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Mohamed Manal Bilal, Mahmoud Madeha Ali; International Journal of Advance Research, Ideas and Innovations in Technology
© 2018, www.IJARIIT.com All Rights Reserved Page | 1664
ISSN: 2454-132X
Impact factor: 4.295 [Volume 4, Issue 3]
Available online at: www.ijariit.com
The nurse’s knowledge and attitudes towards the Palliative care
among nurses staff at Sabia general hospital 2018 Manal Bilal Mohamed
Omdurman Islamic University, Omdurman, Sudan
Madeha Ali Mahmoud
Assiut University, Assiut, Egypt
ABSTRACT
The aim of our study is to assess the nurse's knowledge and attitudes towards Palliative Care among nurses working in Sabia
general hospitals and to find an association between nursing staff, knowledge, attitude and selected demographic variables.
Material and methods: We performed a cross-sectional descriptive survey using a self-administered questionnaire. The total
number of completed and returned questionnaires was 53, giving a 100% response rate. The study was conducted between
December 2017 and January 2018 Study Sample: simple random sampling consisted of 53 nurses, who work in the previously
mentioned settings invited to participate in the study. The tool of the study: For data collection, a self-administrative
questionnaire was developed by researchers and used to assess. Nurses’ socio-demographic characteristic as regards their age,
gender, Nursing Qualification, Department of work, Working experience, Training in caring terminally ill clients, and assessed
knowledge, attitudes regard plaintive care, also assessed the relation between socio-demographic data and knowledge and
attitude. Results showed that respondents have fair knowledge toward palliative care 27 (50.9%) and fair attitude 30
(56.6%).there is the significant relationship between knowledge and demographic data p-value is .004.conclusion nurses showed
poor knowledge towards palliative care and half of them showed fair attitude. Material and methods: We performed a c ross-
sectional descriptive survey using a self-administered questionnaire. The total number of completed and returned questionnaires
was 53, giving a 100% response rate. The study was conducted between December 2017 and January 2018 Study Sample: simple
random sampling consisted of 53 nurses, who work in the previously mentioned settings invited to participate in the study.
Keywords: Nurses, Knowledge, Attitude and palliative care
1. INTRODUCTION
Life-threatening diseases cause a decrease in the quality of life and they bring about various problems including physical,
psychosocial, spiritual ones, and especially pain. In patients with diseases which cannot be treated despite the advances in
medicine, approaches aiming at reducing the patient's distress and improving the quality of life should be applied. In accordance
with this view, the approach of palliative care has been developed in order to meet the needs of patients and their relatives. (1)
Palliative care is comfort care that given to terminally ill person so as to promote comfort and relief pain. The goal of this care is to
provide comfort and highest quality life but is not to cure patients also address mental health and spiritual needs along with the
physical needs (2).
The term “palliative” is derived from the Latin word "pallium" meaning cloth or curtain (3). One essential characteristics of palliative
care is the necessity of the team approach. The nurse, who spends a long time with patients and aims to give them the best quality
care, has a prominent place in this team. This is because the member of health discipline who deals with diseases threatening life
and who directly provides care to patients whose death is imminent within the health system is nurse. (4)
Nurses are the most numerous healthcare providers in almost every country; they are often the primary caregivers. Historically,
nurses have been involved in the provision of palliative care. Nurses have played various roles in the development of palliative care,
offering leadership, support and focus for the movement (5). Palliative patients must admit to hospital, because the problems
cannot be handled in the home due to insufficient family care. More than half of the home patients moves in th e last
months for dying still to another setting because of acute medical problems, lack of professional homecare or overload of the
informal care (6).
A very important value for palliative care is to enable people to make decision regard selection of their end-of-life care and place of
death. Data also suggest that most people with advanced illnesses prefer to be cared for and death at home or near their home (7).
Mohamed Manal Bilal, Mahmoud Madeha Ali; International Journal of Advance Research, Ideas and Innovations in Technology
© 2018, www.IJARIIT.com All Rights Reserved Page | 1665
Nurses as well as other healthcare workers often feel not well-prepared for their task in palliative care and are much in need of
more expertise in the field of pain and symptom management, communication and dealing with ethical dilemmas (8).
