评估中国癌症病人临终护理过程中护士应具备的能力和素质

Background: This study aimed to determine the competencies of nurses in the care of terminally ill cancer patients in the palliative care unit: Specifically, it was sought answers to the following questions:
What is the profile of the nurses in the Palliative Care Unit in terms of:
 1.1 Age  1.2 Gender  1.3 Education  1.4 Civil Status
 1.5 Work experience in Palliative Care Unit
What is the level of competency of nurses working in the Palliative Care Unit?
How do patients perceive the care given by the staff nurses at the Palliative Care Unit?
Is there a significant difference in the level of end-of-life care competencies of nurses when grouped according to profile variables?
Is there a significant relationship between level of competencies of nurses and patient perception of the care given by staff nurses?
What framework can be developed for an end-of-life care program based on the findings of the study?
Methods: Non-probability sampling was used in this study. 33 staff nurses working in the Palliative Care Unit and 33 patients from the morning shift in PCU were included in this survey. Two questionnaires were used as the main instruments to gather data and information in this study.
To test for the significant differences in the level of competency of staff nurses when they are grouped according the profile variables, analysis of variance (ANOVA) and the t-test were used. To test the relationship between the staff nurses level of competencies and patients perception of end-of-life care, t-test was applied.
1. Question 1: What is the profile of the nurses in the Palliative Care Unit in terms of: Age, Gender, Educational Attainment, Civil Status, Work experience in Palliative Care Unit?
Tables 1 to 5 illustrate the demographic profile of the staff nurses in terms of age, gender, educational attainment and work experience in the Palliative Care Unit.
Table 1 represents the frequency and percentage distribution of the respondents according to age.
Table 2 represents the frequency and percentage distribution of the respondents according to gender.
Table 3 presents the frequency and percentage distribution of the respondents according to Civil Status. .
Table 4 shows the distribution of staff nurse respondents when grouped according to educational attainment.
Table 5 The Frequency and Percentage Distribution of the Nurse Respondents According to years of work experience in PCU.
Table 6 represents that out of the 33patients included in the age category group of 65-74 years old.
Table 7represents the frequency and percentage distribution of the patient-respondents according to gender.
Table 8presents the frequency and percentage distribution of the respondents according to Civil Status.
Table 9presents the frequency and percentage distribution of the patient-respondent according to educational attainment.
Q2. What is the level of competencies of nurses working in the Palliative Care Unit?
 In determining the level of competencies of nurses in PCU, the respondents were asked to measure the extent by which the competencies were performed by them through a Likert-type questionnaire.
Table 10 Level of competencies of nurses in terms of communication skills according to age                  
Table 11 Level of competencies of nurses in terms of communication skills according to educational attainment   
Table 12 Level of competencies of nurses in terms of communication skills according to civil status    
Table 13 Level of competencies of nurses in terms of communication skills according to years in PCU  
Table 14 Level of competencies of nurses in terms of pain management according to age   
Table 15 Level of competencies of nurses in terms of pain management according to educational attainment         
Table 16 Level of competencies of nurses in terms of pain management according to civil status         
Table 17 Level of competencies of nurses in terms of pain management according to years in PCU    
Table 18 Level of competencies of nurses in terms of care of dying patients according to age
Table 19 Level of competencies of nurses in terms of care of dying patients according to educational attainment   
Table 20 Level of competencies of nurses in terms of care of dying patients according to civil status
Table 21 Level of competencies of nurses in terms of care of dying patients according to years in PCU
Table 22 Level of competencies of nurses in terms of support family according to age
Table 23 Level of competencies of nurses in terms of support family according to educational attainment 
Table 24 Level of competencies of nurses in terms of support family according to civil status 
Table 25 Level of competencies of nurses in terms of support family according to years in PCU            
Table 26  Summary  From Table 26. The total mean score for all the indicators of competencies is 3.82. It is interpreted that the competencies of staff nurses in Palliative Care Unit are exhibited to the Moderate extent. This is show that the staff nurses are good in competencies when they provide nursing in End-of-life.
Q3. How do patients perceived the care given by the staff nurses at the Palliative Care Unit?
      Table 27 Patients’ perception of care given by the staff nurse at Palliative Care Unit. The total mean score for all the indicators of patients’ perception is 3.48. It is interpreted that the Patients’ perception of care given by the staff nurse at Palliative Care Unit are exhibited to the Moderate extent.
Q4. Is there a significant difference in the level of competencies of nurses when grouped according to profile variables?
Table 29 Level of competencies of nurses according to age
Table 30 Level of competencies of nurses according to educational attainment           
Table 31 Level of competencies of nurses according to Civil status
Table 32 Level of competencies of nurses according to Work experience
There is a significant difference in the level of competencies of nurses when grouped according to profile variables.
Q5.  Is there a relationship between level of competencies of nurses and patient perception of the care given by staff nurses?
From Table 33, Pearson correlation table shown p=.445, there is no relationship between level of competencies of nurses and patient perception of the care given by staff nurses.
Q6. What framework can be developed for an end-of-life care program based on the findings of the study?
 From this study, there are forth the scope and key elements of thought processes involved in providing palliative care. Specifically, the palliative care skills includes: 1) Communication skills; 2) Pain management; 3) Care of the dying patient, for example, physical care, psychological care and Spiritual care; and 4) Support to the family.
Summary of findings
Majority of the staff nurse respondents are middle adults while majored of the patient respondents belong to old age and most of them are male.
Majority from both groups of respondents are married.
In terms of educational attainment majority of staff nurses (14, 42.4%) finished Junior college which among the patient respondents majority (18, 41.9%) just finished elementary.
Majority of the staff nurses (14, 42.4%) have been working in the Palliative Care Unit from one (1) to three (3) years.
The level of competency of staff nurse is no significant difference.
There is no significant difference in the level of competency of staff nurses when they are grouped according to profile variables.
There is no significant different relationship between the level of competency by the staff nurses and the patients’ perception on the care given them by the staff nurses.
Conclusions
Based on the gathered data, the researcher was able to come up with the following conclusions:
The staff nurses have the necessary competencies to care for terminally ill cancer patients in Palliative Care Units.
The staff nurses’ levels of competency are not affected by profile variables.
In patients perception on the care they received from the staff nurses depend on the level of competency of the staff nurses.
Key words: the competencies of nurse, End-of-life, quality nursing, palliative care.
References
1. Oncology Social Workers' Attitudes toward Hospice Care and Referral Behavior Becker J. E. (2004, February). Health-and-Social-Work, 29(1), 36-45.
2. Stuart Todd. (2002). Death Does Not Become Us: The Absence of Death and Dying In Intellectual Disability Research Journal of Gerontological Social Work, 38 (1/2), 225.
3. Patrick DL, Engelberg RA, Curtis JR. Evaluating the quality of dying and death.J Pain Symptom Manage 2001; 22(3): 717–726.

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