Research
Palliative care knowledge, attitudes and perceived self-competence of nurses working in Vietnam Abstract
Aim: To explore palliative care knowledge, attitudes and perceived self-competence of nurses working in oncology settings in Hanoi, Vietnam. Method: The study employed a cross-sectional descriptive survey design. The self-administered questionnaires consisted of three validated instruments: the Expertise and Insight Test for Palliative Care, the Attitude Toward Care of the Dying Scale B and the Palliative Care Nursing Self Competence Scale. The sample consisted of 251 nurses caring for cancer patients in three oncology hospitals in Vietnam. Results: The responses identified low scores in nurses’ palliative care knowledge related to pain and other symptom management and psychological and spiritual aspects. Nurses’ responses reflected discomfort in communicating about death and establishing therapeutic relationship with oncology patients who require palliative care. Additionally, nurses reported low scores in perceived self-competence when providing pain management and addressing social and spiritual domains of palliative care. The findings also revealed that nurses who had higher palliative care knowledge scores demonstrated attitudes which were more positive and expressed greater perceived self-competence. Conclusion: Nurses working in oncology wards need more education to develop their knowledge and skills of palliative care, especially in the areas of pain management, psychological and spiritual care, and communication. Key words: Palliative care l Oncology nursing l Knowledge l Attitude
Ly Thuy Nguyen, Lecturer, Hanoi Medical University, Hanoi, Vietnam; Patsy Yates, Head, School of Nursing, Queensland University of Technology, Queensland, Australia; Yvonne Osborne, Senior Lecturer, School of Nursing, Queensland University of Technology, Queensland, Australia Correspondence to: Ly Thuy Nguyen nguyenthuyly@hmu. edu.vn
448
T
he development of a knowledgeable, skilled, and competent nursing workforce is an essential component of safe, quality care to meet palliative care needs for the increasing number of people with cancer, particularly those in the terminal stages. In Vietnam, more than 150 000 people are diagnosed with cancer annually (Krakauer et al, 2007) and within the 2-year period from 2005 to 2006, approximately 94 000 deaths from cancer were reported (Ngoan le et al, 2007). However, studies conducted throughout Vietnam have identified that there is no national training course for Vietnamese nurses in palliative care (Green et al, 2006; Krakauer et al, 2010). While limited attention has been paid to identifying what is required to prepare nurses to meet
the increasing demand for palliative care services in Vietnam, evidence from other countries indicates a considerable variation in the nature, scope and approach to the delivery of palliative care among nurses across different contexts (Iranmanesh et al, 2008; Ronaldson et al, 2008; Abu-Saad Huijer et al, 2009; Latour et al, 2009; Lansdell and Beech, 2010; Ho et al, 2010; Maria et al, 2011; Sato et al, 2014). This variation is owing to a number of factors, most commonly the lack of education necessary to develop graduates who are capable of responding compassionately to diverse human responses to dying (Ferrell et al, 2010; White and Coyne, 2011). Indeed, there is general consensus across many countries (e.g. Spain, Greece, Lebanon, Australia, UK) that palliative care education should be given increased attention to prepare nurses with the necessary knowledge, attitudes and perceived self-competence (Abu-Saad Huijer et al, 2009; Ho et al, 2010; Lansdell and Beech, 2010; Ford and McInerney, 2011; Maria et al, 2011). In addition to educational preparation, the complex and personal nature of the issues related to caring for patients with life-limiting illnesses means that a range of demographic characteristics and professional factors can influence a nurse’s comfort and skill in palliative care. Research in this area has produced mixed and inconsistent associations between nurses’ characteristics and palliative care knowledge (Abu-Saad Huijer et al, 2009; Knapp et al, 2009; Ford and McInerney, 2011), and nurses’ characteristics and their attitudes towards caring for the dying (Iranmanesh et al, 2008; Lange et al, 2008; Latour et al, 2009; Ho et al, 2010; Lansdell and Beech, 2010; Matsui and Braun, 2010; Ford and McInerney, 2011; Knapp et al, 2011; Maria et al, 2011; Gama et al, 2012). A review of existing research also highlights that other than knowledge or skills, limited focus has been placed on other key indicators of nurses’ actual practice behaviours in palliative care. No single study has comprehensively exam-
© 2014 MA Healthcare Ltd
Ly Thuy Nguyen, Patsy Yates, Yvonne Osborne
International Journal of Palliative Nursing 2013, Vol 20, No 9
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 23, 2015. For personal use only. No other uses without permission. . All rights r
Research
ined the associations between background characteristics of nurses, knowledge, attitudes and perceived competence in providing palliative care. Given the early stage of development of palliative care and the gaps in knowledge regarding nurses’ palliative care practices in Vietnam, the aims of this study of nurses working in oncology settings in Vietnam were to: ●●Describe their palliative care knowledge, attitudes and perceived self-competence levels ●●Examine demographic and employment-related factors that influence their knowledge, attitudes and perceived self-competence in palliative care ●●Explore the relationships between their palliative care knowledge, attitudes and perceived self-competence.
