| Summary: | 碩士 === 輔英科技大學 === 護理系碩士班 === 108 === Background: Hospice palliative care is primarily employed for caring patients with terminal cancer. Compared with determining patients with terminal cancer, determining whether ventilator-dependent patients with eight noncancer diseases have entered their terminal stage of illness is more difficult. Therefore, the ethical decision of withholding or withdrawing is of marked importance.
Objective: This study explored the relationship between and the attitude toward and the knowledge of nurses (including nurse practitioners) for the care of ventilator-dependent terminally ill patients. Nurses working in the intensive care unit (ICU) of a medical center, a regional teaching hospital, and a district teaching hospital in southern Taiwan were recruited as the participants.
Methods: This study adopted a cross-sectional design and used convenience sampling to recruit 338 nurses who had worked in the ICU of a medical center, a regional teaching hospital, and a district teaching hospital in southern Taiwan for at least 6 months. The “Knowledge and Attitudes of Clinical Nurses Regarding End-of-Life Care” questionnaire developed by Su et al. was employed as the research instrument. This questionnaire comprised 3 sections and 3 self-developed short answer questions. A Chinese version of the SPSS 22.0 software suite was used for descriptive statistics, independent samples t tests, and one-way analyses of variance (ANOVA). If the F-test of the one-way ANOVA achieved significance (α= .05), then the Scheffe’s method was employed to conduct posthoc comparison, a Pearson’s correlation analysis, and a multilinear regression analysis.
Results: The average score of ICU nurses for end-of-life care knowledge was 90.16±11.03, with a Cronbach’s α of .96. Their average score for end-of-life care attitude was 72.46±7.71, with a Cronbach’s α of .94. Results showed that ICU nurses achieved statistical significance in the factors of demographic characteristics, work characteristics, educational attainment, and experience of mourning (p < .05). Results of Pearson’s product–moment correlation analysis showed that the higher positive correlation coefficient the nurses obtained in their “Knowledge of Clinical Nurses Regarding End-of-Life Care Scale” and “Attitudes of Clinical Nurses Regarding End-of-Life Care Scale,” the more sufficient knowledge they had of end-of-life care, and the more positive their attitude became toward such care. In terms of the predictors of nurses’ knowledge of and attitude toward end-of-life care, F-test results from the multilinear regression model achieved significance for both knowledge (F = 6.36, p < .001) and attitude (F = 4.34, p < .001). In addition, t test results showed that nurses’ knowledge of end-of-life care could predict their attitude toward such case; that is, nurses with mire knowledge were more positive toward offering end-of-life patients hospice and palliative care.
Conclusion: ICU nurses’ knowledge of the care for ventilator-dependent terminally ill patients is significantly and positively correlated with their attitude. The more comprehensive the nurses’ knowledge context of end-of-life care is, the more positive and willing they become in actively providing end-of-life care. Comprehensive on-the-job training and clinical practices of hospice palliative care should be implemented in the future to assist terminally ill patients in passing away peacefully.
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