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Hernández-Sánchez ML, Aguilar-García CR. Conocimiento del personal de enfermería sobre cuidados paliativos en pacientes hospitalizados de medicina interna. Rev Enferm Inst Mex Seguro Soc. 2016;24(2):87-90.

Knowledge of nurses on palliative care for internal medicine inpatients

María Lesvia Hernández-Sánchez,¹ César Raúl Aguilar-García²

¹Unidad de Cuidados Intensivos Neonatales, Hospital General de Zona 48, Instituto Mexicano del Seguro Social, Ciudad de México; ²Servicio de Medicina Interna, Hospital General de Zona 197, Instituto Mexicano del Seguro Social, Texcoco, Estado de México. México

Correspondence: María Lesvia Hernández-Sánchez

Emails: ma_leshs197@yahoo.com.mx; miymc2010@hotmail.com

Received: February 25^th 2014

Judged: October 24^th 2014

Accepted: January 16^th 2015

Abstract

Introduction: The care of the patient in terminal stage is becoming increasingly important within the health system and the patient should avoid suffering in the final stage of his life. That is why health professionals must be committed to work together, in order to apply the knowledge and skills and change the attitudes of nurses to effectively carry out palliative care to the suffering and death.

Objective: To determine the level of knowledge of palliative care by the nursing staff.

Methodology: It was carried out a descriptive, transversal study, with 41 nurses of the Internal Medicine department of an area general hospital. Information was collected on a multiple-choice questionnaire, which was based on the level of knowledge of palliative care in various chronic diseases. The information obtained was processed in Word and Excel, and descriptive statistics was applied.

Results: Of the staff, 80.49% knows about palliative care, and 19.51% do not have enough knowledge of what is palliative care.

Conclusions: It is extremely important that nursing staff assigned to internal medicine in area general hospitals have a sufficient level of knowledge about what palliative care is and what it encompasses, in order to provide quality care to avoid the pain and suffering of the terminally ill.

Keywords: Bereavement care; Terminal care; Terminally ill; Palliative care

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Introduction

By the nature of their work, nurses are in constant contact with human suffering and death. Terminally ill patients expect to get the help needed to accept and address that last stage of life, and the care necessary to enable them maintain the greatest possible comfort during those difficult times.¹

In 1990 the World Health Organization (WHO) defined palliative care as the active total care of patients whose disease does not respond to curative treatment. Control of pain and psychological, social, and spiritual problems is paramount. It is emphasized that palliative care should not be limited to the last days of life but applied progressively as the disease progresses and depending on the needs of patients and family.²

In 2002, WHO expanded the definition of palliative care as follows:

An approach that improves the quality of life of patients and families facing the problems associated with life-threatening diseases, through the prevention and relief of suffering by means of early and impeccable identification, assessment and treatment of pain, and other physical, psychological, and spiritual problems.^3,4

Palliative care is directed to the individual based on their integrity, so the intervention of a multidisciplinary team, with the central role of the nurse, is necessary. Different health professionals interact in this team: doctors, nurses, psychologists, physiotherapists, pharmacists, occupational therapists. Its main objective is to provide comfort and quality of life to the patient in the terminal stage.⁵
Several aspects are conjoined in the terminal phase of the disease. These are highlighted below:

1. Presence of advanced, progressive, and incurable disease.
2. Lack of reasonable possibilities of response to specific treatment; presence of numerous problems or multifactorial and changing symptoms.
3. Great emotional impact on the patient, family, and therapeutic team related to the explicit or implicit presence of death.
4. Prognosis of life less than six months.

Not only cancer patients who meet these characteristics are recipients of palliative care.^6,7 There are patients with other diseases (such as progressive and chronic infectious diseases such as HIV/AIDS, chronic respiratory failure, terminal chronic renal failure, heart failure, or degenerative neurological diseases) that require help and support from the multidisciplinary team.⁸ These latter pathologies are the ones nursing staff most frequently face in internal medicine departments at hospitals. The aim of this study was to assess nurses’ level of knowledge about palliative care that they provide to patients with terminal illness in the internal medicine service of an area general hospital.