Aim of the study: The aim of this is study is to assess the nurses' knowledge and attitudes towards Palliative Care among
nurses working in Sabia general hospitals and to find association between nursing staff, knowledge, attitude and selected
demographic variables
2. METHODOLOGY
Study design: Descriptive cross sectional study was used for conducting the study
Study Setting: The data were collected from ICU, ER, Medical wards, and Surgical wards at Sabia general hospital.
Study period: The study was conducted between December2017 and January 2018
Study Sample: simple random sampling consisted of 53 nurses, who work in the previously mentioned settings invited to participate
in the study.
Tool of the study: For data collection a self-administrative questionnaire was developed by researchers and used to assess
a. Nurses’ socio-demographic characteristic as regards their age, gender, Nursing Qualification, Department of work, Working experience, Training in caring terminally ill clients
b. Participants' knowledge assessed as follows: each question had true and false choices (1) awarded for each correct answer; (0) for incorrect. Correct responses were summed up to get a total knowledge scores for each participant. Total score for all
questions reached 19 grades. The knowledge scores were classified into Poor knowledge (≤50%), Fair knowledge(65-
50%), and (≥65%) considered Good knowledge
c. Attitude assessed using a 5-item Likert scale (ranging from strongly agree 5 to strongly disagree, 1) It had 12 item rating scale with the highest score of 5 for each option and total possible score was 60. The attitude scores were categorized into
good (≥65%), fair (65-50%), and poor (≤50%) Data were analyzed using SPSS package Version 20. The data was analyzed
using descriptive (frequency and percentage) and inferential statistics based on the objectives.
3. RESULTS The majority of respondents 26 (49.1%) were within the age 20 - 30 years followed by 18 (34.0%) were of years, 31-40 years and
9(17.0%) were of 41-50 years, old. female 27 (50.9%) male 26 (49.1%). Level of education of the majority of participants are with
diploma and less 25 (47.2%) which is near to half of respondents. Other educational qualifications recorded included 22 (41.5%)
Nursing Bachelor and Nursing Master6 (11.3%). Around 18 (34.0%) were from Surgical Ward, 14 (26.4%) from Medical ward,
13 (24.5%) from ICU, and 8 (15.1%) from Emergency Department. The majority of nurses 32 (60.4%) had less than 5 years of
experience and only 18 (34.0%) indicating more than5 years of nursing experience, while between 11-15 years their experience
only 3 (5.7%).
Respondents were asked to record if they had received training towards PC findings revealed that, 32 (60.4%) not received
training program toward pc while the rest of group received theprogram21(39.6%) as in Table (1).
Table 2: showed that around half of the nurses 27(49.1%) 26 (50.9%) had poor mean score knowledge and fair mean knowledge
level of palliative care respectively. In table (3) More than half of the nurses were more likely to disagree of Palliative care is
given only for dying patient 25(47.2%)as well as they also disagree if the nurse should withdraw from his/her involvement with
the patient 26(49.1).also 22(41.5%)of nurses disagreed with the beneficial for the chronically sick person to verbalize his/her
feelings.
The attitudes toward the length of time required to give nursing care to a dying person would frustrate the nurse, represent 31(58.5%)
of disagree while 12(22.6%) agree that attitudes toward Family should maintain as normal an environment as possible for
their dying member21(39.6)disagree while only11(20.8%) agree that Whereas that attitudes toward the family should be involved
in the physical care of the dying person were varied from agree to disagree 18(34.0%)and 16(30.2%). Most of nurses disagreed for
the question about difficulties of establish close relationship with the family of dying member 31(58.5%).Approximately more than
half of nurses 31(58.5) agreed with Nursing care for the patient's family should continue throughout the period of grief and
bereavement It is interesting to note that Nursing care should extend to the family of the dying person (approximately
27(50.9%).26.0% agreed that when a patient asks, “Nurse am I dying?” they think it is best to change the Subject to something
cheerful. And they would be uncomfortable if he entered the room of a terminally ill person and found him/her crying 21(39.6% )
While their attitudes were slightly different regarding the afraid to become friends with chronically sick and dying patients.
