Nurses' knowledge and attitudes towards palliative care and death: a learning intervention

Abstract

Background: In many countries, nurses are ill-prepared to provide care to patients with terminal illnesses. Limited education and training affect their ability to deliver proper palliative care. Only a few studies have explored appropriate and effective training methods of palliative care in China. Therefore, we aimed to provide evidence for a palliative care training system by appraising the effects of a mixed-method intervention on participants' knowledge of palliative care and attitudes towards dying patients and death.

Methods: An e-learning intervention approach was adopted for 97 nurses from oncology departments across five hospitals, using a mobile terminal combined with a virtual forum and face-to-face interactions. We conducted a pre- and post-training evaluation through the Palliative Care Quiz of Nursing (PCQN), Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B), and Death Attitude Profile-Revised (DAP-R).

Results: After a three-week intervention, there was a significant increase in the PCQN and FATCOD-B scores as compared to the baseline. For PCQN, the total score increased from 10.3 ± 1.9 to 11.1 ± 2.2 (p = .011) and the score for management of pain and other symptoms increased from 7.7 ± 1.7 to 8.4 ± 1.7 (p = .003). FATCOD-B scores increased noticeably from 100.6 ± 7.9 to 102.9 ± 8.9 (p = .019). The DAP-R scores showed no obvious difference between pre- and post-intervention results.

Conclusions: The mixed-method intervention was effective in improving participants' knowledge and attitudes about palliative care. The implementation of training for nurses at appropriate intervals during both education and professional life is required, especially regarding the improvement in participants' attitudes towards death. Therefore, palliative care training in China should receive more attention.

Keywords: Attitude; Internet-based intervention; Knowledge; Nursing; Palliative care.

Fig. 1

Participants’ flow (N = 97)

Fig. 2

PCQN, FATCOD-B, and DAP-R scores pre- and post-intervention (N = 97). a, Total PCQN scores ranged from 0 to 20, with higher scores indicating greater knowledge. Scores in philosophy and principles of palliative care ranged from 0 to 4, scores in management of pain and other symptoms ranged between 0 and 13, and scores in psychosocial aspects of care ranged from 0 to 3. PCQN: Palliative Care Quiz of Nursing. b, Scores on the scale ranged from 0 to 150 with higher scores indicating a favourable attitude towards care for the dying. FATCOD-B: Frommelt Attitudes Towards Care of the Dying Scale Form B. c, Scores on each subscale, ranging from 1 to 7, represented the five attitudes towards death. A higher score indicated a greater tendency to share the corresponding attitude towards death. DAP-R: Death Attitude Profile-Revised. Data were presented as estimated means and deviations. The height of the error bar in Fig. 2 is equal to the mean value of the variable plus the standard deviation. Paired t-tests were used for analysis of the difference between pre- and post-intervention scores. *p ≤ .05 for differences between pre- and post-intervention