Research Article
Open Access
Palliative Care Practice and Associated Factors among
Nurses Working in Jimma University Medical Center
South-West Ethiopia, 2017
Temamen Tesfaye1*, Yeamanuelwork Anbessie2 and Admasu Belay Gizaw3
1Jimma University, Institute of Health, School of Nursing and Midwifery, Ethiopia.
2Jimma University Medical Centre, Ethiopia.
3Jimma University School of Nursing and Midwifery, Ethiopia.
2Jimma University Medical Centre, Ethiopia.
3Jimma University School of Nursing and Midwifery, Ethiopia.
*Corresponding author: Temamen Tesfaye Yunka, Jimma University School of Nursing and Midwifery; P.O. Box: 378 Ethiopia. Fax: 0471-
11-14-50; Tel: +251913153299, 2514711112213; Email:
@
Received: June 20, 2018; Accepted: July 19, 2018; Published: July 27, 2018
Citation: Temamen T, Anbessie Y Gizaw AB (2018) Palliative Care Practice and Associated Factors among Nurses Working in Jimma University Medical Center South-West Ethiopia, 2017. Palliat Med Care 5(3): 1-8.
DOI: 10.15226/2374-8362/5/3/00160
AbstractTop
Background: Palliative care is an approach that improves the
quality of life of patients and their families facing problem associated
chronic and with life threatening illness. Since Nurses are pivotal
role players in providing palliative care, identifying their level of
knowledge, attitude and practice is very crucial. Conversely, there
is paucity of information on palliative care practice and associated
factors in the study area.
Objective: This study aimed to assess palliative care practice and associated factors among nurses working in Jimma University Medical Center south-west Ethiopia.
Methods: Institution based cross-sectional study was conducted among 243 nurses. The study participants were selected using simple random sampling method and data was collected using structured self-administrated questionnaires. Descriptive, Bivariate and Multivariable logistic regression analyses were performed. Statistical level of significance was declared at P< 0.05.
Results: A total of 237 nurses were responded correctly and yielding a response rate of 97.5%. Around two third [65.8%] of the study participants had poor palliative care practices. Age, clinical area, years of experience, monthly income and level of knowledge about palliative care services significantly associated with overall palliative care practices.
Conclusion: Almost two third of the nurses had poor palliative care practices. Age, clinical area, years of experience, monthly income and level of knowledge about palliative care services are significantly associated with overall palliative care practice. Thus, efforts should be made in designing and providing short and long term training for nurses on palliative care practices.
Keywords: Palliative care; Nurses; End-of life care; Chronic illness; Jimma.
Objective: This study aimed to assess palliative care practice and associated factors among nurses working in Jimma University Medical Center south-west Ethiopia.
Methods: Institution based cross-sectional study was conducted among 243 nurses. The study participants were selected using simple random sampling method and data was collected using structured self-administrated questionnaires. Descriptive, Bivariate and Multivariable logistic regression analyses were performed. Statistical level of significance was declared at P< 0.05.
Results: A total of 237 nurses were responded correctly and yielding a response rate of 97.5%. Around two third [65.8%] of the study participants had poor palliative care practices. Age, clinical area, years of experience, monthly income and level of knowledge about palliative care services significantly associated with overall palliative care practices.
Conclusion: Almost two third of the nurses had poor palliative care practices. Age, clinical area, years of experience, monthly income and level of knowledge about palliative care services are significantly associated with overall palliative care practice. Thus, efforts should be made in designing and providing short and long term training for nurses on palliative care practices.
Keywords: Palliative care; Nurses; End-of life care; Chronic illness; Jimma.
Background
Palliative care is a holistic approach that improves the quality
of life of patients and their families facing the problem associated
with chronic and life-threatening illness, through the prevention
and relief of suffering by means of early identification and
impeccable assessment and treatment of pain and other health
problems [1]. Evidence shows that palliative care is effective in
improving the Quality of Life by meeting the needs of people with
life threatening illness and their families [1, 2].
According to the World health organization estimation, by 2020 non-communicable disease will be prevalent as communicable diseases in developing countries especially in sub-Saharan Africa. This is an indicator for increased need in palliative care service. Despite the needs of palliative care and documented evidence of palliative care in improving the quality of life, the development and access to comprehensive, integrated palliative care service remains limited in most developing countries. Consequently, only few countries in SSA have integrated the new concept of palliative care into their agenda and currently palliative care provision remains inadequate and available to less than 5% [3- 7].