Half of them disagree of becoming friend with him/her 27(50.9%) in table (4) revealed that a highly statistically significant
relation between Nurses' demographic data with total mean of knowledge (.004, ) Where it was revealed that no statistical
significant relation among total mean of knowledge of palliative care with the hospitals and departments of work(.201)
Table 1: Socio demographic data
% Frequency Variable
Age
49.1 26 20-30 years
34.0 18 31-40 years
17.0 9 41-50 years
Gender
49.1 26 Male
50.9 27 Female
Nursing qualification
47.2 25 Diploma or less
Mohamed Manal Bilal, Mahmoud Madeha Ali; International Journal of Advance Research, Ideas and Innovations in Technology
© 2018, www.IJARIIT.com All Rights Reserved Page | 1666
41.5 22 Bachelor
11.3 6 Master
Department of work
26.4 14 Medical ward
34.0 18 Surgical Ward
24.5 13 Intensive Care Unit
15.1 8 Emergency Department
Working experience
60.4 32 Less than 5 years
34.0 18 5-10 years
5.7 3 11-15 years
Training towards PC
39.6 21 yes
60.4 32 no
Table 2(a): Knowledge of nurses regard palliative care
False (%) True (%) Statement
12(22.6) 41 (77.4) Palliative care should be applied as early as possible in patients with chronic and life-threatening diseases
41(77.4) 12 (22.6) Palliative care is one of the most important components of cancer prevention 32(60.4) 21(39.6) Palliative care is a service which starts as soon as diagnosis is made in patients with cancer 21(39.6) 32(60.4) Palliative care is a service only for patients with cancer 21(39.6) 32(60.4) Palliative care is essentially the care for terminally ill patients 38(71.7) 15(28.3) Palliative care helps patients to relieve pain and to improve the quality of care 23(43.4) 30(56.6) Palliative care is a therapeutic care 27(50.9) 26(49.1) Palliative care seeks to maximize the functional capacity of the individual by being sensitive to
religious values, beliefs, culture, and individuality 32(60.4) 21(39.6) Palliative care should be started when medical and surgical methods of treatment are ineffective 22(41.5) 31(58.5) Palliative care helps patients to relieve pain and suffering during the terminal period and provides a
good death without losing one’s dignity
Table 2(b): Knowledge of nurses regard palliative care
No (%) Yes (%) Statement
23(43.4) 30(56.6) Palliative care is applied regardless of whether the individual receives treatment
22(41.5) 31(58.5) In the palliative care approach, family members are supported during disease process and
during grief period after the death
22(41.5) 31(58.5) Palliative care only consists of pain control
15(28.3) 38(71.7) Palliative care neither slows down nor accelerates death
10(18.9) 43(81.1) In palliative care the continuity of care is maintained by being together with the patient
everywhere including hospital, home, mobile clinic, day care center, and nursing home
28(52.8) 25(47.2) Persons who benefit from palliative care should contact with health professionals at any
time
18(34) 35(66.0) Chronic diseases such as chronic obstructive pulmonary disease are also included in the
context of palliative care
25(47.2 28(52.8) Palliative care and hospice care serve the same purpose
15(28.3) 38(71.7) Palliative care team includes physicians, nurses, social workers, psychologists
physiotherapists, dieticians, pharmacists, chaplains, patients' relatives and volunteers
% no mean knowledge
0 o Good (>65%)
50.9 27 Fair (50-65%)
49.1 26 Poor (<50%)
Table 3: Attitude of nurses regard palliative care
Strongly
agree
Agree Uncertain disagree Strongly
disagree
Statement
13(24.5) 0 6(11.3) 9(17.0) 25(47.2) Palliative care is given only for dying patient
8(15.1) 1(1.9) 1(1.9) 17(32.1) 26(49.1) As a patient nears death; the nurse should withdraw from
his/her involvement with the patient
19(35.8) 5(9.4) 3(5.7) 4(7.5) 22(41.5) It is beneficial for the chronically sick person to verbalize
his/her feelings
12(22.6) 3(5.7) 1(1.9) 6(11.3) 31(58.5) The length of time required to give nursing care to a dying
person would frustrate me
Mohamed Manal Bilal, Mahmoud Madeha Ali; International Journal of Advance Research, Ideas and Innovations in Technology
© 2018, www.IJARIIT.com All Rights Reserved Page | 1667
11(20.8) 1(1.9) 3(5.7) 17(32.1) 21(39.6) Family should maintain as normal an environment as possible
for their dying member
18(34.0) 15(28.3) 2(3.8) 2(3.8) 16(30.2) The family should be involved in the physical care of the
