Elsevier

Nurse Education Today

Volume 80, September 2019, Pages 15-21
Nurse Education Today

Attitudes and knowledge of undergraduate nursing students about palliative care: An analysis of influencing factors

https://doi.org/10.1016/j.nedt.2019.05.040Get rights and content

Abstract

Background

With the growing aging population, continual increase of the number of the old, and increase of cancer survival rate, palliative care is being considered a global public health issue. As a core force for the sustainable development of the nursing field, undergraduate nursing students' knowledge about and attitudes toward palliative care will directly affect the quality of care for dying patients in the future.

Objective

To investigate undergraduate nursing students' knowledge about and attitudes toward palliative care and analyze their influencing factors.

Methods

This descriptive and cross-sectional survey was conducted in 2016. A total of 1200 Chinese undergraduate nursing students were randomly selected as the survey subjects using stratified sampling method. The revised palliative care quiz for nursing (PCQN) and a self-designed questionnaire were used to measure students' knowledge and attitudes.

Results

The mean score of the revised PCQN was 16.10 ± 5.04. Only a few respondents (19.8%) expressed desire to work in palliative care in the future. The findings show that knowledge and school, grade, gender, birthplace, and religious beliefs have statistically significant impacts (P < 0.01). In addition, logistic regression analysis showed that talking about death and caring for dying family members can have a significant influence on students' attitudes (P < 0.05).

Conclusion

At present, Chinese undergraduate nursing students' knowledge about palliative care is minimal with the majority holding negative attitudes. Thus, the development of an effective end-of-life care program for nursing students is critical.

Introduction

The National Bureau of Statistics of China released a population data on 28 February 2019, showed that the number of people aged 60 and above was 249.49 million, which accounted for 17.9%. Furthermore, the population aged 65 and above was 166.58 million, which accounted for 11.9% percent of the total population by the end of 2018 in China (National Bureau of Statistics of China, 2019). With the rapidly aging population and improved cancer survival rate, the number of patients that require quality palliative care is also increasing (Park et al., 2019). Nurses play an essential role in providing palliative care to terminally ill patients and their family members because they spend the longest time with patients and their proximity to patients' bedsides (Smith et al., 2018; Khraisat et al., 2017; Sopalliative careheck, 2016; Sarabia-Cobo et al., 2016). However, many studies show that nurses and nursing students lack enough knowledge about palliative care and feel ill-prepared to care for dying patients (Farmani et al., 2019; Sujatha and Jayagowri, 2017; Khraisat et al., 2017; Gilliland, 2015; Gillan et al., 2014; Al Qadire, 2014). Today's students are future nurses, and their knowledge about and attitude toward palliative care will directly affect the quality of care for dying patients in the future. Therefore, improving students' knowledge about palliative care and changing attitudes through palliative education is important.

Glover et al. (2017) reported a study at a university in the southern United States in 2017 and found that nearly 85% of senior nursing students reported that they received inadequate training in palliative and end-of-life care in their baccalaureate programs, and with similar research about nurses in Iran (Jabbari et al., 2019; Dehnavieh et al., 2015). Furthermore, previous researches have demonstrated that education on palliative care and death were excluded in the undergraduate nursing curricula in Argentina, Cameroon, and Korea (Mutto et al., 2007; Bassah et al., 2016; Choi et al., 2012). In Iran, 80% of nurses and nursing students declared that the demand for palliative care is increasing, and they are in need of further knowledge and education (Park et al., 2019; Azami-Aghdash et al., 2015).

To date, reports on knowledge about and attitudes toward palliative care among Chinese nursing students remain lacking. Therefore, the author carried out this study to investigate the level of knowledge and attitude toward palliative care and analyze their influencing factors among Chinese undergraduate nursing students.

Section snippets

Design

In 2016, descriptive research methods and cross-sectional surveys were conducted in China. By using a stratified random sampling method, 1200 undergraduate nursing students from four medical universities in the Guangxi Zhuang Autonomous Region were randomly selected as study samples. The revised palliative care quiz for nursing (PCQN) and a self-designed questionnaire were used to measure students' knowledge and attitudes.

Participants

There are 4 medical universities in Guangxi, namely, Guangxi Medical

Participants

We distributed 1200 questionnaires, and a total of 1156 Chinese undergraduate nursing students responded. A response rate of 96.3% was achieved. The participants' age ranged from 18 to 25 years old (mean = 20.81, SD = 1.37). All participant schools have yet to set an end-of-life care curriculum, and all the students had no clinical practices in hospitals at the moment of the survey. Table 1 presents other detailed demographics.

Knowledge about palliative care and influencing factors

In this study, the mean score was 16.10 (SD = 5.04), and the minimum

Discussion

Our survey results reflect that knowledge about palliative care among Chinese nursing students was insufficient, and a negative attitude was held toward palliative care. To the best of our knowledge, all participant schools have yet to formulate a specialized, compulsory, and unified end-of-life care curriculum at the moment of the survey. That is, the content of palliative care was only embedded in one unit of other nursing specialized courses. As a result, this problem has attracted the

Limitations

Several limitations should be considered. First, this study was conducted in Guangxi without additional data from other provinces. Hence, the results cannot be generalized to all Chinese nursing students. Second, this was a cross-sectional study without longitudinal observation of the subjects. Finally, due to time constraints, we only conducted a questionnaire survey, and did not carry out an intervention. Consequently, future research should improve on these aspects. And now we are preparing

Conclusion

The present findings revealed that knowledge about palliative care among Chinese undergraduate nursing students, specifically in pain management, is deficient. The date analysis indicated that school, grade, gender, birthplace and religious belief were influencing factors on knowledge (P < 0.01). In addition, experiences of talking about death and caring for dying family members positively influenced students' attitudes (P < 0.05). We suggest that medical universities should set up an

Funding

This research was supported by Guangxi Medical University [grant numbers WLXSZX16084, 2018SZ0205] and National Steering Committee for Graduate Education of Medical Professional Degrees [grant numbers B2-YX20180304-04].

Ethical considerations

This study maintains the anonymity of all the participants, who can opt whether or not to participate. Formal written consent was obtained from all participants. We further guaranteed that the identity of the participants will not be disclosed and that their answers will be confidential. Ethical approval for the project was gained from the ethics committees of the universities [grant numbers ECGXMU16293].

Acknowledgment

We would like to extremely thank all participants who accepted and gave their free time to participate in this study as well as investigators for research assistance. The three investigators are Feng HL, Gan QK and Tan ZW. The authors also particularly acknowledge Lan YS for his contribution in data analysis.

Declaration of competing interest

The authors declare no conflicts of interest.

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