The implementation of palliative care is a global health challenge especially in developing countries because; the service is isolated in majorities of African countries, scattered in scope, not well supported, heavily donor dependent, had unclear policies, limited healthcare resource, Role unfamiliarity, poor perception, low level of practice and low knowledge about benefits by service users, health care workers and supporting community [8-12].
There are also insufficient government policies recognizing palliative care as an essential component of healthcare, inadequate training for healthcare professionals and limited awareness among the general public about palliative care. Moreover, there are limited studies in the area of patients palliative care needs which will support to provide appropriate care. Hence, palliative care needs are often under-assessed and addressed. As a result, up to 80% of pain is under-treated and about two-thirds of palliative care needs are missed. Addressing physical, emotional, social and spiritual needs and supporting people to achieve a sense of peace and meanings of life and prevention of end-of-life sufferings are unthinkable without integration of pallative care[13- 17].
Study conducted in different countries showed that nurses had poor knowledge and practice towards palliative care services, while they had favourable attitude [18, 19]. Sex, years of experience, working units and training were predicting variables of practice of palliative care [18, 20, 21].
The most recent information on nursing posts in different country showed that palliative care & life-threatening illness mainly relies on nurses. Knowledge, attitude and practice towards palliative care is critical among health care professionals mainly among nurses. Therefore, this study focuses on assessing palliative care practice level and associated factors among nurses working at Jimma University Medical centre.
According to the World health organization estimation, by 2020 non-communicable disease will be prevalent as communicable diseases in developing countries especially in sub-Saharan Africa. This is an indicator for increased need in palliative care service. Despite the needs of palliative care and documented evidence of palliative care in improving the quality of life, the development and access to comprehensive, integrated palliative care service remains limited in most developing countries. Consequently, only few countries in SSA have integrated the new concept of palliative care into their agenda and currently palliative care provision remains inadequate and available to less than 5% [3- 7].
The implementation of palliative care is a global health challenge especially in developing countries because; the service is isolated in majorities of African countries, scattered in scope, not well supported, heavily donor dependent, had unclear policies, limited healthcare resource, Role unfamiliarity, poor perception, low level of practice and low knowledge about benefits by service users, health care workers and supporting community [8-12].
There are also insufficient government policies recognizing palliative care as an essential component of healthcare, inadequate training for healthcare professionals and limited awareness among the general public about palliative care. Moreover, there are limited studies in the area of patients palliative care needs which will support to provide appropriate care. Hence, palliative care needs are often under-assessed and addressed. As a result, up to 80% of pain is under-treated and about two-thirds of palliative care needs are missed. Addressing physical, emotional, social and spiritual needs and supporting people to achieve a sense of peace and meanings of life and prevention of end-of-life sufferings are unthinkable without integration of pallative care[13- 17].
Study conducted in different countries showed that nurses had poor knowledge and practice towards palliative care services, while they had favourable attitude [18, 19]. Sex, years of experience, working units and training were predicting variables of practice of palliative care [18, 20, 21].
The most recent information on nursing posts in different country showed that palliative care & life-threatening illness mainly relies on nurses. Knowledge, attitude and practice towards palliative care is critical among health care professionals mainly among nurses. Therefore, this study focuses on assessing palliative care practice level and associated factors among nurses working at Jimma University Medical centre.
Methods and Materials
Study Area, Period and Design
The study was conducted in Jimma University Medical center
from April 1-5, 2017 found in Jimma town at South-West of
Ethiopia. It has a total bed capacity around 555 with nearly 1600
hospital staffs. Institution based cross-sectional study design was
employed.
Sample Size and Sampling Technique
A total of 243 nurses were selected from 523 nurses by simple
random sampling method from different working units.
Data Collection Tools and Procedure
The data collection instrument included four sections. Section
one: A socio demographic variables. Section two comprised
knowledge questions which taken from the Palliative Care
Knowledge Test [PCKT] using questions with Yes or No answers.
The third section included attitude questions, which adapted
from Frommelt Attitude toward Care of the Dying [FATCOD]
questionnaire. It has a 5 point Likert scale. The last section had
8 practical questions which the researchers constructed from
guidelines and various literatures related to palliative care
practice. [18, 24].
A Pre-test was conducted on 24 nurses at Limmu Genet district hospital in Jimma Zone to check clarity of data collection tools. Based on the result of pretest, necessary modification was done [before pretest the attitude part was measured through the original FATCOD questionnaire which consists of 30 items. However, after pretest the questionnaires were reduced to 17 items because some of the questions were difficult to understand and increase bulkiness of the questioner]. Data was collected by three trained MSc nursing students and they were facilitated the data collection procedure.