Methods A cross-sectional survey using a self-administered questionnaire was employed for this study.
Setting and sampling The target population for this study was made up of registered nurses (RN) working in the three oncology hospitals in the capital of Vietnam, namely: The National Cancer Institute of Vietnam; Hanoi Oncology Hospital; and the Nuclear Medicine and Oncology Centre of Bach Mai Hospital. These are leading hospitals specialising in oncology, providing screening, treatment, and care for cancer patients across the north of Vietnam. Moreover, all institutes have palliative care units, which have been responsible for training new health professionals in providing palliative care for cancer patients in the terminal stages of disease.
© 2014 MA Healthcare Ltd
Instruments Three instruments were used in this study. Firstly, an ‘expertise and insight test for palliative care’ was used to assess knowledge of palliative care (Adriaansen and Achterberg, 2004). This instrument was developed in 2003 for the evaluation of the effects of a post-basic palliative care course (Adriaansen and Achterberg, 2004). It was thus deemed useful by the authors for determining basic palliative care knowledge among nurses in this study. The instrument used comprised 18 items from the Palliative Care Quiz for Nurses (PCQN) (Ross et al, 1996) and 18 newly developed items, which were derived from a literature review regarding the needs of palliative patients and nurses. Of the 36 items, one item was adjusted to include Vietnamese cultural considerations. A further two items, originating in the PCQN, were excluded as they have been reported
International Journal of Palliative Nursing 2014, Vol 20, No 9
to be too difficult (i.e. exceeding the 0.80 item difficulty) (Ross et al, 1996), with fewer than 50% of nurses answering these two items correctly (Knapp et al, 2009). The final set of 34 items was used to measure nurses’ palliative care knowledge in three domains: basic principles of palliative care (6 items), controlling symptoms and pain (21 items) and psychological and spiritual care (7 items). The 34-item tool used a ‘true/ false/don’t know’ format with possible scores ranging from 0 to 34. A score of one was given for correct answers and no score was given for either incorrect responses or missing or ‘don’t know’ answers. The overall score for the sample was determined by calculating the sum of correct responses for each of the respondents. In this study, the Cronbach’s alpha was 0.718 indicating a high degree of internal consistency. Nurses’ attitudes towards the care of the dying were evaluated with the Frommelt Attitude Towards Care of the Dying Scale (FATCOD) (Frommelt, 2003). This scale consists of 30 items, 15 of which were worded positively and 15 negatively. Positive items were scored from 1 (strongly disagree) to 5 (strongly agree). For negative items, these scores were reversed. Possible scores ranged from 30 to 150. A higher score indicated more positive attitudes towards caring for this patient population. According to Ford and McInerney (2011), the FATCOD is divided into two domains: FATCOD I relates to attitude towards patients with terminal illness (personcentred care—21 items) and FATCOD II relates to attitudes towards the patient’s family (familycentred care—9 items). In this study, FATCOD had high internal consistency, with a Cronbach’s alpha value of 0.716. The Palliative Care Nursing Self Competence scale (PCNSC) (Desbiens and Fillion, 2011) was used to assess nurses’ perceived competence. This scale is a comprehensive instrument with 10 dimensions: ●● Pain management (3 items) ●● Other symptoms management (4 items) ●● Psychological care (3 items) ●● Social care (2 items) ●● Spiritual care (4 items) ●● Care associated with functional status (3 items) ●● Ethical and legal issues (4 items) ●● Interprofessional collaboration and communication (3 items) ●● Personal and professional issues related to nursing care (4 items) ●● End-of-life care (4 items). The response-scale format, which was employed to rate the strength of perceived selfcompetence, ranges from 1 (not at all competent)
❛Limited attention has been paid to identifying what is required to prepare nurses to meet the increasing demand for palliative care services in Vietnam.❜
449
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 23, 2015. For personal use only. No other uses without permission. . All rights r
Research
Table 1. Background characteristics of participants Characteristics
Frequency (n)
