Analysis of Nurses' Knowledge in the Implementation of End of Life Care in Intensive Care Units in Indonesia

Abstract

End of life care is a form of comprehensive care to help patients with life-threatening conditions and their families, which can be implemented in the intensive care unit (ICU) setting. The aim of this study was to analyze factors associated with nurses’ knowledge in implementing end of life care in the ICU. This study was quantitative research which used an analytic-correlational design with a cross-sectional study approach. The sampling technique used was total sampling, and all nurses working in the ICU of the hospital were recruited (n=40). The research instruments used were a socio-demographic form and a modified RN End of Life Knowledge Assessment survey. This study found that 12.5% of respondents had working experience of at least 72 months; 52.5% had diploma level of education; and 67.5% had poor knowledge. No respondents had obtained training previously. No significant association was found between knowledge and educational level (p = 0.269) or working experience (p = 0.801) using the Spearman test.


Keywords: end of life care, ICU, knowledge factors, nurses

References
[1] Adamski J, Goraj R, Onichimowski D, Gawlikowska E, Weigl W. The differences between two selected intensive care units located in central and northern Europe: Preliminary observation. Anaesthesiology Intensive Therapy. 2015;47(2):117–24.

[2] Salime RAA. Knowledge and practices of nurses about end of life nursing care for critically ill patients, manial University Hospital: A suggested intervention protocol [CU Theses]. 2012;

[3] Beckstrand RL, Kirchhoff KT. Providing end-of-life care to patients: Critical care nurses’ perceived obstacles and supportive behaviors. American Journal of Critical Care. 2005;14(5):395–403.

[4] Curtis JR, Treece PD, Nielsen EL, et al. Integrating palliative and critical care: Evaluation of a quality-improvement intervention. American journal of respiratory and critical care medicine. 2008;178(3):269–75.

[5] Enggune M, Ibrahim K, Agustina HR. Persepsi perawat neurosurgical critical care unitterhadap perawatan pasien menjelang ajal. Jurnal Keperawatan Padjadjaran. 2014;2(1).

[6] Davis A. An assessment of nurses’ knowledge and attitudes toward end of life care pain management. Gardner-Webb University; 2014.

[7] Ferrell BR, Coyle N, Paice J. Oxford textbook of palliative nursing. Oxford University Press; 2014.

[8] Ruland CM, Moore SM. Theory construction based on standards of care: A proposed theory of the peaceful end of life. Nursing Outlook. 1998;46(4):169–75.

[9] World Health Organization. WHO definition of palliative care. Geneva: World Health Organization; 2016.

[10] Registered Nurses’ Association of Ontario. End-of-life care during the last days and hours. Regist Nurses’ Association Ontario. 2011;(Sept):123.

[11] Henny P. Care homes and equipment guiding principles for assessment and provision. Royal College of Occupational Therapists; 2019.

[12] Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine. Critical Care Medicine. 2008;36(3):953–63.

[13] Kementerian kesehatan RI. Departemen kesehatan republik Indonesia Jakarta; 2008.

[14] Ayed A, Sayej S, Harazneh L, Fashafsheh I, Eqtait F. The nurses’ knowledge and attitudes towards the palliative care. Journal Education Practice. 2015;6(4):91–9.

[15] Harris M, Gaudet J, O’reardon C. Nursing care for patients at end of life in the adult intensive care unit. Journal Nurse Education Practice. 2014;4(6):84.

[16] Skår R. Knowledge use in nursing practice: The importance of practical understanding and personal involvement. Nurse Education Today. 2010;30(2):132–6.

[17] Guadu T, Anteneh S, Kassa H, Demeke T. Assessment of nurses’ knowledge, attitude, practice and associated factors towards palliative care: In the case of amhara region hospitals. Advances in Biological Research. 2016;10(2):110–23.

[18] Mandesh A. Knowledge practice and associated factors towards pediatrics palliative care of nurses working at selected hospitals in Addis Ababa, Ethiopia. College of Health Sciences School of Alllied Health Science Department of Nursing and Midwifery Assessment of Nurses; 2014.

[19] Wulandari F. Hubungan tingkat pengetahuan perawat tentang perawatan paliatif dengan sikap terhadap penatalaksanaan pasien dalam perawatan paliatif di RS Dr. Moewardi surakarta. Universitas Muhammadiyah Surakarta; 2012.

[20] Budiman RA. Kapita selekta kuesioner: pengetahuan dan sikap dalam penelitian kesehatan. Jakarta Salemba Medika. 2013;2013:4-8.

[21] Siagian E. Hubungan pengetahuan dan sikap tenaga kesehatan terhadap kematian tentang keperawatan paliatif. Chmk Nursing Scientific Journal. 2020;4(Sept):278–84.

[22] City of Hope Pain, Palliative Care Resource City Center. Instruments used in end of life (EOL) care education. Nursing Outlook. 2014.

[23] Sorifa B, Mosphea K. Knowledge and practice of staff nurses on palliative care. IJHRMLP. 2015;1(2):41–5.

