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Zhao J, Wang Y, Xiao B, Ye F, Chen J, Huang Y, Li T, Chen X, Ma H, Zhang Q, Zou Z. Behaviors and influencing factors of Chinese oncology nurses towards hospice care: a cross-sectional study based on social cognitive theory in 2022. BMC Palliat Care 2024; 23:53. [PMID: 38395799 PMCID: PMC10885468 DOI: 10.1186/s12904-024-01385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Although there is growing demand for hospice care in China due to its aging population and increasing cancer rates, the sector remains slow to expand. Oncology nurses are the primary providers of hospice care, but little is known about their behaviors towards hospice care and related factors. METHODS This cross-sectional study conveniently sampled 933 oncology nurses from six grade A tertiary hospitals in Hubei Province between January to March 2022. The questionnaire was composed of seven parts: general information (including sociodemographic and work-related information), hospice care behaviors, hospice care knowledge, hospice care attitudes, hospice care self-efficacy, hospice care outcome expectancy, and hospice care environment. Data were analyzed using descriptive analysis, independent sample t-tests, one-way ANOVA, Pearson's correlation, multiple linear regression, random forest regression, and BP neural network model analysis. RESULTS A total of 852 questionnaires were valid. The mean score of hospice care behaviors was 50.47 ± 10.56, with a mean item score of 3.61 ± 0.75. The three highest scoring behaviors were "pain assessment of patients (4.21 ± 0.91)", "satisfying the physical and mental needs of dying patients (4.04 ± 0.92)", and "creating good relationships between the medical staff and family members (4.02 ± 0.87)". The two lowest-scoring behaviors were "proactively recommending medical institutions for hospice care to terminally ill patients and their families (2.55 ± 1.10)" and "proactively talking to patients and families about death-related topics for patients who are critically ill and cannot be reversed (2.87 ± 1.03)." Multiple linear regression, random forest regression, and BP neural network models all showed that the frequency of sharing hospice care experiences with colleagues, hospice care attitudes, hospice care self-efficacy, and hospice care environments were positively associated with hospice care behaviors. CONCLUSIONS The frequency of hospice care behaviors among Chinese oncology nurses is generally at a moderate to high level. The results provide a basis for promoting hospice care behaviors among oncology nurses in order to improve the quality of life for terminally ill cancer patients.
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Affiliation(s)
- Jing Zhao
- School of Nursing, Wuhan University, Located on No. 115 Donghu Road, Wuhan, Hubei province, 430071, China
| | - Yu Wang
- School of Nursing, Wuhan University, Located on No. 115 Donghu Road, Wuhan, Hubei province, 430071, China
| | - Binbin Xiao
- Renmin Hospital of Wuhan University, No.238 Jiefang Road, WuChang Distirct, Wuhan, Hubei Province, 430060, China
| | - Fucheng Ye
- Wuhan University of Technology, Wuhan, China
| | - Jianfei Chen
- School of Nursing, Wuhan University, Located on No. 115 Donghu Road, Wuhan, Hubei province, 430071, China
| | - Yingjuan Huang
- School of Nursing, Wuhan University, Located on No. 115 Donghu Road, Wuhan, Hubei province, 430071, China
| | - Ting Li
- Hubei Cancer Hospital, Wuhan, China
| | - Xiaoli Chen
- School of Nursing, Wuhan University, Located on No. 115 Donghu Road, Wuhan, Hubei province, 430071, China
| | - Hongmei Ma
- Renmin Hospital of Wuhan University, No.238 Jiefang Road, WuChang Distirct, Wuhan, Hubei Province, 430060, China.
| | - Qing Zhang
- School of Nursing, Wuhan University, Located on No. 115 Donghu Road, Wuhan, Hubei province, 430071, China.
| | - Zhijie Zou
- School of Nursing, Wuhan University, Located on No. 115 Donghu Road, Wuhan, Hubei province, 430071, China.