Percentage (%)
Male
21
8.4
Female
228
91.6
Gender
Having a friend or relative suffering from life-limiting illness No
170
68.8
Yes
77
31.2
Secondary nurses (2 years)
149
60.8
3-year bachelor nurses
50
20.4
4-year bachelor nurses
46
18.8
No
89
35.5
Yes
162
64.5
Surgical
87
34.9
Medical
52
20.9
Palliative care unit
19
7.6
Chemo and radiotherapy
80
32.1
Other
11
4.5
Education profile
Previous palliative care education
Practice settings
0–25%
6
2.9
26–50%
111
52.8
≥51%
93
44.3
Characteristics
Mean (SD)
Min–max
Age (years)
30.98 (7.09)
21–55
Nursing experience (months)
96.36 (76.26)
2–384
Oncology experience (months)
87.15 (66.7)
1–384
Palliative care experience (months)
69.77 (64.63)
0–384
to 6 (highly competent) with the possible total score ranging from 34 to 204 across the 34 items. The Cronbach’s alpha value of PCNSC in this study was 0.97, indicating a very high internal consistency. These instruments were translated into Vietnamese using the forward and backward translation process based on Brislin’s model (Brislin, 1986). The use of more than one bilingual translator and a group discussion between the experts and investigator helped achieve strong cultural and functional equivalence between the original version and the translated version of the instruments.
Research Ethics Committee (Approval No: 1200000620). A package, containing a participant information sheet, a self-administered questionnaire and envelopes, was left with the head nurse of each oncology unit for distribution to staff and attached to the notice board in the nursing office so that nurses on other shifts could obtain information about the study. Participants could answer the questionnaire at a convenient time and deposit it, in a sealed envelope, into a box located in the nursing offices of each ward. The box was sealed so that nurses choosing to participate were not identified and their responses remained confidential.
Data collection
The Statistical Package for Social Sciences (SPSS) version 21 for Windows was used to analyse the data. The level of significance for all analyses was set at less than 0.05 (p ≤0.05). Frequencies and percentages were calculated for each of the varia-
Ethical clearance was obtained from the Hanoi School of Public Health Ethical Committee (Approval No: 012-144/DD-YTCC) and Queensland University of Technology Human
450
Data analysis
© 2014 MA Healthcare Ltd
Percentage of work involved in caring for the dying
International Journal of Palliative Nursing 2014, Vol 20, No 9
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 23, 2015. For personal use only. No other uses without permission. . All rights r
Research
Table 2. Levels of palliative care knowledge, attitudes and perceived self-competence. Variables
Mean ± SD
Total knowledge score (possible score: 0–34)
19.8 ± 3.38
Principle (possible score: 0–6)
3.84 ± 1.03
Pain and symptom management (possible score: 0–21)
11.13 ± 2.7
Psychological and spiritual care (possible score 0–7)
4.82 ± 1.21
Total Attitudes to Care of the Dying score (possible score: 30–150)
103.54 ± 7.46
Attitudes towards patients with terminal illnesses (possible score: 21–105)
69.77 ± 3.7
Attitudes towards the patient’s family (possible score: 9–45)
33.77 ± 3.76
Total perceived self-competence score (possible score: 34–204)
126.81 ± 33.11
Pain management (possible score: 3–18)
10.56 ± 3.18
Other symptoms management (possible score: 4–24)
15.6 ± 4.1
Psychological care (possible score: 3–18)
11.8 ± 3.34
Social care (possible score: 2–12)
4.1 ± 1.45
Spiritual care (possible score: 4–24)
13.6 ± 4.3
Care associated with functional status (possible score: 3–18)
11.12 ± 3.4
Ethical and legal issues (possible score: 4–14)
14.6 ± 4.48
Interprofessional collaboration and communication (possible score: 3–18)
11.7 ± 3.9
Personal and professional issues related to nursing care (possible score: 4–24)
14.8 ± 4.36
End-of-life care (possible score: 4–24)
16.15 ± 4.1
bles and the data were verified. The KolmogorovSmirnov (K-S) test was employed to determine the normality of total scores of the three factors (i.e. palliative care knowledge, attitudes and perceived self-competence). Then, bivariate analysis (students t-test for two groups; ANOVA (analysis of variance) for more than two groups of independent variables; Pearson’s correlation for continuous independent variables) was used to explore the associations between background characteristics and total score of each factor. Lastly, Pearson’s correlation was performed to identify relationships between these three factors.
