.98 ± 0.64‡ | |||||||||
History taking | 3.14 ± 0.83 | 2.89 ± 0.65‡ | |||||||||
EOL care | 3.17 ± 0.73 | 3.05 ± 0.63‡ | |||||||||
Total | 3.16 ± 0.59 | 2.96 ± 0.53 | |||||||||
Counselling (1–4) | Crisis management for individuals and families | 2.80 ± 0.82 | 2.99 ± 0.64‡ | ||||||||
Communication and counselling | 2.91 ± 0.85 | 3.00 ± 0.64§ | |||||||||
Spiritual needs assessment | 2.60 ± 0.86 | 2.95 ± 0.65§ | |||||||||
Spiritual care | 2.55 ± 0.87 | 2.95 ± 0.63§ | |||||||||
Understanding and care for the psychological shock of a patient at EOL and patient’s family members | 2.67 ± 0.90 | 3.04 ± 0.62§ | |||||||||
Total | 2.71 ± 0.79 | 2.99 ± 0.59 | |||||||||
Management (1–4) | Stress management for employees | 2.71 ± 0.84 | 3.09 ± 0.60‡ | ||||||||
Management and role of hospice team | 2.26 ± 0.88 | 3.06 ± 0.57‡ | |||||||||
Quality improvement of hospice | 2.26 ± 0.90 | 3.08 ± 0.61‡ | |||||||||
Hospice management (operating system of human resource/facilities/financial management) | 2.04 ± 0.90 | 2.98 ± 0.65‡ | |||||||||
Volunteer management | 1.92 ± 0.92 | 2.92 ± 0.61‡ | |||||||||
Total | 2.24 ± 0.78 | 3.03 ± 0.54 | |||||||||
Program (1–4) | Truth notification and protecting patients’ rights | 2.38 ± 0.91‡ | 2.99 ± 0.60§ | ||||||||
Complementary alternative therapy to improve comfort | 2.37 ± 0.89† | 3.03 ± 0.58§ | |||||||||
Education and support for families | 2.72 ± 0.87 | 2.95 ± 0.63§ | |||||||||
Bereavement management for families: types, methods, and care management for bereaved families | 2.45 ± 0.92† | 2.95 ± 0.61§ | |||||||||
Ethical decision-making and care planning | 2.48 ± 0.87† | 3.01 ± 0.58§ | |||||||||
Total | 2.48 ± 0.79 | 2.99 ± 0.56 | |||||||||
Characteristic | n (%) | Total Confidence | Confidence 1 | Confidence 2 | Confidence 3 | Confidence 4 | |||||
Mean ± SD | t/F(p) | Mean ± SD | t/F(p) | Mean ± SD | t/F(p) | Mean ± SD | t/F(p) | Mean ± SD | t/F(p) | ||
Received hospice, palliative, and EOL care education† | |||||||||||
Yes | 43 (42.6) | 2.86 ± 0.55 | −2.51 (.014) | 3.36 ± 0.48 | −3.16 (.002) | 2.83 ± 0.76 | −1.40 (.164) | 2.46 ± 0.75 | −2.61 (.010) | 2.57 ± 0.77 | − 1.16 (.250) |
No | 58 (57.4) | 2.56 ± 0.62 | 3.00 ± 0.62 | 2.61 ± 0.81 | 2.06 ± 0.77 | 2.38 ± 0.80 | |||||
Main disease group cared for | |||||||||||
CHF (a) | 26 (25.5) | 2.62 ± 0.52 | 5.82 (.001) (a, b, c < d) | 3.06 ± 0.46 | 6.88 (< .001) (a, b < d) | 2.71 ± 0.84 | 1.96 (.126) | 2.10 ± 0.81 | 3.41 (.021) (a, b < d) | 2.44 ± 0.73 | 5.11 (.003) (b, c < d) |
Stroke(b) | 26 (25.5) | 2.44 ± 0.72 | 2.86 ± 0.70 | 2.45 ± 0.90 | 2.07 ± 0.90 | 2.19 ± 0.87 | |||||
ESRD(c) | 25 (24.5) | 2.64 ± 0.55 | 3.20 ± 0.55 | 2.69 ± 0.71 | 2.14 ± 0.65 | 2.32 ± 0.71 | |||||
ESLD(d) | 25 (24.5) | 3.08 ± 0.43 | 3.54 ± 0.43 | 2.98 ± 0.65 | 2.66 ± 0.60 | 2.96 ± 0.67 | |||||
Characteristic | n (%) | Total educational needs | Educational needs 1 | Educational needs 2 | Educational needs 3 | Educational needs 4 | |||||
Mean ± SD | t/F(p) | Mean ± SD | t/F(p) | Mean ± SD | t/F(p) | Mean ± SD | t/F(p) | Mean ± SD | t/F(p) | ||
Received hospice, palliative, and EOL care education§ | |||||||||||
Yes | 42 (42.4) | 3.08 ± 0.45 | −1.40 (.166) | 3.06 ± 0.48 | 1.43 (.156) | 3.09 ± 0.52 | 1.21 (.229) | 3.13 ± 0.49 | 1.69 (.094) | 3.05 ± 0.53 | 0.76 (.449) |
No | 57 (57.6) | 2.94 ± 0.48 | 2.91 ± 0.50 | 2.94 ± 0.63 | 2.95 ± 0.58 | 2.97 ± 0.52 | |||||
Main disease group cared for‡ | |||||||||||
CHF (a) | 26 (26.0) | 2.88 ± 0.58 | 3.40 (.021)(b > d) | 2.89 ± 0.54 | 3.29 (.024) (b > d) | 2.86 ± 0.70 | 2.04 (.114) | 2.88 ± 0.65 | 2.41 (.072) | 2.88 ± 0.63 | 2.84 (.042) (b > d) |
Stroke(b) | 26 (26.0) | 3.19 ± 0.40 | 3.13 ± 0.41 | 3.22 ± 0.60 | 3.25 ± 0.53 | 3.21 ± 0.44 | |||||
ESRD(c) | 23 (23.0) | 3.05 ± 0.34 | 3.09 ± 0.38 | 3.00 ± 0.37 | 3.04 ± 0.46 | 3.06 ± 0.43 | |||||
ESLD(d) | 25 (25.0) | 2.82 ± 0.49 | 2.72 ± 0.66 | 2.88 ± 0.59 | 2.94 ± 0.45 | 2.80 ± 0.61 |
Correlation between total clinical experience, total knowledge, attitude, confidence, and educational needs
Factors affecting confidence
Independent variables | β | S.E. | Std. β | t(p) | R2 | Adj R2 | F(p) |
---|---|---|---|---|---|---|---|
Constant | 2.85 | 0.40 | 7.07 (< .001) | .224 | .182 | 5.37 (< .001) | |
Received hospice, palliative, and EOL care education | 0.30 | 0.11 | 0.25 | 2.63 (.010) | |||
Total educational needs | −0.17 | 0.12 | −0.14 | −1.40 (.164) | |||
Main disease group: CHF† | 0.20 | 0.16 | 0.15 | 1.27 (.206) | |||
Main disease group: ESRD† | 0.09 | 0.16 | 0.07 | 0.61 (.545) | |||
Main disease group: ESLD† | 0.55 | 0.16 | 0.39 | 3.45 (.001) |