Palliative Care Practice and Associated Factors Among Nurses Working in Chronic Care Units of Tertiary Hospitals in Ethiopia: A Cross-Sectional Study

Figures & data

Table 1 Socio-Demographic Characteristics of Nurses Who Worked in Chronic Units of Tertiary Hospitals in Ethiopia

Variables	Category	Frequency (N)	Percentage (%)
Hospital	Tikur Anbessa Hospital	147	59
	St. Paul’s Hospital	71	28.5
	Hawassa Hospital	31	12.5
Sex	Male	107	43
	Female	142	57
Age	20–30	101	40.6
	31–40	103	41.3
	41–50	35	14.1
	>50	10	4
Marital status	Married	134	53.8
	Single	108	43.4
	Widowed	1	0.4
	Divorced	6	2.4
Religion	Orthodox	141	56.6
	Muslim	39	15.7
	Catholic	11	4.4
	Protestant	58	23.3
Level of education	BSc	192	77.1
	MSc	57	22.9
Working department	Cancer center	132	53
	Chronic wards	75	30.1
	ART clinic	42	16.9
Experience	<=2 years	99	39.8
	2–5 years	117	47
	>5 years	33	13.2
Monthly income	4000–6000	75	30.2
	6001–8000	92	36.9
	≥8001	82	32.9

Table 2 Response of Tertiary Hospitals’ Nurses on Questions Related to Institutional Factors for Palliative Care

Variables	Category	Frequency (N)	Percent (%)
Training	Yes	81	32.5
	No	168	67.5
Workload	Yes	189	75.9
	No	60	24.1
Guideline utilization	Yes	99	39.8
	No	150	60.2
Barriers to deliver PC	Yes	179	71.9
	No	70	28.1

Table 3 Tertiary Hospitals’ Nurses’ Responses to Questions Regarding Their Knowledge of Palliative Care

variables	Category	Frequency (N)	Percent (%)
Do you know the definition of PC	Yes	218	87.8
	No	30	12.
	Do not know	1	0.4
Palliative care is appropriate only in situations where there is evidence of a downhill trajectory or deterioration.	Yes	84	33.7
	No	163	66.5
	Do not know	2	0.8
The extent of the disease determines the method of pain treatment.	Yes	96	38.6
	No	150	60.2
	Do not know	3	1.2
Adjuvant therapies are important in managing pain.	Yes	188	75.5
	No	59	23.7
	Do not know	2	0.8
Drug addiction is a major problem when morphine is used on a long-term basis for the management of pain.	Yes	86	34.5
	No	160	64.3
	Do not know	3	1.2
The provision of PC requires emotional detachment.	Yes	68	27.3
	No	163	65.5
	Do not know	18	7.2
During the terminal stages of an illness, drugs that can cause respiratory depression are appropriate for the treatment of severe dyspnea.	Yes	172	69.1
	No	68	27.3
	Do not know	9	3.6
The philosophy of PC is compatible with that of aggressive treatment.	Yes	182	73.1
	No	54	21.7
	Do not know	13	5.2
The use of placebos is appropriate in the treatment of some types of pain.	Yes	195	78.3
	No	44	17.7
	Do not know	10	4
Meperidine (Demerol) is not an effective analgesic in the control of chronic pain.	Yes	163	65.5
	No	67	26.9
	Do not know	19	7.6
The accumulation of losses renders burnout inevitable for those who seek work in PC.	Yes	85	34.1
	No	159	63.9
	Do not know	5	2
Manifestations of chronic pain are different from those of acute pain.	Yes	186	74.7
	No	61	24.5
	Do not know	2	0.8
Terminally ill patients have the right to choose “Do not resuscitate” (DNR).	Yes	186	74.7
	No	55	22.1
	Do not know	8	3.2

Table 4 Tertiary Hospitals’ Nurses’ Response to Questions on Attitude Towards Palliative Care