dying person
5(9.4) 13(24.5) 1(1.9) 3(5.7) 31(58.5) It is difficult to form a close relationship with the family of a
dying member
31(58.5) 13(24.5) 1(1.9) 3(5.7) 5(9.4) Nursing care for the patient's family should continue
throughout the period of grief and bereavement
22.6)) 12 27(50.9) 1(1.9) 13(24.5) 0 Nursing care should extend to the family of the dying person
12(22.6) 0 1(1.9) 13(24.5) 27(50.9) When a patient asks, “Nurse am I dying?' I think it is best to
change the Subject to something cheerful
12(22.6) 0 1(1.9) 13(24.5) 27(50.9) I am afraid to become friends with chronically sick and dying
patients
21(39.6) 15(28.3) 3(5.7) 5(9.4) 9(17.0) I would be uncomfortable if I entered the room of a terminally
ill person and found him/her crying
% Frequency Mean attitude
0 0 Good (>65%)
56.6 30 Fair (50-65%)
43.4 23 Poor (<50%)
Table 4: Association between mean of scores knowledge, attitude of palliative care with selected variables
Item Mean SD P value
Knowledge
Age 1.6792 .75380 .004
Gender 1.5094 .50469
Nursing qualification 1.6981 .74897
Work experience 1.4528 .60657
Attitudes
Age 1.6792 .75380 .201
Gender 1.5094 .50469
Nursing qualification 1.6981 .74897
Work experience 1.4528 .60657
4. DISCUSSION In this study the respondents age range between 21-25which represent 50% with diploma and less, also more of them are female.
Half of them not received any training program regard palliative care .and their experience less than 5 years. It is necessary to for
nurses to have good knowledge and attitude to palliative care, so assessing nursing knowledge and attitude are also important
because knowledge and good attitude play important role in delegating care with dying member. Regard their knowledge towards
palliative care their mean knowledge between fair and poor in this study the description of knowledge scores have shown that 50.9%
had fair knowledge and 49.1% had poor knowledge, about palliative care. To the contrary this study that one which carried in Addis
Ababa, finding showed that 30.5% of nurses had as good knowledge (9). The poor or fair knowledge in our study may be due to
lack of updating information regarding palliative care, and this might be due to the fact that PC education program did not carried
regularly in the hospital, or work in bedside care are overworked because of the nursing shortage in the nursing staff. Therefore,
they have limited time to enhance and updated their knowledge about palliative care.
In study done in Northern districts, Palestine, the mean knowledge of participants is poor (45.8 %), which is support our study (10).
The description of attitude shows that the mean scores of respondents 30 (56.6%) of them had fair attitude and 23 (43.4%) had poor
attitude towards palliative care.
This finding was in contrary with the findings of study done in Addis Ababa , 259 (76%) had favorable attitude towards PC
(9). And other study done in India the study indicated 92.8% of nursing students had favorable attitude (56.7± 8.5) towards palliative
care which is in contrary with our study (11). In relation to Correlation between knowledge, attitude and socio demographic data
(age, gender, qualification and work experience) there is significant relation between knowledge and socio demographic data like
age, period of experience and qualification p value .004. It means when the nurses experience and qualification increase their
favorable knowledge also improves which is similarly to study done in India where they found that significant relation between
knowledge and demographic data(age) p value0.01.(11). While the correlation between attitude and demographic data is
insignificant p value.201
5. CONCLUSIONS and RECOMMENDATIONS At the end of this study, which was conducted in order to determine the knowledge levels of nurses on palliative care,
it was found that nursing students’ knowledge about the concepts of palliative care was poor level and attitude was fair it was
affected by socio-demographic characteristics such as age, gender, and qualification and work experience were significantly higher
in relation to knowledge.
Mohamed Manal Bilal, Mahmoud Madeha Ali; International Journal of Advance Research, Ideas and Innovations in Technology
© 2018, www.IJARIIT.com All Rights Reserved Page | 1668
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