[24] Tarihoran D, S S, W G. Indonesian palliative care - Background result recommendation. 2017.

[25] Zaghla H, Yossef W, Ali Z, Salime RAA. Knowledge and practice of nurses about end of life nursing care for critically ill patients. Cairo University Hospital: A suggested intervention protocol. 2014.

[26] Rahmadhani N, Studi P, Keperawatan I, Kedokteran F, Ilmu D, Yogyakarta UM. Naskah publikasi. 2014.

[27] Siringoringo E, Nontji W, Hadju V. Faktor – faktor yang berhubungan dengan stress kerja perawat di ruang icu rs stella maris makassar. Jurnal Kesehatan Panrita Husada. 2017;2(1):9–19.

[28] Intan N, Hk H, Hotmaida L. Hubungan tingkat stres kerja dengan tingkat kelelahan kerja perawat icu rumah sakit immanuel bandung abstrak pendahuluan rumah sakit adalah institusi pelayanan kesehatan yang menyelenggarakan pelayanan kesehatan perorangan secara paripurna yang terdiri da. 2015;9:487–500.

[29] Said AT. Knowledge and practice of intensive care nurses on prevention of ventilator associated pneumonia at Muhimbili national hospital, Dar es Salaam, Tanzania. Muhimbili University of Health and Allied Sciences; 2012.

[30] Huijer HA-S, Dimassi H. Palliative care in Lebanon: Knowledge, attitudes and practices of physicians and nurses. Journal Medicine Liban. 2007;55(3):121–8.

[31] David A, Banerjee S. Effectiveness of “palliative care information booklet” in enhancing nurses’ knowledge. Indian Journal Palliative Care. 2010;16(3):164.

[32] Al-Kindi SG, Zeinah GFA, Hassan AA. Palliative care knowledge and attitudes among oncology nurses in Qatar. American Journal of Hospice and Palliative Medicine. 2014;31(5):469–74.

[33] Joseph J. An evaluation to assess the knowledge regarding palliative care in neonatal nursing among staff nurses working in selected hospitals at Bangalore. International Journal of Public Health Science (IJPHS). 2013;2(2):67–74.

[34] Harazneh L, Ayed A, Fashafsheh I, Ali GAE-N. Knowledge of palliative care among bachelors nursing students. Journal of Health, Medicine and Nursing. 2015;18:25– 32.

[35] Kassa H, Murugan R, Zewdu F, Hailu M, Woldeyohannes D. Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia. BMC Palliative Care. 2014;13(1):6.

[36] Notoatmodjo S. Promosi kesehatan, teori & aplikasi. Jakarta: Rineka Cipta; 2010.

[37] Joy YL. The influence of a palliative care education intervention in increasing knowledge and self-efficacy of nurses practicing in long-term care. 2015.

[38] Malloy P, Paice J, Coyle N, Coyne P, Smith T, Ferrell B. Promoting palliative care worldwide through international nursing education. Journal Transculture Nursing. 2014;25(4):410–7.

[39] Choi M, Lee J, Kim S, Kim D, Kim H. Nurses’ knowledge about end-of-life care: Where are we? The Journal of Continuing Education in Nursing. 2012;43(8):379–84.

[40] Sullivan AM, Lakoma MD, Billings JA, Peters AS, Block SD. Teaching and learning end-of-life care: Evaluation of a faculty development program in palliative care. Academic Medicine. 2005;80(7):657–68.

[41] Thomas N, Nixen N, Ramshida T, Gireesh G. A descriptive study to assess the knowledge and attitude of staff nurses regarding palliative care in selected hospital, mangaluru. American International Journal of Research in Humanities, Arts and Social Sciences. 2015;13(1).

[42] Alshaikh Z, Alkhodari M, Sormunen T, Hilleras P. Nurses’ knowledge about palliative care in an intensive care unit in Saudi Arabia. Middle East Journal Nurse. 2015;9(1):3– 6.

[43] Hunt DP. The concept of knowledge and how to measure it. Journal Intellectual Capital. 2003. [44] Notoatmodjo S. Ilmu kesehatan masyarakat. 2003.

[45] Fridh I, Forsberg A, Bergbom I. Doing one’s utmost: Nurses’ descriptions of caring for dying patients in an intensive care environment. Intensive Critical Care Nursing. 2009;25(5):233–41.

[46] Gaffney MK. Critical care nurses’ perceptions of their knowledge and self-efficacy about providing end-of-life care. Walden University; 2015.

[47] Prem V, Karvannan H, Kumar SP, et al. Study of nurses’ knowledge about palliative care: A quantitative cross-sectional survey. Indian Journal Palliative Care. 2012;18(2):122.

[48] Ningsih NS. Pengalaman perawat dalam memberikan perawatan paliatif pada anak dengan kanker di wilayah Jakarta. Universitas Indonesia; 2011.

[49] Saunders DC. End of life care strategy. Journal Community Nurse. 2008;22(8–9):27.

[50] Muscat RJ. Training. United States: Thail; 2019.