A Pre-test was conducted on 24 nurses at Limmu Genet district hospital in Jimma Zone to check clarity of data collection tools. Based on the result of pretest, necessary modification was done [before pretest the attitude part was measured through the original FATCOD questionnaire which consists of 30 items. However, after pretest the questionnaires were reduced to 17 items because some of the questions were difficult to understand and increase bulkiness of the questioner]. Data was collected by three trained MSc nursing students and they were facilitated the data collection procedure.
Operational Definition [18]
Good knowledge = ≥75% of total score of the Palliative Care
knowledge test [PCKT] scale
Poor knowledge = < 75% of total score of the Palliative Care knowledge test [PCKT] scale.
Favorable attitude = ≥ 50 of the total score of [FATCOD] Scale.
Unfavorable attitude = < 50% of the total score of [FATCOD] Scale.
Good practice = ≥75% response of nurses from a total practice questions.
Poor practice = < 75% response of nurses from a total practice questions.
Poor knowledge = < 75% of total score of the Palliative Care knowledge test [PCKT] scale.
Favorable attitude = ≥ 50 of the total score of [FATCOD] Scale.
Unfavorable attitude = < 50% of the total score of [FATCOD] Scale.
Good practice = ≥75% response of nurses from a total practice questions.
Poor practice = < 75% response of nurses from a total practice questions.
Data Processing and Analysis
The completed questionnaires were checked for
inconsistencies and missed values before data entry. Data
analysis was made using SPSS version 21.0 software. Descriptive
statistics, Binary and Multivariable logistic regression analysis
were done to describe and identify factors affecting palliative
care practice among nurses.
Ethical Consideration
Ethical clearance letter was obtained from institutional
review board [IRB] of Jimma University. Study participants were
briefed about the study and oral consent were obtained and they
are informed that participating in this study was fully voluntary.
In addition, confidentiality of the information was assured.
Results
Socio-Demographic Characteristics
From total of 243 randomly selected nurses, 237 (97.5%)
questionnaires were returned. More than half 124 (52.3%) of
respondents were females and 105 (44.3%) were between the
age group of 26-30 years. Almost half 119 (50.2) nurses were
married and 103 (43.5 %) were followers of orthodox religion.
The qualification of respondents showed that 127 (53.6%) had
Bachelor of Science (BSc) in nursing and 151 (63.7%) of them
had less than or equal to five years of work experience. About one
fourth 60 (25.3%) of nurses earn monthly salary between 3001-
4000 Ethiopian birr and 41 (17.3%) of nurses working in surgical
unit. More than half 133 (56.1%) of nurse had no any training
related to palliative care and 104 (43.9%) of them had less than
or equal to two years’ experience in caring terminal ill patients
(Table 1).
Nurses’ Knowledge towards Palliative Care
One hundred thirty eight (58.2%) of nurses were believed
that palliative care should only be provided for patient who has
curative treatment available. More than two third 165 (69.6%)
of nurses said that getting spiritual support important to
terminally ill patients and 173 (73%) of them believe that family
involvement in any aspect of patient care is part of palliative
care. More than three fourth 185(78.1%) of nurse thought that
manifestation of chronic pain is different from those of acute pain
and 125 (52.7%) of them understood that palliative care service
extending after mortal care (Table 2). Overall level of knowledge
showed that majority 127 (53.6%) of nurses working in Jimma
University medical center had Poor knowledge and 110 (46.4%)
had Good knowledge about palliative care services (Figure 1).