Results
© 2014 MA Healthcare Ltd
Characteristics of participants A total of 251 responses were received, representing 71.7% of nurses across the three oncology settings. The study sample consisted predominantly of women (91.6%) with a mean age of 30.98 (SD=7.09, range from 21 to 55). The most common educational level was secondary (2 years) (60.8%). More than one-third had not received any palliative care education (35.5%) while 44.3% nurses reported that ≥51% of their work was related to caring for the dying. Table 1 displays the summary of background characteristics of respondents.
Palliative care knowledge Symptom and pain management The mean total knowledge score was 19.8
International Journal of Palliative Nursing 2014, Vol 20, No 9
(SD=3.38) on a scale ranging from 9 (low knowledge) to 32 (high knowledge) (Table 2). With regards to questions on symptom and pain management, the study sample showed a lack of understanding in this domain of care. For example, only one fifth of respondents (19.7%) correctly identified that ‘The progress of disease does not determine the pain treatment methods’ and 73.5% of respondents incorrectly believed that ‘drug addiction is a serious problem when morphine is used on a long-term basis for the management of cancer pain’. Only 10 of 22 questions in this domain were correctly scored by more than 50% of the nurses surveyed. Psychological and spiritual care In terms of psychological and spiritual care, more than half (60.3%) of the respondents were incorrect in believing that ‘men resolve their grief more quickly than women’ and 54.8% of nurses were incorrect in choosing ‘rejecting help always indicates that informal caregivers are overburdened’. The remaining items were correctly scored by 50%–96% of nurses. Basic principles of palliative care Overall, the results indicated lower scores in nurses’ palliative care knowledge regarding pain and symptom management and psychological and spiritual domains. However, a better understanding was found in the knowledge of palliative care principles, with at least 50% of the
451
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 23, 2015. For personal use only. No other uses without permission. . All rights r
Research
Table 3. Relationships between independent variables and three outcome variables Categorical independent variables
Knowledge Mean (95% CI) t-test/ANOVA (p value)
Attitudes Mean (95% CI) t-test/ANOVA (p value)
Perceived self- competence Mean (95% CI) t-test/ANOVA (p value)
3-year bachelor and secondary nurses
19.63 (18.95–20.01) t=-1.975*
99.03 (98.06–99.96)
124.75 (119.46–129.83) t= -1.739
4-year bachelor nurses
20.72 (19.07–21.09) (0.049)
102.24 (100.14–104.52) t=-2.301* (0.02)
135.03 (125.43–144.61)
None
19.33 (18.6–19.9)
t=-1.627
99.09 (97.65–100.47)
119.29 (111.69–127.16) t=-2.484*
Yes
20.05 (19.5–20.54)
(0.11)
100.03 (98.82–101.23)
Education profile (0.084)
Palliative care education t=-0.477 (0.63)
130.56 (124.89–136.09) (0.018)
Percentage of work involved in caring for the dying 0–25%
18.83 (11.8–25.87)
101.66 (86.75–116.57)
118.75 (38.98–198.52)
26–50%
19.77 (19.15–20.38)
102.74 (101.4–104.13) F=3.44* (0.034)
119.51 (112.50–126.53) F=1.548 0.216
≥51
20.33 (19.63–21.03)
105.27 (102.8–104.82)
128.02 (121.42–134.63)
Surgical
19.43 (18.77–20.09)
102.98 (101.4–104.6)
133.24 (125.94–140.54)
Medical
20.65 (19.70–21.61)
102.5 (99.92–105.08)
132.39 (121.00–143.58)
Palliative care units
22.95 (21.58–24.32)
104.14 (100.1–108.45)
141.85 (133.12–148.57) F=8.836*** (
Palliative care knowledge, attitudes and perceived self-competence of nurses working in Vietnam Abstract
Aim: To explore palliative care knowledge, attitudes and perceived self-competence of nurses working in oncology settings in Hanoi, Vietnam. Method: The study employed a cross-sectional descriptive survey design. The self-administered questionnaires consisted of three validated instruments: the Expertise and Insight Test for Palliative Care, the Attitude Toward Care of the Dying Scale B and the Palliative Care Nursing Self Competence Scale. The sample consisted of 251 nurses caring for cancer patients in three oncology hospitals in Vietnam. Results: The responses identified low scores in nurses’ palliative care knowledge related to pain and other symptom management and psychological and spiritual aspects. Nurses’ responses reflected discomfort in communicating about death and establishing therapeutic relationship with oncology patients who require palliative care. Additionally, nurses reported low scores in perceived self-competence when providing pain management and addressing social and spiritual domains of palliative care. The findings also revealed that nurses who had higher palliative care knowledge scores demonstrated attitudes which were more positive and expressed greater perceived self-competence. Conclusion: Nurses working in oncology wards need more education to develop their knowledge and skills of palliative care, especially in the areas of pain management, psychological and spiritual care, and communication. Key words: Palliative care l Oncology nursing l Knowledge l Attitude