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Tu W, Fan H, Liu W, Zhao X, Li M, Gao X. Status and influencing factors of knowledge, attitude and self-reported practice regarding hospice care among nurses in Hainan, China: A cross-sectional study. Nurs Open 2024; 11:e2082. [PMID: 38268300 PMCID: PMC10757569 DOI: 10.1002/nop2.2082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
AIM This study is to investigate the current status of knowledge, attitude and self-reported practice in hospice care among nurses in Hainan, China, and then to analyse its influencing factors and mediating effects. This provides a basis for formulating scientific and standardized hospice care training programmes for nurses. METHODS This cross-sectional study investigated knowledge, attitude and self-reported practice in hospice care among 1819 nurses in Hainan, China. Convenience sampling was used to select participants from 45 hospitals and nursing homes in 14 cities and counties from October to December 2021. A scale of knowledge, attitude and self-reported practice of healthcare providers in hospice care (Chinese version) was administered to collect data during the study period. Statistical analyses, including t-tests, one-way ANOVA, post-hoc analysis and multiple linear regression, assessed the status of knowledge, attitude and self-reported practice of hospice care in nurses and identified influencing factors. The PROCESS macro program model 4.0 was employed to explore the mediating effect of attitude on knowledge and self-reported practice in hospice care. RESULTS Nurses in Hainan displayed low knowledge (mean = 7.68, SD = 3.53), moderate attitudes (mean = 88.13, SD = 12.10) and self-reported practice (mean = 51.81, SD = 9.82) in hospice care. Current employment and willingness to engage in hospice care were significant factors influencing knowledge, attitude and self-reported practice in hospice care. Attitude partially mediated the relationship between knowledge and self-reported practice. PATIENT OR PUBLIC CONTRIBUTION This study focuses on nurses' knowledge, attitude and self-reported practice in hospice care and does not directly involve patients or the public. However, the findings enhance hospice care provided to patients and the broader community by improving nurses' knowledge and skills. This study informs evidence-based training programmes and interventions, benefiting those in need of hospice care services.
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Affiliation(s)
- Wen Tu
- International Nursing SchoolHainan Medical UniversityHaikouHainanChina
- College of NursingUniversity of UtahSalt Lake CityUtahUSA
| | - Huiying Fan
- International Nursing SchoolHainan Medical UniversityHaikouHainanChina
| | - Wenling Liu
- International Nursing SchoolHainan Medical UniversityHaikouHainanChina
| | - Xiaoting Zhao
- International Nursing SchoolHainan Medical UniversityHaikouHainanChina
| | - Mingdong Li
- Department of Orthopedics and Traumatology, Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikouHainanChina
| | - Xing Gao
- International Nursing SchoolHainan Medical UniversityHaikouHainanChina
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Xu Y, Zhang S, Wang J, Shu Z, Jing L, He J, Liu M, Chu T, Teng X, Ma Y, Li S. Nurses' practices and their influencing factors in palliative care. Front Public Health 2023; 11:1117923. [PMID: 37275481 PMCID: PMC10234102 DOI: 10.3389/fpubh.2023.1117923] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/17/2023] [Indexed: 06/07/2023] Open
Abstract
Background In 2017, the Chinese government launched a pilot project in palliative care, in which Shanghai was a pioneer. Nurses play a key role in palliative care services as they are the main providers improving the quality of services for patients and their families. However, little is known about practices and influencing factors in the field of palliative care from a nursing perspective in China. This is an original empirical study that has meticulously analyzed the interrelationship and intensity between practices and other factors among nurses in the initial stage of palliative care in primary healthcare institutions in Shanghai, China. Methods A descriptive-correlational study design was used to sample 2,829 eligible palliative care nurses by purposive sampling survey in 225 healthcare institutions in Shanghai, China. Descriptive analyses were performed using IBM SPSS 24.0 software. Structural equation modeling was applied to analyze the data by AMOS 20.0. Data were collected using the well-designed Knowledge, Attitudes, and Practices of Hospice Care (KAPHC) scale. Results The final model showed a good model fit. Self-efficacy directly influenced practices (β = 0.506, P < 0.01) and indirectly influenced practices (β = 0.028, P < 0.01) through intention. Subjective norm directly influenced practices (β = 0.082, P < 0.01) and indirectly influenced practices (β = 0.030, P < 0.01) through intention. Intention (β = 0.152, P < 0.01) and knowledge (β = 0.068, P < 0.01) directly influenced practices. Perceived susceptibility (β = -0.027, P < 0.01), perceived benefits (β = -0.017, P < 0.01), and perceived barriers (β = -0.014, P < 0.01) indirectly influenced practices through intention. Conclusion This study provided evidence of the associations of knowledge, perceived susceptibility, benefits, barriers, subjective norm, self-efficacy, intention, and practices among nurses concerning palliative care and interventions improving their actual work practices. Our findings revealed that self-efficacy, intention, and subjective norms greatly influenced practices. It is imperative to take interventions that focus precisely on self-efficacy, intention, and subjective norms to improve nurses' practices.
