Nurses' knowledge, attitude, and competence regarding palliative and end-of-life care: a path analysis

Nurses' knowledge regarding palliative and end-of-life (EOL) care has been documented, but the competence of nurses in Taiwan has not been deeply analyzed and may affect the use of EOL care.

We aimed to (1) assess the palliative care knowledge, competence and attitude of nurses in a general hospital and (2) examine the paths connecting nurses' demographic characteristics, previous experiences, knowledge, competence, and attitude.

A correlational, cross-sectional survey design was implemented to recruit 682 eligible nurses. The questionnaires included demographic information and palliative and EOL care knowledge, attitude, and competence scales. Path analysis was employed for statistical analysis using structural equation modeling.

Overall, 76% of the questions assessing palliative and hospice knowledge were answered correctly. Nurses' palliative attitudes were divided into "positive perception" and "negative perception". "Positive perception" was highly correlated with competence (r = 0.48, p < 0.001), but "negative perception" was not significantly correlated with competence (r = -0.07, p = 0.25). "Positive perception" (β =  -0.01, p = 0.84) and competence (β =  0.02, p = 0.80) were not related to palliative knowledge. "Negative perception", however, was negatively associated with palliative knowledge (β =  -0.20, p < 0.01).

This study suggests continuing education to decrease nurses' "negative perception" attitude regarding the provision of information to patients and families to provide better palliative and EOL care.

Nurses' attitudes and competences with respect to palliative care and EOL care are critical. Areas for further research and advanced palliative and EOL care-related education and training are suggested and may be applied in future clinical interventions.