Ly Thuy Nguyen, Lecturer, Hanoi Medical University, Hanoi, Vietnam; Patsy Yates, Head, School of Nursing, Queensland University of Technology, Queensland, Australia; Yvonne Osborne, Senior Lecturer, School of Nursing, Queensland University of Technology, Queensland, Australia Correspondence to: Ly Thuy Nguyen nguyenthuyly@hmu. edu.vn
448
T
he development of a knowledgeable, skilled, and competent nursing workforce is an essential component of safe, quality care to meet palliative care needs for the increasing number of people with cancer, particularly those in the terminal stages. In Vietnam, more than 150 000 people are diagnosed with cancer annually (Krakauer et al, 2007) and within the 2-year period from 2005 to 2006, approximately 94 000 deaths from cancer were reported (Ngoan le et al, 2007). However, studies conducted throughout Vietnam have identified that there is no national training course for Vietnamese nurses in palliative care (Green et al, 2006; Krakauer et al, 2010). While limited attention has been paid to identifying what is required to prepare nurses to meet
the increasing demand for palliative care services in Vietnam, evidence from other countries indicates a considerable variation in the nature, scope and approach to the delivery of palliative care among nurses across different contexts (Iranmanesh et al, 2008; Ronaldson et al, 2008; Abu-Saad Huijer et al, 2009; Latour et al, 2009; Lansdell and Beech, 2010; Ho et al, 2010; Maria et al, 2011; Sato et al, 2014). This variation is owing to a number of factors, most commonly the lack of education necessary to develop graduates who are capable of responding compassionately to diverse human responses to dying (Ferrell et al, 2010; White and Coyne, 2011). Indeed, there is general consensus across many countries (e.g. Spain, Greece, Lebanon, Australia, UK) that palliative care education should be given increased attention to prepare nurses with the necessary knowledge, attitudes and perceived self-competence (Abu-Saad Huijer et al, 2009; Ho et al, 2010; Lansdell and Beech, 2010; Ford and McInerney, 2011; Maria et al, 2011). In addition to educational preparation, the complex and personal nature of the issues related to caring for patients with life-limiting illnesses means that a range of demographic characteristics and professional factors can influence a nurse’s comfort and skill in palliative care. Research in this area has produced mixed and inconsistent associations between nurses’ characteristics and palliative care knowledge (Abu-Saad Huijer et al, 2009; Knapp et al, 2009; Ford and McInerney, 2011), and nurses’ characteristics and their attitudes towards caring for the dying (Iranmanesh et al, 2008; Lange et al, 2008; Latour et al, 2009; Ho et al, 2010; Lansdell and Beech, 2010; Matsui and Braun, 2010; Ford and McInerney, 2011; Knapp et al, 2011; Maria et al, 2011; Gama et al, 2012). A review of existing research also highlights that other than knowledge or skills, limited focus has been placed on other key indicators of nurses’ actual practice behaviours in palliative care. No single study has comprehensively exam-
© 2014 MA Healthcare Ltd
Ly Thuy Nguyen, Patsy Yates, Yvonne Osborne
International Journal of Palliative Nursing 2013, Vol 20, No 9
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 23, 2015. For personal use only. No other uses without permission. . All rights r
Research
ined the associations between background characteristics of nurses, knowledge, attitudes and perceived competence in providing palliative care. Given the early stage of development of palliative care and the gaps in knowledge regarding nurses’ palliative care practices in Vietnam, the aims of this study of nurses working in oncology settings in Vietnam were to: ●●Describe their palliative care knowledge, attitudes and perceived self-competence levels ●●Examine demographic and employment-related factors that influence their knowledge, attitudes and perceived self-competence in palliative care ●●Explore the relationships between their palliative care knowledge, attitudes and perceived self-competence.