Variables	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
	N (P)	N (P)	N (P)	N (P)	N (P)
Giving nursing care for patients is a worthwhile learning experience	13 (5.2)	36 (14.5)	23 (9.2)	118 (47.4)	59 (23.7)
Death is not the worst thing that can happen to a person.	36 (14.4)	79 (31.7)	15 (6)	84 (33.7)	35 (14)
I would be uncomfortable talking about impending death with the dying person.	25 (10)	81 (32.5)	15 (6)	86 (34.5)	41 (16.5)
Nursing care for the patient’s family should continue throughout the period of grief and bereavement.	20 (8)	75 (30)	13 (5.2)	83 (33.3)	58 (23.2)
I would not want to be assigned to care for a dying person.	23 (9.2)	79 (31.7)	19 (7.6)	75 (30.1)	53 (21.2)
The nurse should not be the one to talk about death with the dying person.	42 (16.8)	99 (39.7)	9 (3.6)	66 (26.5)	33 (13.25)
The length of time required to give nursing care to a dying person would frustrate me.	21 (8.4)	92 (36.9)	18 (7.2)	80 (32.1)	38 (15.26)
It is difficult to form a close relationship with the family of a dying person.	33 (13.2)	95 (38.1)	15 (6)	79 (31.7)	27 (10.8)
There are times when death is welcomed by the dying person	32 (12.9)	88 (35.3)	30 (12)	68 (27.3)	31 (12.4)
When a patient asks, “nurse, am I dying?”, I think it is best to change the subject to something cheerful.	36 (14.4)	125 (50)	19 (7.6)	43 (17.2)	26 (10.4)
The family should be involved in the physical care of the dying person.	20 (8)	66 (26.5)	18 (7.2)	88 (35.3)	57 (22.8)
I am afraid to become friends with a dying person.	20 (8)	91 (36.5)	15 (6)	79 (31.7)	44 (17.6)
I would feel like running away when the person actually died.	24 (9.6)	83 (33.3)	14 (5.6)	79 (31.7)	49 (19.6)
As a patient nears death, the nurse should withdraw from his/her involvement with the patient.	21 (8.4)	82 (32.9)	18 (7.2)	73 (29.3)	55 (22.1)
Families should be concerned about helping their dying member make the best of his/her remaining life.	34 (13.6)	62 (24.8)	11 (4.4)	94 (37.7)	48 (19.2)
Families should maintain as normal an environment as possible for their dying member.	13 (5.2)	66 (26.5)	18 (7.2)	94 (37.7)	58 (23.2)
It is beneficial for the dying person to verbalize his/or feelings.	15 (6)	61 (24.49)	15 (6)	102 (40.9)	56 (22.4)
Nursing care should extend to the family of the dying person.	18 (7.2)	61 (24.4)	17 (6.8)	95 (38.1)	58 (23.2)
Addiction to pain relieving medication should not be a nursing concern when dealing with a dying person.	40 (16)	101 (40.5)	19 (7.6)	59 (23.6)	30 (12)
I would be uncomfortable if I entered the room of a terminally ill person and found him/her crying.	40 (16)	101 (40.5)	19 (7.6)	59 (23.6)	30 (12)
Family members who stay close to a dying person often interfere with the professionals’ job with the patient.	37 (14.8)	58 (23.2)	17 (6.8)	94 (37.7)	43 (17.2)

Table 5 Tertiary Hospitals’ Nurses’ Response to Each of the Nurses-to-Patient Communication Questions

Questions	Never	Rarely	Sometimes	Often	Always
	N (P)	N (P)	N (P)	N (P)	N (P)
Do you inform the patients their right?	7 (2.8)	36 (14.4)	26 (10.4)	129 (51.8)	51 (20.4)
Do you inform patients of the results when taking their vital signs (blood pressure, temperature, heart rate)?	4 (1.6)	72 (28.9)	25 (10)	78 (31.3)	70 (28.1)
Do you give the patient information on any diagnostic tests (namely the type of test, its purpose, preparation and what will happen during the test?	7 (2.8)	70 (28.1)	37 (14.8)	80 (32.1)	55 (22)
Do you inform the patient about the medication-taking during hospitalization (kind, dose, side effects)?	13 (5.2)	55 (22)	38 (15.2)	86 (34.5)	57 (22.8)
Do you keep patients informed on the condition of their health?	6 (2.4)	50 (20)	51 (20.4)	87 (34.9)	55 (22)
Do you inform the family about the health conditions of critical patients and children?	3 (1.2)	62 (24.8)	40 (16)	40 (36.9)	40 (20.8)
Do you try to include/inform them about the decisions related to their therapy?	6 (2.4)	49 (19.6)	49 (19.6)	91 (36.5)	54 (21.6)
Do you provide information to the patients when they ask you?	2 (0.8)	53 (21.2)	45 (18)	98 (39.3)	51 (20.4)
Are you polite and friendly towards your patients (manner of speaking, protection of privacy, respect in diversity)?	4 (1.6)	42 (16.8)	56 (22.4)	86 (34.5)	61 (24.4)
Do you immediately respond to their call for help (notification button, sign)?	1 (0.4)	38 (15.2)	53 (21.2)	95 (38.1)	62 (24.8)
Do you inform the patients on how to take care of their self at home after being released from the hospital?	5 (2)	30 (12)	44 (17.6)	102 (40.9)	68 (27.3)
Do you inform the patients about positions which help to alleviate pain?	3 (1.2)	39 (15.6)	41 (16.4)	89 (35.7)	77 (30.9)
Do you dedicate adequate time to communicate with patients?	5 (2)	29 (11.6)	37 (14.5)	99 (39.8)	79 (31.7)
Do you respond to the patients’ concerns and complaints during their stay at the hospital?	3 (1.2)	16 (6.4)	25 (10)	153 (61.4)	52 (20.9)