Table 1: Socio-demographic characteristics of nurses working at
Jimma University Medical center, April 2017 (n= 237)
Socio-demographic Characteristics |
n |
% |
Sex |
||
Male |
113 |
47.7 |
Female |
124 |
52.3 |
Age in years |
||
20-25 |
96 |
40.5 |
26-30 |
105 |
44.3 |
31-40 |
27 |
11.4 |
>41 |
9 |
3.8 |
Marital Status |
||
Married |
119 |
50.2 |
Single |
106 |
44.7 |
Divorced |
6 |
2.5 |
Widowed |
6 |
2.5 |
Religion |
||
Orthodox |
103 |
43.5 |
Muslim |
68 |
28.7 |
Protestant |
56 |
23.6 |
Others (Catholic, Wake feta) |
10 |
4.2 |
Qualification |
||
Diploma in Nursing |
106 |
44.7 |
B. Sc in Nursing |
127 |
53.6 |
MSc in Nursing |
4 |
1.7 |
Work experience |
||
<5 years |
151 |
63.7 |
6-10 years |
60 |
25.3 |
11-15 years |
10 |
4.2 |
16 years and above |
16 |
6.8 |
Monthly salary (Eth. Birr*) |
||
2000-3000 |
48 |
20.3 |
3001-4000 |
60 |
25.3 |
4001-5000 |
58 |
24.5 |
5001-6000 |
21 |
8.9 |
>6001 |
50 |
21.1 |
Clinical area/Working units |
||
Surgical ward |
41 |
17.3 |
Medical ward |
24 |
10.1 |
MCH* |
33 |
13.9 |
Pediatrics ward |
36 |
15.2 |
Chronic Illness clinic |
15 |
6.3 |
Maternity ward |
32 |
13.5 |
OPD* |
23 |
9.7 |
Others (psychiatry, OR*, ICU*) |
33 |
13.9 |
Training on palliative care |
||
Yes |
104 |
43.9 |
No |
133 |
56.1 |
Experience in caring terminal ill patients |
||
<2 |
104 |
43.9 |
5-Mar |
69 |
29.1 |
>6 |
26 |
11 |
Don’t have |
38 |
16 |
*Eth. Birr: Ethiopian birr, MCH: Maternal and child health, OPD:
Outpatient department, OR: Operation room, ICU: Intensive care Unit.
Table 2: Distribution of knowledge variables towards palliative care
services among nurses working at Jimma University Medical center,
April 2017 (n= 237)
Variables |
Response |
n |
% |
Palliative care should only be provided for patient who has on curative treatment available |
Yes |
138 |
58.2 |
No |
99 |
41.8 |
|
Long term use of Morphine can induce addiction |
Yes |
132 |
55.7 |
No |
105 |
44.3 |
|
Adjuvant therapies are important in Managing pain |
Yes |
191 |
80.6 |
|
No |
46 |
19.4 |
Getting Spiritual support is important to terminally ill patient |
Yes |
165 |
69.6 |
No |
72 |
30.4 |
|
Morphine should be used to relieve Dyspnea in cancer patient |
Yes |
127 |
53.6 |
No |
110 |
46.4 |
|
Respiratory desperation will be common when Opioids are taken |
Yes |
129 |
54.4 |
No |
108 |
45.6 |
|
Palliative care Service extending after mortar care |
Yes |
125 |
52.7 |
No |
112 |
47.3 |
|
Benzodiazepines should be effective for controlling delirium |
Yes |
124 |
52.3 |
No |
113 |
47.7 |
|
Some dying patient will require continuous sedation to alleviate suffering |
Yes |
148 |
62.4 |
No |
89 |
37.6 |
|
Family involvement in patient care is part of palliative care |
Yes |
173 |
73 |
No |
64 |
27 |
|
Higher calorie intake needed terminal stage of cancer |
Yes |
157 |
66.2 |
No |
80 |
33.8 |
|
Manifestation of chronic pain different from those of acute pain |
Yes |
185 |
78.1 |
No |
52 |
21.9 |
|
Terminally ill patient encourage having hope against all odd |
Yes |
146 |
61.6 |
No |
91 |
38.4 |
Attitude towards Palliative Care
From the total study participants 96(40.5%) were agreed
that giving care to the dying person is a worthwhile experience.
One hundred two (43%) of nurses agreed that caring for the
patient’s family should continue throughout the period of grief
and bereavement. About 73(30.8%) of the respondents strongly
disagree with the idea that they wouldn’t want to give care for
the dying person. On another hand 104 (43.9%) agreed families
Figure 1:Overall level of knowledge of nurses working at Jimma University
Medical center, April 2017 (n= 237)
should be concerned about helping their dying member make
the best of his/her remaining life and 56 (23.6%) rejected the
dying person should not allowed to make decisions about his/her
physical care (Table 3).
In summary, more than three fourth 188(79.3%) of nurses had favorable attitude towards palliative care services (Figure 2).
In summary, more than three fourth 188(79.3%) of nurses had favorable attitude towards palliative care services (Figure 2).
