Knowledge and Practice of Nurses on Palliative Care in Tertiary Hospitals

ABSTRACT


INTRODUCTION
Palliative care will necessitate policies and guidelines being in place at the institutional level to ensure that family and community members are trained to care.After guidelines are established, basic medications and supplies can be provided in the hospital, clinic, or home settings.Procurement, storage, and distribution will be integral to any program seeking to provide palliative care.(WHO, 2020).Hundreds of thousands of individuals in Bangladesh, including children, require palliative care today, as they are frequently identified at the end stages of non-communicable diseases due to a lack of knowledge, early detection, and intervention.This guideline is intended to supplement our healthcare practitioners' knowledge in order to offer high-quality care for people with life-threatening conditions in our communities.With the assistance of this guideline, it is intended that the medical community will campaign for the relief of pain and suffering, as well as provide services to people in need.(National Guideline Palliative Care, BSMMU).
A palliative care unit has been designated as a Palliative Care Center (CPC).Currently, the CPC of Bangladesh Sheikh Mujib Medical University provides outpatient services, day care services, 24-hour telephone consultation services, limited home care and bereavement care services within Dhaka city, inpatient services, limited rehabilitation services, training for professionals and community volunteers, and a few research projects.(Bangladesh Burea of Statistics, 2007).The majority of countries do not have official palliative care policies or integrated palliative care services in place to meet basic palliative care standards.(Khan, F. et al., 2008).Treatment of pain and other symptoms in the latter stages of life-threatening diseases such as cancer must be considered in order to maintain quality of life.End-of-life care is one of the tasks that nurses perform on a regular basis.The combined effect of health care personnel's knowledge, attitudes, beliefs, and experiences allows palliative care to be administered successfully.(Etafa W., et al., (2020).Cancer is the most common condition that requires palliative care, and cancer-Corresponding Author: Julia Sultana related death rates in Bangladesh were 7.5 percent in 2005 and are expected to rise to 13 percent by 2030.It's also been noticed that 80-90 percent of these patients who visit oncologists are in an incurable state, with the only choice being palliative treatment, which includes pain control.(NIPORT, 2014).The problem is exacerbated by nurses' lack of awareness of the PC concept and an insufficient regulatory framework for palliative care.During PC nursing, nurses assist patients in coping with emotional challenges that may occur as a result of their illness.(Bibi F., et al., 2020).Palliative care is a multidisciplinary approach that focuses on the patient as well as their loved ones.In the palliative oncology literature, terminology like supporting care, optimum supportive care, palliative care, and hospice care were rarely and inconsistently defined.Palliative care aims to improve patients' quality of life and lessen the burden of sickness by limiting the use of severe therapeutic procedures at the end of life and reducing long-term illness suffering through symptom management, nursing care, and psychosocial and spiritual support.However, the general public is unaware of this therapy method (Zeru, et, al.2020).In the end-stage of life-threatening diseases like cancer, treatment of pain and other symptoms must be considered to preserve the quality of life.End-of-life care is one of the routine activities of nurses.Nurses are an essential part of the palliative care team in providing high standards of care since they spend the longest time with patients.The related study highlighted that nurses' knowledge about palliative care is inadequate.This study will help to indicate the need for coverage of palliative care in the education of in-service nurses to increase their knowledge and therefore practice.

MATERIALS AND METHODS Study design:
The study was a cross-sectional study.

Data collection method/technique
The assessment of the level of knowledge and Practice on palliative care among nurses working in selected tertiary hospitals.The pre-tested semi-structured questionnaire was used.At the beginning of data collection, written permission was taken from the Director of the hospital.Informed written consent was taken from the respondents.Data was collected from the respondents through a face-to-face self-administered questionnaire in Bangla.The respondents were given full assurance on some ethical point, all information will be kept confidential and used for academic purposes only.

DATA PROCESSING AND ANALYSIS
The data collected from respondents were analyzed after the completion of data collection, to maintain consistency, data were checked, edited manually and verified, rearranged, before tabulation.Data were coded, categorized according to objectives &and variables, and edited for analysis on the computer by using the software Statistical Package for Social Science (SPSS) version 23 and Microsoft Excel.

