res- impotent

Introduction

Everyone is mortal; hence, death is an inevitable phenomenon that affects every person across the globe. Nurses play a critical role in the beginning and ending of individuals’ lives as they are present at birth and dying moments. Many nurses play a vital role in caring for individuals who are in their final days on the world. As such, nurses perceive palliative care to be the most stressing facet of nursing. This is because it is emotionally draining to see a patient experience immense pain due to the inevitability of their death. Despite the view that palliative care is emotionally straining, it improves the quality of life of patients with terminal illnesses, such as cancer. This form of care also assists families of patients diagnosed with life-threatening ailments or organ failures. This is because palliative care involves early identification, and impeccable evaluation and curing of physical and emotional pain associated with chronic diseases. Consequently, most nations, including Saudi Arabia, have integrated this care model into their healthcare settings to help individuals who are close to death.

Saudi Arabia has been transforming its palliative care to meet the needs of individuals suffering from terminal illness. Palliative care began in Saudi Arabia at the King Faisal Specialist Hospital and Research Centre (KFSH&RC) over two decades ago. Its popularity has grown rapidly due to an increase in the number of individuals experiencing terminal illnesses, especially cancer. The survey undertaken by the Saudi Cancer Registry discovered that the nation recorded 11,946 cases of cancer in 2008(Alshammary et al., 2014). By 2030, cancer cases in Saudi Arabia are expected to grow by 5 to 10 times. The prediction is driven by changes in the nation’s demographics, as the elderly and middle-aged will be the most affected by the chronic condition. At the same time, survival rates of cancer in Saudi Arabia and across the Eastern Mediterranean region are relatively lower than in Europe and United States (Fadhil, Lyons & Payne, 2017). This is because cancer in this region is diagnosed while in its late stage; hence, it cannot be cured. As such, palliative care becomes the only solution for most cancer patients in the Eastern Mediterranean region.

Despite the crucial role of palliative care in caring for patients with terminal illnesses in the Eastern Mediterranean region, it remains inconsistent and patchy. Several factors have contributed to this challenge, including insufficient education on palliative care among healthcare professionals especially for nurses and limited access to pain management medicines. As such, the residents of Saudi Arabia do not have sufficient access to palliative care despite the increased cases of terminal illness (Abudari et al., 2014). The outlook implies that there is a need to reform national healthcare policies to integrate this form of care into the nation’s medical systems.

It is evident that palliative care is yet to be fully felt across Saudi Arabia despite being the only quality solution to most patients suffering from terminal illnesses. The condition has been driven by ineffective policies that have limited access to opioids, which are critical to palliative care. Painkillers enhance the quality of lives of people close to death due to the absence of better alternatives. These medications help in pain management as chronic conditions come with intense agony. Therefore, there is a need for the Saudi government, through the Ministry of Health to initiate policies that will improve the quality and accessibility of palliative care.

Significance of the Study:

This study will help the higher authority to make strategies in order to improve quality and of palliative care among oncology staff nurses

Aim of the study:

The aim of this study will assess the quality of nurses’ preparedness to practice palliative care King Abdullah specialized children hospital in Riyadh

Objectives:

· Assess nurses’ knowledge, attitude and practices about palliative care.

· Determine the effect of the training program about palliative care on quality of nursing care.

· Identify factors affecting quality of nurses’ preparedness to practice palliative care.

Research questions:

The following research questions guided the study:

1. What is the knowledge, attitude and practices of nurses toward palliative care?

2. What is the effect of receiving training program on quality of nurses’ preparedness to practice palliative care?

3. What are the factors affecting quality of nurses’ preparedness to practice palliative care?

Methodology

Study Design

The study design is descriptive cross-sectional design that is used to answer the research questions.

The Study Setting

The study will be conducted in King Abdullah specialize children hospital (KASCH) in National Guard Health Affairs (NGHA) in Riyadh. KAMC is well recognized as a distinguished healthcare provider. It has six directorates of nursing services including outpatient, pediatric, oncology, transplant, surgical, pediatric emergency, pediatric ICU. Oncology covered by one directory.

Study Participants and Sampling Technique

The total nurses’ population in KASCH is 1334 nurses. The study will be conducted on adult oncology, which includes 166 nurses distributed on five units. All nurses who meet inclusion criteria will be invited to participate in the study.

Inclusion Criteria

· All inpatients staff nurses, nurse coordinators, nurse managers and clinical resource nurses who are working in adult oncology in KASCH in Riyadh.

· Saudi and non-Saudi nurses with graduate, post graduate or diploma degree.

· Having experience of less than a year and up to more than ten years.

Exclusion criteria:

· Nurse residents, interns, outpatient nurses are excluded from the study.