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Affiliation(s)
- Yifan Xu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shiwen Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingrong Wang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiqun Shu
- Disciplinary Planning Office, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Centre for Specialty Strategy Research of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiangjiang He
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
| | - Mengtian Liu
- School of Foreign Language Education, Jilin University, Jilin, China
| | - Tianshu Chu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaohan Teng
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Shuijing Li
- Department of Primary Health, Shanghai Municipal Health Commission, Shanghai, China
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Ye Z, Jing L, Zhang H, Qin Y, Chen H, Yang J, Zhu R, Wang J, Zhang H, Xu Y, Chu T. Attitudes and influencing factors of nursing assistants towards hospice and palliative care nursing in chinese nursing homes: a cross-sectional study. BMC Palliat Care 2023; 22:49. [PMID: 37098562 PMCID: PMC10127064 DOI: 10.1186/s12904-023-01175-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/14/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Hospice and palliative care nursing (HPCN) in China is mainly available at public primary care institutions, where nursing homes (NHs) are rarely involved. Nursing assistants (NAs) play an essential role in HPCN multidisciplinary teams, but little is known about their attitudes towards HPCN and related factors. METHODS A cross-sectional study was designed to evaluate NAs' attitudes towards HPCN with an indigenised scale in Shanghai. A total of 165 formal NAs were recruited from 3 urban and 2 suburban NHs between October 2021 and January 2022. The questionnaire was composed of four parts: demographic characteristics, attitudes (20 items with four sub-concepts), knowledge (nine items), and training needs (nine items). Descriptive statistics, independent samples t-test, one-way ANOVA, Pearson's correlation, and multiple linear regression were performed to analyse NAs' attitudes, influencing factors, and their correlations. RESULTS A total of 156 questionnaires were valid. The mean score of attitudes was 72.44 ± 9.56 (range:55-99), with a mean item score of 3.6 ± 0.5 (range:1-5). The highest score rate was "perception of the benefits for the life quality promotion" (81.23%), and the lowest score rate was "perception of the threats from the worsening conditions of advanced patients" (59.92%). NAs' attitudes towards HPCN were positively correlated with their knowledge score (r = 0.46, P < 0.01) and training needs (r = 0.33, P < 0.01). Marital status (β = 0.185), previous training experience (β = 0.201), location of NHs (β = 0.193), knowledge (β = 0.294), and training needs (β = 0.157) for HPCN constituted significant predictors of attitudes (P < 0.05), which explained 30.8% of the overall variance. CONCLUSION NAs' attitudes towards HPCN were moderate, but their knowledge should be improved. Targeted training is highly recommended to improve the participation of positive and enabled NAs and to promote high-quality universal coverage of HPCN in NHs.