Methods A cross-sectional survey using a self-administered questionnaire was employed for this study.
Setting and sampling The target population for this study was made up of registered nurses (RN) working in the three oncology hospitals in the capital of Vietnam, namely: The National Cancer Institute of Vietnam; Hanoi Oncology Hospital; and the Nuclear Medicine and Oncology Centre of Bach Mai Hospital. These are leading hospitals specialising in oncology, providing screening, treatment, and care for cancer patients across the north of Vietnam. Moreover, all institutes have palliative care units, which have been responsible for training new health professionals in providing palliative care for cancer patients in the terminal stages of disease.
© 2014 MA Healthcare Ltd
Instruments Three instruments were used in this study. Firstly, an ‘expertise and insight test for palliative care’ was used to assess knowledge of palliative care (Adriaansen and Achterberg, 2004). This instrument was developed in 2003 for the evaluation of the effects of a post-basic palliative care course (Adriaansen and Achterberg, 2004). It was thus deemed useful by the authors for determining basic palliative care knowledge among nurses in this study. The instrument used comprised 18 items from the Palliative Care Quiz for Nurses (PCQN) (Ross et al, 1996) and 18 newly developed items, which were derived from a literature review regarding the needs of palliative patients and nurses. Of the 36 items, one item was adjusted to include Vietnamese cultural considerations. A further two items, originating in the PCQN, were excluded as they have been reported
International Journal of Palliative Nursing 2014, Vol 20, No 9
to be too difficult (i.e. exceeding the 0.80 item difficulty) (Ross et al, 1996), with fewer than 50% of nurses answering these two items correctly (Knapp et al, 2009). The final set of 34 items was used to measure nurses’ palliative care knowledge in three domains: basic principles of palliative care (6 items), controlling symptoms and pain (21 items) and psychological and spiritual care (7 items). The 34-item tool used a ‘true/ false/don’t know’ format with possible scores ranging from 0 to 34. A score of one was given for correct answers and no score was given for either incorrect responses or missing or ‘don’t know’ answers. The overall score for the sample was determined by calculating the sum of correct responses for each of the respondents. In this study, the Cronbach’s alpha was 0.718 indicating a high degree of internal consistency. Nurses’ attitudes towards the care of the dying were evaluated with the Frommelt Attitude Towards Care of the Dying Scale (FATCOD) (Frommelt, 2003). This scale consists of 30 items, 15 of which were worded positively and 15 negatively. Positive items were scored from 1 (strongly disagree) to 5 (strongly agree). For negative items, these scores were reversed. Possible scores ranged from 30 to 150. A higher score indicated more positive attitudes towards caring for this patient population. According to Ford and McInerney (2011), the FATCOD is divided into two domains: FATCOD I relates to attitude towards patients with terminal illness (personcentred care—21 items) and FATCOD II relates to attitudes towards the patient’s family (familycentred care—9 items). In this study, FATCOD had high internal consistency, with a Cronbach’s alpha value of 0.716. The Palliative Care Nursing Self Competence scale (PCNSC) (Desbiens and Fillion, 2011) was used to assess nurses’ perceived competence. This scale is a comprehensive instrument with 10 dimensions: ●● Pain management (3 items) ●● Other symptoms management (4 items) ●● Psychological care (3 items) ●● Social care (2 items) ●● Spiritual care (4 items) ●● Care associated with functional status (3 items) ●● Ethical and legal issues (4 items) ●● Interprofessional collaboration and communication (3 items) ●● Personal and professional issues related to nursing care (4 items) ●● End-of-life care (4 items). The response-scale format, which was employed to rate the strength of perceived selfcompetence, ranges from 1 (not at all competent)
❛Limited attention has been paid to identifying what is required to prepare nurses to meet the increasing demand for palliative care services in Vietnam.❜
449
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 23, 2015. For personal use only. No other uses without permission. . All rights r
Research
Table 1. Background characteristics of participants Characteristics
Frequency (n)