Table 6 Tertiary Hospitals’ Nurses’ Response to Each of the Palliative Care Practice-Related Questions

Questions	Categories	Frequency	Percent (%)
When do you initiate palliative care discussion?	During diagnosis	173	69.5
	When the disease progress	55	22.1
	At the end of life	21	8.4
Do you inform terminal ill patient about their diagnosis?	Yes	135	54.2
	Depending on family’s wish	218	87.6
What are the factors you consider when you treat terminally ill patient?	Spiritual /religious	198	79.5
	Medical situation	212	85.1
	Culture	202	81.1
	Psychological conditions	166	66.7
How would address spiritual issues and your concerns to the patients.	Connect with spiritual counselor or pastoral care	80	32.1
	Listen with empathy	58	23.3
	Impose your own view	69	27.7
	Understand patient’s reaction.	42	16.9
Culture assessment during patient care include	Truth telling and decision –making	203	81.5
	Preferences regarding disclosure of information.	166	66.7
	Perspective of death, suffering	155	62.2
How do you address psychological issues of the patient during care?	Emotional support	212	85.1
	Counseling patients	183	73.5
	Hide the truth about prognosis of the disease	32	12.9
In your current practice whom do you involve in the decision-making process related patient condition?	Patient	202	81.3
	Family	113	45.4
	My own	249	100
	Other health professional	201	80.7
How do you perceive terminally ill patient concern or question?	Patient right	206	82.7
	Treat	26	10.4
	Doubting your professionalism	17	6.8
Communication to the family of terminally ill patient depends on:	Family’s ability to assimilate	187	75.1
	Their involvement in decision making	146	58.6
	Your willingness to disclose information	56	22.5
Types of pain medication /analgesics commonly used in your practice for Pain	Paracetamol suppository syrup	147	59.0
	Codeine	197	79.1
	Morphine	219	88.0
How do you assess patient pain?	Using tools for assessment	222	89
	Observation	190	76.3
	Grade with face	105	42.2
	Intensity	65	26.1

Table 7 Multivariable Logistic Regression Analysis of Tertiary Hospitals’ Nurses’ Practice of Palliative Care and Its Associated Factors

Variables	Practice of Nurses		COR	P-value	AOR	P-value
	Poor N(P)	Good N(P)
Age
20–30	50(46.7%)	51(35.9%)	1		1
31–40	41(38.3)	62(43.7%)	1.48 (0.85–2.58)	0.164	1.70 (0.82–3.54)	0.152
41–50	8(7.5%)	27(19%)	3.30 (1.37–7.97)*	0.008	2.44(0.79–7.50)	0.119
>50	8(7.5%)	2(1.4%)	0.24 (0.05–1.21)	0.085	0.38(0.04–3.62)	0.406
Study participants’ working Hospital
Tikur Anbessa	82(76.6%)	65(45.8%)	1		1
St. Paul’s	14(13.1%)	57(40.1%)	5.13(2.63–10.02)*	0.001	5.41(2.35–12.47)**	0.001
Hawassa	11(10.3%)	20(14.1%)	2.29(1.02–5.12)*	0.043	1.20(0.41 −3.50)	0.739
Educational competency
Bachelor of science	99(92.5)	93(65.5)	0.15(0.06–0.34)*	0.001	0.35(0.13–0.93)**	0.037
Master of science	8(7.5)	49(34.5)	1		1
Working department
Cancer center	49(45.8%)	83(58.5%)	1		1
ART	19(17.8%)	23(16.2%)	0.71(0.35–1.44)	0.349	0.67(0.27–1.64)	0.383
Chronic OPD	39(36.4%)	36(25.4%)	0.54(0.30–0.96)*	0.038	0.50(0.23–1.07)	0.077
Experience
≤ 2 years	38(35.5%)	61(43%)	1		1
2–5 years	50(46.7%)	67(47.2%)	0.51(0.48–1.44)	0.706	1.07(0.52–2.19)	0.843
> 5 years	19(17.8%)	14(9.9%)	2.5(1.02–6.08)*	0.043	2.37(0.76–7.37)	0.135
Training
Yes	26(24.3%)	55(38.7%)	0.50(0.29–0.88)*	0.017	0.587(0.28–1.22)	0.156
No	81(75.7%)	87(61.3%)	1		1
Knowledge level
Poor	85(79.4%)	57(40.1%)	0.17(0.10–0.30)*	0.001	0.22(0.11–0.47)**	0.001
Good	22(20.6)	85(59.9%)	1		1
Attitude level
Unfavorable	50(46.7%)	32(22.5%)	3.11(1.75–5.53)*	0.001	0.32(0.16–0.65)**	0.002
Favorable	57(53.3%)	110(77.5%)	1		1

Notes: *p-value < 0.20; **p-value < 0.05.

Abbreviations: COR, crude odds ratio; AOR, adjusted odds ratio.