Data Collection Tools:

Data collection will be conducted using online self-administered structured questionnaire which developed by the researcher; the tool of data collection will be consists of two parts:

· The first part will concerned with socio-demographic data for nurses such as age, gender, qualification, and years of experience…. etc.

· The second part will concerned with knowledge of nurses regarding using Palliative Care Quiz for Nurses (PCQN) which created by Ross et al. (1996), at the University of Ottawa, Canada (Ref 1)

· The third part will concerned with attitude of nurses regarding using Palliative

Validity and Reliability:

The pilot study will carried out to evaluate the validity and reliability of the questionnaire in order to detect any ambiguity in the tool, clarity of the items, as well as to determine the time consumed for data collection. Necessary modifications were carried out and develop the final form of the tool. Cronbach's alpha coefficient will be used to measure the reliability of the items.

Data Analysis:

The data will be analyzed by using the Statistical Package for Social Sciences (SPSS) Version 20. For descriptive statistical analysis; frequencies and percentages were used for all variables included in the study to describe the demographic data and explore the knowledge and attitude of nurses, arithmetic means and standard deviations are also used. For inferential analysis, the Chi-Square test will be used to examine the relation and association between variables. The statistical test of significance, or p-value, in this study will set at <0.05. The internal consistency of the tool will be measured by calculating the Cronbach’s alpha.

Ethical Considerations

· Informed consents will obtained from all participants for agreement about participation.

· The participants will have the data collection tool that contained an explanation of the study, its purpose, and the required instructions will be given to participants.

· Participation will be voluntary and participants have the right to refuse participating in the study.

· All answers will be maintained confidential and for the purpose of the current study only

References

Abudari, G., Zahreddine, H., Hazeim, H., Assi, M. A., & Emara, S. (2014). Knowledge of and attitudes towards palliative care among multinational nurses in Saudi Arabia. International journal of palliative nursing, 20(9), 435-441.

Alshammary, S. A., Abdullah, A., Duraisamy, B. P., & Anbar, M. (2014). Palliative care in Saudi Arabia: Two decades of progress and going strong. Journal of Health Specialties, 2(2), 59.

Anstey, S., Powell, T., Coles, B., Hale, R., & Gould, D. (2016). Education and training to enhance end-of-life care for nursing home staff: a systematic literature review. BMJ supportive & palliative care, 6(3), 353-361.

Ayed, A., Sayej, S., Harazneh, L., Fashafsheh, I., & Eqtait, F. (2015). The Nurses' Knowledge and Attitudes towards the Palliative Care. Journal of Education and Practice, 6(4), 91-99

Balicas, D. N. P. (2018). The Effect of Palliative Care Nursing Education to Improve Knowledge in Palliative Care of Hospital-Based Nurses Caring for Patients with Chronic, Serious Illness.

Behr, D. J. (2014). Evaluation of Impact of End-Of-Life Nursing Education Consortium (Elnec) Education On Registered Nurses.

Bodine, J. L. (2016). A Comparison of Educational Approaches to the End-of-Life-Nursing Education Consortium (ELNEC) Course.

Bush, T., & Shahwan-Akl, L. (2013). Palliative care education–does it influence future practice?. Contemporary nurse, 43(2), 172-177.

Campion, C., Kassaye, A., Sutherland, S., Carruthers, M., Riley, J., Wood, J., & Stevens, A. M. (2016). Improving end-of-life care in nursing homes: an innovative model of education and training. EUROPEAN JOURNAL OF PALLIATIVE CARE, 23(5), 222-226.

Cavaye, J., & Watts, J. H. (2012). End-of-life education in the pre-registration nursing curriculum: Patient, carer, nurse and student perspectives.

Dalal, S., & Bruera, E. (2017). End‐of‐life care matters: Palliative cancer care results in better care and lower costs. The oncologist, 22(4), 361-368.

Di Giulio, P., Finetti, S., Giunco, F., Basso, I., Rosa, D., Pettenati, F., ... & Monti, M. (2019). The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study. Journal of pain and symptom management, 57(1), 93-99.

Fadhil, I., Lyons, G., & Payne, S. (2017). Barriers to, and opportunities for, palliative care development in the Eastern Mediterranean Region. The Lancet Oncology, 18(3), e176-e184.

Hanratty, B., Hibbert, D., Mair, F., May, C., Ward, C., Corcoran, G., ... & Litva, A. (2006). Doctors' understanding of palliative care. Palliative medicine, 20(5), 493-497.

Harazneh, M. L., Ayed, M. A., Fashafsheh, I., & Ali, G. A. E. N. (2015). Knowledge of palliative care among bachelors nursing students. Journal of Health, Medicine and Nursing, 18, 25-32.