Percentage (%)
Male
21
8.4
Female
228
91.6
Gender
Having a friend or relative suffering from life-limiting illness No
170
68.8
Yes
77
31.2
Secondary nurses (2 years)
149
60.8
3-year bachelor nurses
50
20.4
4-year bachelor nurses
46
18.8
No
89
35.5
Yes
162
64.5
Surgical
87
34.9
Medical
52
20.9
Palliative care unit
19
7.6
Chemo and radiotherapy
80
32.1
Other
11
4.5
Education profile
Previous palliative care education
Practice settings
0–25%
6
2.9
26–50%
111
52.8
≥51%
93
44.3
Characteristics
Mean (SD)
Min–max
Age (years)
30.98 (7.09)
21–55
Nursing experience (months)
96.36 (76.26)
2–384
Oncology experience (months)
87.15 (66.7)
1–384
Palliative care experience (months)
69.77 (64.63)
0–384
to 6 (highly competent) with the possible total score ranging from 34 to 204 across the 34 items. The Cronbach’s alpha value of PCNSC in this study was 0.97, indicating a very high internal consistency. These instruments were translated into Vietnamese using the forward and backward translation process based on Brislin’s model (Brislin, 1986). The use of more than one bilingual translator and a group discussion between the experts and investigator helped achieve strong cultural and functional equivalence between the original version and the translated version of the instruments.
Research Ethics Committee (Approval No: 1200000620). A package, containing a participant information sheet, a self-administered questionnaire and envelopes, was left with the head nurse of each oncology unit for distribution to staff and attached to the notice board in the nursing office so that nurses on other shifts could obtain information about the study. Participants could answer the questionnaire at a convenient time and deposit it, in a sealed envelope, into a box located in the nursing offices of each ward. The box was sealed so that nurses choosing to participate were not identified and their responses remained confidential.
Data collection
The Statistical Package for Social Sciences (SPSS) version 21 for Windows was used to analyse the data. The level of significance for all analyses was set at less than 0.05 (p ≤0.05). Frequencies and percentages were calculated for each of the varia-
Ethical clearance was obtained from the Hanoi School of Public Health Ethical Committee (Approval No: 012-144/DD-YTCC) and Queensland University of Technology Human
450
Data analysis
© 2014 MA Healthcare Ltd
Percentage of work involved in caring for the dying
International Journal of Palliative Nursing 2014, Vol 20, No 9
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 23, 2015. For personal use only. No other uses without permission. . All rights r
Research
Table 2. Levels of palliative care knowledge, attitudes and perceived self-competence. Variables
Mean ± SD
Total knowledge score (possible score: 0–34)
19.8 ± 3.38
Principle (possible score: 0–6)
3.84 ± 1.03
Pain and symptom management (possible score: 0–21)
11.13 ± 2.7
Psychological and spiritual care (possible score 0–7)
4.82 ± 1.21
Total Attitudes to Care of the Dying score (possible score: 30–150)
103.54 ± 7.46
Attitudes towards patients with terminal illnesses (possible score: 21–105)
69.77 ± 3.7
Attitudes towards the patient’s family (possible score: 9–45)
33.77 ± 3.76
Total perceived self-competence score (possible score: 34–204)
126.81 ± 33.11
Pain management (possible score: 3–18)
10.56 ± 3.18
Other symptoms management (possible score: 4–24)
15.6 ± 4.1
Psychological care (possible score: 3–18)
11.8 ± 3.34
Social care (possible score: 2–12)
4.1 ± 1.45
Spiritual care (possible score: 4–24)
13.6 ± 4.3
Care associated with functional status (possible score: 3–18)
11.12 ± 3.4
Ethical and legal issues (possible score: 4–14)
14.6 ± 4.48
Interprofessional collaboration and communication (possible score: 3–18)
11.7 ± 3.9
Personal and professional issues related to nursing care (possible score: 4–24)
14.8 ± 4.36
End-of-life care (possible score: 4–24)
16.15 ± 4.1
bles and the data were verified. The KolmogorovSmirnov (K-S) test was employed to determine the normality of total scores of the three factors (i.e. palliative care knowledge, attitudes and perceived self-competence). Then, bivariate analysis (students t-test for two groups; ANOVA (analysis of variance) for more than two groups of independent variables; Pearson’s correlation for continuous independent variables) was used to explore the associations between background characteristics and total score of each factor. Lastly, Pearson’s correlation was performed to identify relationships between these three factors.