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Affiliation(s)
- Zhuojun Ye
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China.
| | - Haoyu Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Yongfa Qin
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Hangqi Chen
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Jiying Yang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Ruize Zhu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Jingrong Wang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Huiwen Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Yifan Xu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Tianshu Chu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
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Teng X, Tang M, Jing L, Xu Y, Shu Z. Healthcare Provider Knowledge, Attitudes, and Practices in Hospice Care and Their Influencing Factors: A Cross-sectional Study in Shanghai. Int J Health Policy Manag 2022; 11:3090-3100. [PMID: 35988031 PMCID: PMC10105208 DOI: 10.34172/ijhpm.2022.6525] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In 2017, the Chinese government launched a pilot project in hospice care (HC), in which Shanghai was a pioneer. Healthcare provider knowledge, attitudes, and practices in hospice care (KAPHC) may facilitate or hinder HC development. To determine how to design targeted training for healthcare providers and policies to improve their KAPHC, we conducted an original study based on an indigenized KAPHC scale to (a) comprehensively measure the KAPHC baseline of healthcare providers in Shanghai and (b) explore its influencing factors. METHODS A cross-sectional study was designed to evaluate healthcare providers' KAPHC with the indigenized KAPHC scale. Descriptive analysis, linear regression, and Pearson's (r) correlation analysis were performed to uncover providers' KAPHC, its influencing factors, and their correlations. RESULTS The KAPHC scale proved applicable to the knowledge, attitudes, and practices of the large sample of providers we surveyed. The 7027 KAPHC scaling results revealed that 42.44% of participants had HC experience and 57.49% were willing to provide HC. The mean accuracy of the responses related to knowledge was 59.30%. Scoring rates for attitudes, confidence, and self-reported practices were 74.20%, 73.96%, and 75.55%, respectively. The linear regression revealed that higher KAPHC scores were associated with experience and willingness and varied with professional specializations. The Pearson's (r) correlation evidenced that HC practices were strongly correlated with confidence (r = 0.648, P<.001) and moderately correlated with attitudes (r = 0.463, P<.001). CONCLUSION We uncovered that targeted training for enhancing healthcare provider KAPHC in Shanghai should focus on psychological and spiritual care, the management of pain and other symptoms, and traditional Chinese medicine (TCM). Additionally, training should be scaled up for providers with different characteristics. Meanwhile, policy should encourage providers to work enthusiastically in HC-universal high-quality HC requires well-trained, supported, and motivated providers.
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Affiliation(s)
- Xiaohan Teng
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Maocheng Tang
- Department of Traditional Chinese Medicine, Shandong College of Traditional Chinese Medicine, Yantai, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yifan Xu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiqun Shu
- Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Chu T, Zhang H, Xu Y, Teng X, Jing L. Predicting the behavioral intentions of hospice and palliative care providers from real-world data using supervised learning: A cross-sectional survey study. Front Public Health 2022; 10:927874. [PMID: 36249257 PMCID: PMC9561131 DOI: 10.3389/fpubh.2022.927874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023] Open
Abstract
Background Hospice and palliative care (HPC) aims to improve end-of-life quality and has received much more attention through the lens of an aging population in the midst of the coronavirus disease pandemic. However, several barriers remain in China due to a lack of professional HPC providers with positive behavioral intentions. Therefore, we conducted an original study introducing machine learning to explore individual behavioral intentions and detect factors of enablers of, and barriers to, excavating potential human resources and improving HPC accessibility. Methods A cross-sectional study was designed to investigate healthcare providers' behavioral intentions, knowledge, attitudes, and practices in hospice care (KAPHC) with an indigenized KAPHC scale. Binary Logistic Regression and Random Forest Classifier (RFC) were performed to model impacting and predict individual behavioral intentions. Results The RFC showed high sensitivity (accuracy = 0.75; F1 score = 0.84; recall = 0.94). Attitude could directly or indirectly improve work enthusiasm and is the most efficient approach to reveal behavioral intentions. Continuous practice could also improve individual confidence and willingness to provide HPC. In addition, scientific knowledge and related skills were the foundation of implementing HPC. Conclusion Individual behavioral intention is crucial for improving HPC accessibility, particularly at the initial stage. A well-trained RFC can help estimate individual behavioral intentions to organize a productive team and promote additional policies.
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