Hjelmfors, L., Strömberg, A., Karlsson, K., Olsson, L., & Jaarsma, T. (2016). Simulation to teach nursing students about end-of-life care. Journal of Hospice & Palliative Nursing, 18(6), 512-518.

Isaacson, M. J., & Minton, M. E. (2018). End-of-Life Communication. Advances in Nursing Science, 41(1), 2-17.

Kawaguchi, S., Mirza, R., Nissim, R., & Ridley, J. (2017). Internal medicine residents’ beliefs, attitudes, and experiences relating to palliative care: a qualitative study. American Journal of Hospice and Palliative Medicine®, 34(4), 366-372.

Khader, K. A., Jarrah, S. S., & Alasad, J. (2010). Influence of nurses characteristics and education on their attitudes towards death and dying: A review of literature. International Journal of Nursing and Midwifery, 2(1), 1-9.

Khraisat, O. M., Hamdan, M., & Ghazzawwi, M. (2017). Palliative care issues and challenges in Saudi Arabia: knowledge assessment among nursing students. Journal of palliative care, 32(3-4), 121-126.

Lippe, M., Volker, D., Jones, T., & Carter, P. (2017). Evaluating end-of-life care education within nursing programs: A method for targeted curriculum evaluation. Journal of Hospice & Palliative Nursing, 19(3), 266-274.

Malone, L., Anderson, J., & Croxon, L. (2016). Are newly graduated nurses ready to deal with death and dying?-A literature review. Nurs Palliat Care, 1(4), 89-93.

Mani, Z. A. (2016). Intensive Care Unit Nurses Experirnces of Providing End of Life Care. Middle East Journal of Nursing, 101(3031), 1-7.

Martin, E. M., & Barkley Jr, T. W. (2016). Improving cultural competence in end-of-life pain management. Nursing2019, 46(1), 32-41.

Mitrea, N., Mosoiu, D., Ancuta, C., Malloy, P., & Rogozea, L. (2017). The Impact of the End-of-Life Nursing Education Consortium International Training Program on the Clinical Practice of Eastern European Nurses Working in Specialized Palliative Care Services: A Romanian Case Study. Journal of Hospice & Palliative Nursing, 19(5), 424-434.

Nevis, I. (2014). Educational intervention in end-of-life care: an evidence-based analysis. Ontario health technology assessment series, 14(17), 1.

O’Shea, E. R., Lavallee, M., Doyle, E. A., & Moss, K. (2017). Assessing Palliative and End-of-Life Educational Needs of Pediatric Health Care Professionals: Results of a Statewide Survey. Journal of Hospice & Palliative Nursing, 19(5), 468-473.

Pesut, B., & Greig, M. (2018). Resources for educating, training, and mentoring nurses and unregulated nursing care providers in palliative care: a review and expert consultation. Journal of palliative medicine, 21(S1), S-50.

Pieknik, R. (2006). Palliative care education in the acute-care setting. SURGICAL TECHNOLOGIST, 38(2), 14.

Price, D. M., Strodtman, L., Montagnini, M., Smith, H. M., Miller, J., Zybert, J., ... & Ghosh, B. (2017). Palliative and end-of-life care education needs of nurses across inpatient care settings. The Journal of Continuing Education in Nursing, 48(7), 329-336.

Scottish Government. (2008). Living and dying well: A national action plan for palliative and end of life care in Scotland. Part 4: 3.1 Assessment and review of palliative and end of life care needs.

Silbermann, M., Arnaout, M., Daher, M., Nestoros, S., Pitsillides, B., Charalambous, H., ... & Manasrah, N. (2012). Palliative cancer care in Middle Eastern countries: accomplishments and challenges. Annals of oncology, 23(suppl_3), 15-28.

Usta, E., Aygin, D., & Sağlam, E. (2016). Knowledge and opinions of nursing students on palliative care: A university example. Journal of Human Sciences, 13(3), 4405-4415.

Waller, A., Dodd, N., Tattersall, M. H., Nair, B., & Sanson-Fisher, R. (2017). Improving hospital-based end of life care processes and outcomes: a systematic review of research output, quality and effectiveness. BMC palliative care, 16(1), 34.

Wilson, D. M., Goodwin, B. L., & Hewitt, J. A. (2011). An examination of palliative or end-of-life care education in introductory nursing programs across Canada. Nursing research and practice, 2011.

Youssef, H. A. M., Mansour, M. A. M., Al-Zahrani, S. S. M., Ayasreh, I. R. A., & Abd El-Karim, R. A. K. (2015). Prioritizing palliative care: assess undergraduate nursing curriculum, knowledge and attitude among nurses caring end-of-life patients. European Journal of Academic Essays, 2(2), 90-101.