Results
© 2014 MA Healthcare Ltd
Characteristics of participants A total of 251 responses were received, representing 71.7% of nurses across the three oncology settings. The study sample consisted predominantly of women (91.6%) with a mean age of 30.98 (SD=7.09, range from 21 to 55). The most common educational level was secondary (2 years) (60.8%). More than one-third had not received any palliative care education (35.5%) while 44.3% nurses reported that ≥51% of their work was related to caring for the dying. Table 1 displays the summary of background characteristics of respondents.
Palliative care knowledge Symptom and pain management The mean total knowledge score was 19.8
International Journal of Palliative Nursing 2014, Vol 20, No 9
(SD=3.38) on a scale ranging from 9 (low knowledge) to 32 (high knowledge) (Table 2). With regards to questions on symptom and pain management, the study sample showed a lack of understanding in this domain of care. For example, only one fifth of respondents (19.7%) correctly identified that ‘The progress of disease does not determine the pain treatment methods’ and 73.5% of respondents incorrectly believed that ‘drug addiction is a serious problem when morphine is used on a long-term basis for the management of cancer pain’. Only 10 of 22 questions in this domain were correctly scored by more than 50% of the nurses surveyed. Psychological and spiritual care In terms of psychological and spiritual care, more than half (60.3%) of the respondents were incorrect in believing that ‘men resolve their grief more quickly than women’ and 54.8% of nurses were incorrect in choosing ‘rejecting help always indicates that informal caregivers are overburdened’. The remaining items were correctly scored by 50%–96% of nurses. Basic principles of palliative care Overall, the results indicated lower scores in nurses’ palliative care knowledge regarding pain and symptom management and psychological and spiritual domains. However, a better understanding was found in the knowledge of palliative care principles, with at least 50% of the
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Research
Table 3. Relationships between independent variables and three outcome variables Categorical independent variables
Knowledge Mean (95% CI) t-test/ANOVA (p value)
Attitudes Mean (95% CI) t-test/ANOVA (p value)
Perceived self- competence Mean (95% CI) t-test/ANOVA (p value)
3-year bachelor and secondary nurses
19.63 (18.95–20.01) t=-1.975*
99.03 (98.06–99.96)
124.75 (119.46–129.83) t= -1.739
4-year bachelor nurses
20.72 (19.07–21.09) (0.049)
102.24 (100.14–104.52) t=-2.301* (0.02)
135.03 (125.43–144.61)
None
19.33 (18.6–19.9)
t=-1.627
99.09 (97.65–100.47)
119.29 (111.69–127.16) t=-2.484*
Yes
20.05 (19.5–20.54)
(0.11)
100.03 (98.82–101.23)
Education profile (0.084)
Palliative care education t=-0.477 (0.63)
130.56 (124.89–136.09) (0.018)
Percentage of work involved in caring for the dying 0–25%
18.83 (11.8–25.87)
101.66 (86.75–116.57)
118.75 (38.98–198.52)
26–50%
19.77 (19.15–20.38)
102.74 (101.4–104.13) F=3.44* (0.034)
119.51 (112.50–126.53) F=1.548 0.216
≥51
20.33 (19.63–21.03)
105.27 (102.8–104.82)
128.02 (121.42–134.63)
Surgical
19.43 (18.77–20.09)
102.98 (101.4–104.6)
133.24 (125.94–140.54)
Medical
20.65 (19.70–21.61)
102.5 (99.92–105.08)
132.39 (121.00–143.58)
Palliative care units
22.95 (21.58–24.32)
104.14 (100.1–108.45)
141.85 (133.12–148.57) F=8.836*** (
