The level of nurses’ knowledge about and attitude towards caring for dying patients and relationship with evidence-based practice among nurses of primary health care organisations in Kazakhstan: a cross‑sectional study

Abstract

Background: To provide quality care at the end of life or for chronically sick patients, nurses must have good knowledge, attitude, and practice about palliative care. Lack of knowledge about palliative care, negative attitudes towards it, as well as gaps in evidence-based practice among nurses, are some of the most common obstacles to quality palliative care.

Methods: To collect data, a cross-sectional questionnaire was administered to 565 nurses working in primary health care organisations in Astana, Kazakhstan. Data collection was completed from January 2022 to March 2023. The questionnaire contained demographic and professional characteristic questions, the Palliative Care Quiz for Nurses (PCQN), the Frommelt Attitudes Towards Care of the Dying (FATCOD), and the Evidence-based Practice Questionnaire (EBPQ). Descriptive statistics, independent t-tests, and one-way ANOVAs were used for analysis.

Results: The sample size was 565 nurses. Nurses’ palliative care knowledge level was low (mean score: 9.06±2.93). The largest number of the correct answers on the PCQN questionnaire was received in the category "Management and control of pain and other symptoms" (49.95%). The majority of nurses (93%) have a neutral or negative attitude towards caring for dying patients (mean score: 94.50±12.41). Only 6.7% of respondents had a positive attitude. The obtained score (4.39 ± 1.05) on the EBPQ scale indicates an average level of competence in evidence-based practice. Age, work experience, educational level, attendance at palliative care training, and good competencies in evidence-based practice are statistically significant factors that affect knowledge of palliative care. The aspect of knowledge/skills in EBP is the most significant (β=0.122; p=0.005).

Conclusions: An insufficient level of nurses' knowledge about palliative care and a neutral or negative attitude towards caring for dying patients was revealed. Health care providers are encouraged to expand palliative care-related training programs, which together can improve the quality of palliative care nursing services for patients. The results also indicate that much attention, and resources should be directed to improving the level of knowledge of nurses in the field of evidence-based practice, because this aspect significantly affects the level of knowledge on palliative care.

Implications for research, policy, and practice: Further research is needed to identify the factors contributing to nurses' inadequate knowledge of palliative care, including gaps in training and cultural or systemic barriers. Policymakers should develop national frameworks for palliative care training and certification, while healthcare institutions should regularly assess and enhance nurses' knowledge through continuous professional development.

What is already known about the topic

• Most nurses do not receive training in palliative care.


• The benefits of using evidence-based medicine in palliative care are described.


• The most common barriers to providing quality palliative care have been described many times.

What this paper adds

• Primary care nurses have insufficient knowledge of palliative care.


• Primary care nurses have a negative or neutral attitude towards palliative care.


• The use of evidence-based medicine by nurses contributes to the formation of a high level of knowledge about palliative care and a positive attitude towards it.