Table 3: Distribution of Nurses’ attitude towards palliative care at Jimma University medical center, April 2017
Statement |
SDN (%) |
D N (%) |
UN (%) |
A N (%) |
SA N (%) |
Giving care to the dying person a Worthwhile experience |
60(25.3) |
31(13.1) |
21(8.9) |
96(40.5) |
29(12.2) |
Death is not the worst thing that can happen to a person |
51(21.5) |
51(21.5) |
26(11.0) |
80(33.8) |
29(12.2) |
I would be uncomfortable talking about impending death with dying person |
41(17.3) |
44(18.6) |
42(17.7) |
85(35.9) |
25(10.5) |
Nursing caring for the patient's family should continue throughout the period of grief and bereavement |
33(13.9) |
32(13.5) |
40(16.9) |
102(43.0) |
30(12.7) |
I wouldn’t want to care for dying person |
73(30.8) |
59(24.9) |
32(13.5) |
53(22.4) |
20(8.4) |
The non-family care giver shouldn’t be the one to talk about death with the dying person |
48(20.3) |
39(16.5) |
56(23.6) |
75(31.6) |
19(8.0) |
I would be upset when the dying person I was caring for gave up hope of getting better |
52(21.9) |
40(16.9) |
44(18.6) |
86(36.3) |
15(6.3) |
There are time when dying person welcomes death |
29(12.2) |
39(16.5) |
60(25.3) |
83(35.0) |
26(11.0) |
When a patient asks, “Am I dying?" I think it is best to change the subject to something cheerful |
39(16.4) |
27(11.4) |
54(22.8) |
85(35.9) |
32(13.5) |
The family involved in the physical care of the dying person |
23(9.7) |
36(15.2) |
55(23.2) |
98(41.4) |
25(10.5) |
I would hope the person I ‘am caring for dies when I am not present |
41(17.3) |
47(19.8) |
58(24.5) |
70(29.5) |
21(8.9) |
I am afraid to become friends with the dying person |
62(26.2) |
43(18.1) |
55(23.2) |
71(30.0) |
6(2.5) |
Families need emotional support to accept the behavior changes of the dying person |
34(14.3) |
22(9.3) |
43(18.1) |
102(43.0) |
36(15.2) |
Families should be concerned about helping their dying member make the best of his/her remaining life |
32(13.5) |
29(12.2) |
32(13.5) |
104(43.9) |
40(16.9) |
The dying person should not allowed to make decisions about his/her physical care |
52(21.9) |
56(23.6) |
46(19.4) |
68(28.7) |
15(6.3) |
It is beneficial for the dying person to verbalize his/ her feeling |
24(10.1) |
42(17.7) |
37(15.6) |
105(44.3) |
29(12.2) |
Addiction to pain reliving medication should be dealing with patient |
37(15.6) |
36(15.2) |
42(17.7) |
97(40.9) |
25(10.5) |
N: Number, SD: Strongly disagree, D: Disagree, U: Uncertain, A: Agree & SA: Strongly agree
Figure 2:Overall nurses attitudes towards palliative care at Jimma University
Medical center, April 2017.
Practices towards Palliative Care
Almost two third (65.8 %) of the study participants had
poor practice towards palliative care (Figure 3). More than half
121 (51.1%) of the nurses initiate palliative care discussion
with patients during diagnosis of patients. Regarding factors
considered during dealing with terminal ill patients, 208 (87.8%)
Figure 3:Overall level of practice towards palliative care among nurses
working at Jimma University Medical center, April 2017 (n= 237).
of them gave great emphasis on psychological aspect and 135
(57%) of the study participants perceived terminally ill patients
concern as their right. Concerning decision making, 136 (57.4%)
of the respondents revealed that they were comprises patients
idea and 47 (19.8%) involves family members in decision making.
Regarding cultural assessment during patient care 203(85.7%) of the participant were included languages and family communication and 162 (68.4%) of the nurses reported as they listen patients with empathy when addressing the spiritual issue. Around half 115 (48.5%) of the respondents used morphine commonly for treatment of severe pain (Table 4).
Regarding cultural assessment during patient care 203(85.7%) of the participant were included languages and family communication and 162 (68.4%) of the nurses reported as they listen patients with empathy when addressing the spiritual issue. Around half 115 (48.5%) of the respondents used morphine commonly for treatment of severe pain (Table 4).
Table 4: Palliative care practice among nurses working at Jimma
University medical center, 2017.
