Impact of End-of-Life Nursing Education Consortium on Palliative Care Knowledge and Attitudes Towards Care of Dying of Nurses in India: A Quasi-Experimental Pre-post Study

Abstract

Palliative care (PC) training is conspicuously absent in Indian nursing curricula which is an obstacle to deliver quality end of life care (EOLC). End of life care nursing education consortium (ELNEC) aims to improve nursing staff knowledge and attitudes in PC and EOLC, however its impact on knowledge and attitudes has not been investigated in India. We aimed to assess the impact of ELNEC on the knowledge and attitudes of nurses in India towards PC and care of the dying. This prospective study included 108 registered nurses. A pre- and post-training questionnaire containing Palliative Care Quiz of Nursing (PCQN) and Frommelt Attitude toward Care of the Dying Scale Form B (FATCOD-B) was used to evaluate the PC knowledge and attitudes towards EOLC respectively. Subgroup analysis to delineate association of baseline knowledge and attitudes with gender, educational qualification or professional experience of working with patients with cancer or chronic life limiting illnesses were done. Pre-test FATCOD-B and PCQN scores of 110.81 ± 9.37 and 8.45 ± 1.88 reflect favorable attitudes towards care of dying not backed by sufficient PC knowledge respectively. The mean PCQN and FATCOD-B scores improved from 8.45 ± 1.88 to 10.16 ± 1.89 (P = .0001) and from 110.81 ± 9.37 to 119.47 ± 10.14 (P = .0001) respectively; implying a statistically significant improvement in PC knowledge and a more positive attitudes towards care of the dying. End of life care nursing education consortium is effective in improving practicing nurses’ knowledge and attitudes toward PC and care of the dying.

Keywords

attitude end of life care knowledge palliative care nursing

Get full access to this article

View all access options for this article.

References

Bag

Mohanty

Deep

Salins

Bag

. Palliative and end of life care in India - current scenario and the way forward. J Assoc Physicians India. 2020;68(11):61-65.

Macaden

Salins

Muckaden

, et al. End of life care policy for the dying: consensus position statement of Indian association of palliative care. Indian J Palliat Care. 2014;20(3):171-181.

Liu

Dawod

Wonnaparhown

, et al. Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: a systematic review and metaanalysis. Palliat Support Care. 2017;15(6):741-752.

Sung

Ferlay

Siegel

, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249.

Temel

Greer

Muzikansky

, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.

Bag

Mohanty

Deep

Salins

Bag

. Palliative and end of life care in India-Current Scenario and the way forward. J Assoc Phys India. 2020;68:61-65.

The Global Burden of disease: 2004 update. World Health Organisation 2008, Geneva. Available from: http://www.who.int/healthinfo/global.burden.disease/estimates.country/en/index.html

Palliative Care Directory of India. Indian Association of Palliative Care. Available at: https://www.palliativecare.in/palliative-care-directory-of-india/(last accessed 27/05/2022).

Directory of Palliative Care Services. Pallium India. Available from: https://palliumindia.org/clinics (last accessed 31 May 2022).

10.

Finkelstein

Bhadelia

Goh

, et al. Cross country comparison of expert assessments of the quality of death and dying 2021. J Pain Symptom Manage. 2022;63(4):e419-e429. doi:10.1016/j.jpainsymman.2021.12.015

11.

Kulkarni

Anavkar

Ghooi

. Preference of the place of death among Indian people. Indian J Palliat Care. 2014;20:6-11.

12.

Mani

. Limitation of life support in the ICU. Indian J Crit Care Med. 2003;7:112-117.

13.

Prem

Karvannan

Kumar

, et al. Study of nurses’ knowledge about palliative care: a quantitative cross-sectional survey. Indian J Palliat Care. 2012;18(2):122-127.

14.

WHO definition of palliative care. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care (last accessed: 25/04/2022).

15.

Ferrell

Malloy

Virani

. The end of life nursing education nursing consortium project. Ann Palliat Med. 2015;4:61-69. doi:10.3978/j.issn.2224-5820.2015.04.05

16.