Ethical implication
Ethical clearance of the study was approved by the ethical committee of the Institutional Review Board (IRB), NIPSOM, under BSMMU.Before data collection written permission was taken from the director of the hospitals.Before the collection of data briefly explain the aims of the objectives of the study to the respondents.Informed verbal and written consent were taken.In this study, all participants were treated equally and with respect.Confidentiality of the data was maintained strictly.All rights were given to respondents to withdraw from participation at any time without penalty.Data was used for study purposes only.Table 5 shows that out of 308 nurses' 57.5% (177) had moderate practice, 28.5% (88) had adequate practice and 14.0 % (43) had inadequate practice on palliative care.

DISCUSSION
The study intended to find out the knowledge and practice of nurses on palliative care in selected hospitals of Dhaka city.
Palliative care plays a critical role in enhancing the quality of life for individuals facing serious illnesses.Nurses, as frontline healthcare providers, are central to the delivery of palliative care.The results underscore the need for ongoing education and training in palliative care among nurses.The prevalence of nurses with only average knowledge (58.4%) suggests that there is room for improvement in their understanding of palliative care concepts and practices.This might be attributed to variations in the content and depth of palliative care education during their training.As the healthcare landscape evolves, it becomes crucial for nursing curricula to adequately cover palliative care topics, ensuring that future nurses are well-equipped to provide comprehensive support to patients with life-limiting illnesses.The 27.3% of nurses with good knowledge of palliative care can be seen as a positive outcome.This group is likely to be better prepared to manage pain and symptom control, communicate effectively with patients and their families, and make informed decisions regarding end-of-life care options.These nurses can potentially serve as resources within healthcare teams, sharing their expertise and helping to bridge the knowledge gap among their peers.However, the presence of 14

Study place: The study places were Dhaka Medical College Hospital, National Institute of Cancer Research and Hospital, Bangabandhu Shaikh Mujib Medical University (BSMMU). Study period: The study was conducted for a period of one year starting from 1 st January to 31 st December 2021. Study population: All
nurses who are working in selected tertiary hospitals.

Table - 5: Distribution of nurses according to the level of practice
, 27.3% displayed good knowledge, and 14.3% demonstrated poor knowledge regarding palliative care.
Table 3 provides valuable insights into the distribution of nurses' knowledge levels on palliative care.The findings, based on a sample of 308 nurses, reveal that 58.4% of participants exhibited an average level of Corresponding Author: Julia Sultana knowledge Their competence could potentially be attributed to previous training, experience, or a natural aptitude for palliative care.Recognizing and encouraging the practices that have led to their higher competency could contribute to the overall improvement of palliative care across the nursing workforce.A smaller subset of nurses, comprising 14.0% (43 individuals), is marked as having inadequate practice in palliative care.This group represents an area of concern, as inadequate practice could result in suboptimal care for patients with complex needs.It is imperative to investigate the reasons behind this inadequacywhether it is due to lack of training, unfamiliarity with the principles of palliative care, or other factors.Remedial measures, such as targeted educational interventions and mentorship programs, might be necessary to uplift the practice of these nurses and ensure that patients receive the best possible care.Overall, the distribution of nurses across these categories highlights the need for ongoing education and training in palliative care.Continuous professional development is essential for nurses at all practice levels to ensure that they stay updated with the latest practices and techniques.By addressing the gaps identified in the survey, healthcare institutions can work towards providing consistent, highquality palliative care services to patients who require them.CONCLUSIONIn Bangladesh the concept of palliative care is still a neglected topic.Only a few numbers of institutions and hospitals provide palliative care facilities where as this important issue is being ignored by most of the institution, hospitals and clinics in Bangladesh.Bangladesh is one of the developing countries where non-communicable disease burden is increasing day-by-day and Palliative Care is becoming an important issue of public health concern.Public health approach is necessary for rendering effective Palliative Care services for the patients of incurable diseases in Palliative care centers.In this study nurses had good knowledge and good practice but not satisfactory.The nurses, lack of adequate training in Palliative care was one of the causes of the suffering of patients.Adequate training of nurses is necessary to improve the quality of care for dying people.Head, Dept. of Nutrition& Biochemistry, NIPSOM, Mohakhali, Dhaka, for her expert supervision, invaluable support, kind suggestions and sustained close co-operation.Her guidance helped me in all the time of research and writing of this thesis.
practice to a more advanced level.On the other hand, 28.5% (88 individuals) of the nurses are classified as having adequate practice.This group demonstrates a commendable level of proficiency in palliative care, indicating that they are well-equipped to address the needs of patients requiring such specialized attention.