Variables |
Response |
Number |
Percent |
Time of initiation pallaitive care discussion |
During diagnosis |
121 |
51.1 |
When the problem progress |
94 |
39.7 |
|
At the end of the life |
43 |
18.1 |
|
Factors considered when dealing with terminal ill patients |
Cultural |
176 |
74.3 |
Psychological |
208 |
87.8 |
|
Medical |
171 |
72.2 |
|
Social |
169 |
71.3 |
|
Things considered before addressing the spritual issue |
Listen with emphathy |
162 |
68.2 |
Impose owen view |
134 |
56.5 |
|
Understand patients reaction |
151 |
63.7 |
|
Connect with spritual counselor |
143 |
60.3 |
|
Cultural assessment during patient care |
Dietary preference |
196 |
82.7 |
Language, family communication |
203 |
85.7 |
|
Perspective on death suffering and grieving |
174 |
73.4 |
|
Addressing the psychological aspect of the patient during giving pallaitive care |
Emotional support |
179 |
75.5 |
Counselling the patient |
158 |
66.7 |
|
Hiding the teruth |
168 |
70.9 |
|
Whom do you involve in decission making? |
Patient |
136 |
57.4 |
Family |
47 |
19.8 |
|
My own |
13 |
5.5 |
|
Other professionals |
41 |
17.3 |
|
Percetion for terminally ill patients concern |
Patient right |
135 |
57 |
Needing treatment |
55 |
23.1 |
|
Doubting your professinalism |
3 |
1.3 |
|
Attention seeking behaviour |
44 |
18.6 |
|
Commony used medication for severe pain |
Paracetamol |
67 |
28.3 |
Morphine |
115 |
48.5 |
|
Petidine |
28 |
11.8 |
|
Codein |
27 |
11.4 |
Table 5: Adjusted logistic regression model showing predictors of
palliative care practice among nurses working in Jimma University
medical center, April 2017.
Predicting Variable |
P- Value |
AOR* (95% CI) |
Age in years |
||
>41 |
|
1 |
20-25 |
|
0.745(0.383, 1. 452) |
26-30 |
0.019 |
5.549 (1.323, 23.275) |
31-40 |
|
0.448 (0.087, 2.296) |
Clinical area |
||
Surgical |
|
1 |
Medical |
|
0.785 (0.213, 2.899) |
MCH |
0.027 |
0.268 (0.083, 0.864) |
Pediatrics |
|
0.565(0.174, 1.831) |
Chronic illness |
0.02 |
0.166 (0.036, 0.757) |
Maternity |
|
0.527 (0.159, 1.742) |
OPD |
|
0.458 (0.127, 1.659) |
Others (psychiatry, OR, ICU) |
0.03 |
0.276 (0.086, 0.886) |
Years of experience |
||
>15 |
|
1 |
<5 |
|
1.889 (0.952, 3. 748) |
5-10 |
0.013 |
4.344 (1.367, 13.806) |
11-15 |
|
4.271 (0.989, 18.806) |
Monthly salary (Eth. birr) |
||
>6001 |
|
1 |
2000-3000 |
0.005 |
3.633 (1.463, 9.022) |
3001-4000 |
0.023 |
2.867 (1.157, 7.101) |
4001-5000 |
|
1.375 (0.446, 4.241) |
5001-6000 |
|
2.564 (0.99, 6.639) |
level of Knowledge among nurses |
||
Poor knowledge |
|
1 |
Good Knowledge |
0.005 |
0.422 (0.233, 0.766) |
*AOR: Adjusted Odds Ratio
Factors Affecting Palliative Care Practice
Findings of this study revealed age, Clinical area/working unit,
years of experience, monthly salary and level of knowledge are
identified as factors associated with practice towards palliative
care among nurses.
Those study participants who were age between 26-30 years are 5.5 times more likely had poor practice towards palliative care with adjusted odds ratio (AOR) of 5.549 at 95%CI (1.323, 23.275) as compared to those age >41 years. Nurses who are working in maternal and child health, chronic illness clinic OR, ICU and psychiatry unit were 73.2%, 83.4% and 72.4% less likely had poor practice towards palliative care with AOR of 0.268 at 95%CI (0.083, 0.864), 0.166 at 95%CI (0.036, 0.757) and 0.276 at 95%CI (0.086, 0.886) respectively.
Nurses with five to ten years experiences were 4.3 times more likely had poor palliative care practice with AOR of 4.34 at 95%CI (1.37, 13.8) when compare to those greater than fifteen years of experiences. Nurses who earns monthly salary of 2000-3000 and 3001-4000 were 3.6 and 2.9 times more likely had poor practice towards palliative care with AOR of 3.633 at 95%CI (1.463, 9.022) and 2.867 at 95%CI (1.157, 7.101) respectively. Nurses who had good knowledge on palliative care services were 57.8% less likely to have poor palliative care practice as compared to good knowledge with AOR of 0.422 at 95%CI (0.233, 0.766).
Those study participants who were age between 26-30 years are 5.5 times more likely had poor practice towards palliative care with adjusted odds ratio (AOR) of 5.549 at 95%CI (1.323, 23.275) as compared to those age >41 years. Nurses who are working in maternal and child health, chronic illness clinic OR, ICU and psychiatry unit were 73.2%, 83.4% and 72.4% less likely had poor practice towards palliative care with AOR of 0.268 at 95%CI (0.083, 0.864), 0.166 at 95%CI (0.036, 0.757) and 0.276 at 95%CI (0.086, 0.886) respectively.