Ross

McDonald

McGuinness

. The palliative care quiz for nursing (PCQN): the development of an instrument to measure nurses’ knowledge of palliative care. J Adv Nurs. 1996;23(1):126-137.

17.

Frommelt

. The effects of death education on nurses’ attitudes toward caring for terminally ill persons and their families. Am J Hosp Palliat Care. 1991;8(5):37-43.

18.

Hao

Zhan

Huang

Cui

Zhou

. Nurses’ knowledge and attitudes towards palliative care and death: a learning intervention. BMC Palliat Care. 2021;20(1):50.

19.

Barrere

Durkin

LaCoursiere

. The influence of end-of-life education on attitudes of nursing students. Int J Nurs Educ Scholarsh. 2008;5:Article11.

20.

Grubb

Arthur

. Student nurses’ experience of and attitudes towards care of the dying: a cross-sectional study. Palliat Med. 2016;30(1):83-88. doi:10.1177/0269216315616762

21.

Bray

. Care of the dying patient: how comfortable are nursing students toward the care of dying patients at the completion of the associate nursing degree program? Nursing Theses and Capstone Projects, 104; 2012. https://digitalcommons.gardner-webb.edu/nursing_etd/104. last accessed 25/04/2022.

22.

Marinić

Joka

Friganović

Ljubas

Korent

. Nurses’ knowledge of palliative care at primary, secondary and tertiary levels of health care. Croat Nurs J. 2021;5(1):17-28.

23.

Lewis

Reid

McLernon

Ingham

Traynor

. The impact of a simulated intervention on attitudes of undergraduate nursing and medical students towards end of life care provision. BMC Palliat Care. 2016;15:67. doi:10.1186/s12904-016-0143-2

24.

Lorenz

Shugarman

Lynn

. Health care policy issues in end-of-life care. J Palliat Med. 2006;9(3):731-748.

25.

Shea

Grossman

Wallace

Lange

. Assessment of advanced practice palliative care nursing competencies in nurse practitioner students: implications for the integration of ELNEC curricular modules. J Nurs Educ. 2010;49(4):183-189.

26.

Iranmanesh

Razban

Tirgari

Zahra

. Nurses' knowledge about palliative care in Southeast Iran. Palliat Support Care. 2014;12(3):203-210.

27.

Dimoula

Kotronoulas

Katsaragakis

Christou

Sgourou

Patiraki

. Undergraduate nursing students' knowledge about palliative care and attitudes towards end-of-life care: a three-cohort, cross-sectional survey. Nurse Educ Today. 2019;74:7-14.

28.

American Pain Society Quality of Care Committee . Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA, J Am Med Assoc. 1995;274:1874-1880.

29.

Brennan

Carr

Cousins

. Pain management: a fundamental human right. Anesth Analg. 2007;105(1):205-221.

30.

Singer

. Psychosocial impact of cancer. Recent Results Cancer Res. 2018;210:1-11. doi:10.1007/978-3-319-64310-6_1

31.

Karkada

Nayak

Malathi . Awareness of palliative care among diploma nursing students. Indian J Palliat Care. 2011;17(1):20-23.

32.

Redman

White

Ryan

Hennrikus

. Professional needs of palliative care nurses in New South Wales. Palliat Med. 1995;9(1):36-44.

33.

Mutto

Errázquin

Rabhansl

Villar

. Nursing education: the experience, attitudes, and impact of caring for dying patients by undergraduate Argentinian nursing students. J Palliat Med. 2010;13(12):1445-1450.

34.

Wafaa

Ali

Ayoub

. Nurses’ attitude towards caring for dying patient in Mansoura University Hospitals. J Med Biomed Sci. 2010;1(1):16-23.

35.

Vejlgaard

Addington-Hall

. Attitudes of Danish doctors and nurses to palliative and terminal care. Palliat Med. 2005;19(2):119-127.

36.

O'Shea

Mager

. End-of-life nursing education: enhancing nurse knowledge and attitudes. Appl Nurs Res. 2019;50:151197.

37.

Frommelt

. Attitudes toward care of the terminally ill: an educational intervention. Am J Hosp Palliat Care. 2003;20(1):13-22.