Methodology

A descriptive transversal study was performed in an area general hospital. The sample included 41 nurses attached to the internal medicine service in all shifts. Inclusion criteria were: a) that the nursing staff belong to any of the five shifts of categories, and b) that the nurses have academic training as nursing assistant, general nurse, specialist nurse, or registered nurse. A questionnaire was applied to the staff in the study, with multiple choice questions and answers about the environment of palliative care generally. Data collection and data analysis was made using descriptive statistics with percentages and simple frequencies, in addition to making graphs. The information was processed in Excel.

Results

When nurses were asked about the concepts of palliative care and terminal illness, 33 (80.49%) replied that they knew them, while 8 nurses (19.51%) did not. Regarding what thanatology is and its object of study, only 4.88% of nursing staff was knowledgeable about that topic. This is of utmost importance for the comprehensive care that these patients and their families should be offered.

51.22% of staff knew about and knew how to use pain intensity rating scales. This shows that half of the staff surveyed apply the nursing process to palliative care by evaluating and estimating the intensity of pain of terminal stage patients.

Regarding knowledge of bioethics in palliative care, 51.22% knew about this, and 100% of the nursing staff knew how to identify a patient in terminal state. 73.17% recognized the signs and symptoms that characterize a terminally ill patient; therefore, when asked if they took a professional and holistic approach in the management and treatment of patients with terminal illness, 87.8% said yes, because 82.93% have knowledge about the stages of grief. An important aspect is the importance that nurses give the patient’s religion and beliefs. Regarding this, 68.3% of staff said it was not very important, 14.63% believed it was very important, and 17.07% said was not important.

Concerning the recommendations to a patient and family to continue palliative care at home, 90.24% of the staff knew what the recommendations are, and 56.19% knew the main purpose of this care. It was satisfactory that 92.68% of staff had knowledge about who should be part of the multidisciplinary team to provide quality palliative care.

Discussion

In recent years, the role of nursing in palliative care has become central. The nurse is the nearest member of the health team and is in close contact with the patient and their family, especially in the terminal phase of illness; therefore, they must perform the care that is necessary in the last leg of the patient’s life.⁹ The International Council of Nurses, in its position statement on care for dying patients and their families, says:

... The role of nursing is fundamental for palliative care to reduce suffering and improve the quality of life of dying patients and their families through early assessment, identification, and the management of pain and physical, social, psychological, spiritual, and cultural needs.^10,11

That is why this study focuses on assessing nurses’ level of knowledge about palliative care to identify, assess, and treat pain as well as all of the family’s needs when facing a situation like this. The results indicate that most of nursing staff knew and properly applied palliative care with an average knowledge of 79.74%. The basic concepts that got the highest knowledge score, with an average knowledge of 76%, were palliative care, terminal illness, identification of pain in a terminal patient, application of pain scales, the goal of palliative care, and makeup of the multidisciplinary team. The lowest percentage were aspects of bioethics with 51.22%. There are two basic aspects of utmost importance of which nurses need to reinforce their knowledge: application of pain scales, and the goal of palliative care (51.22%), as they are essential to provide palliative care with quality.

Conclusions

The need to provide palliative care to the chronically or terminally ill is becoming increasingly important within the health system. For nurses, the existence of a terminally ill patient is challenging, since the patient and their family have different needs throughout the disease process and when facing death. It is extremely important that nursing staff assigned to internal medicine in area general hospitals have a sufficient level of knowledge about what palliative care is and what it encompasses, as these are related to the patients they face and commonly care for. This is essential to providing quality care in health institutions, so it is a priority that 100% of the staff should have adequate training and knowledge to apply them; this way, all will have the same common goal.

References

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