Nurses with five to ten years experiences were 4.3 times more likely had poor palliative care practice with AOR of 4.34 at 95%CI (1.37, 13.8) when compare to those greater than fifteen years of experiences. Nurses who earns monthly salary of 2000-3000 and 3001-4000 were 3.6 and 2.9 times more likely had poor practice towards palliative care with AOR of 3.633 at 95%CI (1.463, 9.022) and 2.867 at 95%CI (1.157, 7.101) respectively. Nurses who had good knowledge on palliative care services were 57.8% less likely to have poor palliative care practice as compared to good knowledge with AOR of 0.422 at 95%CI (0.233, 0.766).
Discussion
Nurses’ level of knowledge, attitude and practice towards
palliative care is cornerstone for better management and care of
patient with chronic life-threatening illness. Less involvement of
nurses in palliative care practice increases end of life suffering
and despair of patients with chronic life-threatening illness.
Hence, this study assessed the level of palliative care practice and
associated factors among nurses.
In overall, 46.4 % of nurses had good knowledge towards palliative care services. This is indicates more than half of nurses are not equipped with adequate knowledge and information about palliative care service which will contribute to poor practice, assessment and under-addressing of palliative care needs, increased health care cost and end of life suffering. This finding is higher than the findings of studies conducted in Egypt [20] and Addis Ababa [18]. Time difference among studies might be contributed for this result. However, it is lower than the finding of study in Greek [21] where nurses had better knowledge about palliative care. This might be due to socio-economic status and organizational policies and access of training on the palliative.
The current study revealed that 79.3 % of nurses had favorable attitudes towards palliative care services. This finding is consistent with studies done in Iran [22] and India [19]. Conversely, this finding is higher than study conducted in Addis Ababa [18] which revealed that 76% of respondents had favorable attitude towards palliative care services. This difference might be due to better awareness about palliative care and end of life care.
Concerning palliative care practice, 65.8% of nurses had poor practice towards palliative care. It could be related to poor awareness, health care management systems and little integration of palliative care services with regular health care services in Ethiopia. This finding is lower than study conducted in Egypt [20] and Addis Ababa [18] which is 76.6% and 76.2% respectively. The difference might be due to sample size, study period, health care policy and awareness level. Nurses who were participated on this study had better knowledge about palliative care services as compared to nurses in Egypt and Addis Ababa. The findings of this study showed that half of respondents initiating palliative care discussion during diagnosis of patients. It is almost consistence with study done in Addis Ababa [18]. More than two-third of study participants addressed the psychological issue of patients by hiding the truth. This finding is lower than study conducted in Addis Ababa, but higher than study done in Norway [23], where the nurses believed that lying about patients’ diagnosis and treatment is unethical.
Age, working unit, years of experience, monthly salary and level of knowledge were identified as factors that significantly associated with palliative care practice among nurses in this study. Those study participants who were age between 26-30 years are 5.5 times more likely had poor practice compared to those age >41 years. This indicates; as the age of nurse’s increase, the experiences of applying palliative care components might be enhanced. The study also showed that nurses working in the chronic illness clinic and ICU were 83.4% and 72.4% less likely had poor practice towards palliative care compared to surgical ward. The probable reason for this might be due to nurses working in these units might had frequent contact with chronically and terminally patients and they developed better experience in caring these types of cases.
Nurses who had five to ten years of experiences were four times more likely had poor palliative care practice compare to those greater than fifteen years of experience. This is consistent with study done in Egypt [20]. The possible justification for this might be nurses with extended years of experiences had better knowledge, confidence and more familiar in caring of terminal ill patients. Those nurses who earns monthly income of 2000-3000 and 3001-4000 were almost four and three times more likely had poor practice towards palliative care as compared to those nurses who earn greater than or equal to 6001 respectively. This might be related to those nurses who earn better monthly income were more satisfied by their salary and motivated in caring chronically and terminal ill patients. Nurses who had good knowledge on palliative care were 57.8% less likely to have poor palliative care practice. This might be because of knowledge about palliative care is basis for practice and those who knows on how to care these kind of patients had better skill.
As a conclusion, almost two-third of the study participants had poor practice towards palliative care. Age, working unit, years of experience, monthly salary and level of knowledge about palliative care services had strongly associated with practice of palliative care. Knowledge and experience about palliative care play important role for better attitude and practice of palliative care. Therefore, the study findings recommended that efforts should be made in designing and providing short and long term training for nurses on palliative care services. It also recommended that to include palliative care part in the curriculum of nursing education.
In overall, 46.4 % of nurses had good knowledge towards palliative care services. This is indicates more than half of nurses are not equipped with adequate knowledge and information about palliative care service which will contribute to poor practice, assessment and under-addressing of palliative care needs, increased health care cost and end of life suffering. This finding is higher than the findings of studies conducted in Egypt [20] and Addis Ababa [18]. Time difference among studies might be contributed for this result. However, it is lower than the finding of study in Greek [21] where nurses had better knowledge about palliative care. This might be due to socio-economic status and organizational policies and access of training on the palliative.
The current study revealed that 79.3 % of nurses had favorable attitudes towards palliative care services. This finding is consistent with studies done in Iran [22] and India [19]. Conversely, this finding is higher than study conducted in Addis Ababa [18] which revealed that 76% of respondents had favorable attitude towards palliative care services. This difference might be due to better awareness about palliative care and end of life care.
Concerning palliative care practice, 65.8% of nurses had poor practice towards palliative care. It could be related to poor awareness, health care management systems and little integration of palliative care services with regular health care services in Ethiopia. This finding is lower than study conducted in Egypt [20] and Addis Ababa [18] which is 76.6% and 76.2% respectively. The difference might be due to sample size, study period, health care policy and awareness level. Nurses who were participated on this study had better knowledge about palliative care services as compared to nurses in Egypt and Addis Ababa. The findings of this study showed that half of respondents initiating palliative care discussion during diagnosis of patients. It is almost consistence with study done in Addis Ababa [18]. More than two-third of study participants addressed the psychological issue of patients by hiding the truth. This finding is lower than study conducted in Addis Ababa, but higher than study done in Norway [23], where the nurses believed that lying about patients’ diagnosis and treatment is unethical.
Age, working unit, years of experience, monthly salary and level of knowledge were identified as factors that significantly associated with palliative care practice among nurses in this study. Those study participants who were age between 26-30 years are 5.5 times more likely had poor practice compared to those age >41 years. This indicates; as the age of nurse’s increase, the experiences of applying palliative care components might be enhanced. The study also showed that nurses working in the chronic illness clinic and ICU were 83.4% and 72.4% less likely had poor practice towards palliative care compared to surgical ward. The probable reason for this might be due to nurses working in these units might had frequent contact with chronically and terminally patients and they developed better experience in caring these types of cases.
Nurses who had five to ten years of experiences were four times more likely had poor palliative care practice compare to those greater than fifteen years of experience. This is consistent with study done in Egypt [20]. The possible justification for this might be nurses with extended years of experiences had better knowledge, confidence and more familiar in caring of terminal ill patients. Those nurses who earns monthly income of 2000-3000 and 3001-4000 were almost four and three times more likely had poor practice towards palliative care as compared to those nurses who earn greater than or equal to 6001 respectively. This might be related to those nurses who earn better monthly income were more satisfied by their salary and motivated in caring chronically and terminal ill patients. Nurses who had good knowledge on palliative care were 57.8% less likely to have poor palliative care practice. This might be because of knowledge about palliative care is basis for practice and those who knows on how to care these kind of patients had better skill.
As a conclusion, almost two-third of the study participants had poor practice towards palliative care. Age, working unit, years of experience, monthly salary and level of knowledge about palliative care services had strongly associated with practice of palliative care. Knowledge and experience about palliative care play important role for better attitude and practice of palliative care. Therefore, the study findings recommended that efforts should be made in designing and providing short and long term training for nurses on palliative care services. It also recommended that to include palliative care part in the curriculum of nursing education.
Limitations
The study did not include the primary health settings and
private clinics. Due to this reason comparison between public
and private clinic was not performed. Scarcity of similar studies
conducted in Ethiopia makes the comparison and discussion
challenging.
Authors’ Contribution
Yeamanuelwork Anbessie planned the study, involved in
data collection, prepared the first draft proposal and paper,
Temamen Tesfaye contributed to the study conception and design, supervised the study and conducted data analysis.
Admasu Belay, contributed on data analysis, supervised the study, critically revised the manuscript.
Temamen Tesfaye contributed to the study conception and design, supervised the study and conducted data analysis.
Admasu Belay, contributed on data analysis, supervised the study, critically revised the manuscript.
Funding/Support
Jimma university covered the survey cost and support
necessary stationary.
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