The knowledge of nursing toward the role of them in End of life care in Intensive care units and oncology units in Nablus hospitals- Cross sectional study.

1. Prepared by:
Mahdy Basim Kayed (Leader)
Narmeen Nader Mhameed
Aya Soliman Kharoub
Suliman Dawoud Tahan
Khalid Duraidi
Supervised by: Ahmad Ajayeb
Submitted for Dr. Jamal Alqadoumi

2. 1. Introduction.
2. Literature review.
3. Methodology.
4. Results.
5. Discussion.
6. Conclusion.
7. Limitation.
8. Recommendation.

3. • End of life is defined as a final stage of life due to terminal illness,
advanced disease, or irreversible health decline.
• Characterized by limited life expectancy, necessitating focus on
comfort, symptom management, and emotional support.
• Rooted in recognizing inherent dignity of individuals, aiming to
promote well-being during this challenging phase.
 End-of-life care emphasizes compassion, dignity, and support for
patients and their loved ones during a crucial stage of life.

4.  Nursing plays a pivotal role in providing compassionate and
comprehensive support to individuals and families during end-of-life
stages.
 Despite extensive research on nursing in end-of-life care, the
Palestinian healthcare system lacks specific studies, hindering
understanding of challenges and opportunities faced by nurses.
 A focused examination of nursing roles in end-of-life care in Palestine
is essential to identify challenges and develop targeted strategies for
improving care quality.

5. Significant of the study:
Understanding Palestinian nurses' unique role in end-of-life care is crucial for improving
quality and outcomes. By identifying challenges and opportunities, insights drive tailored
interventions and education, enhancing care delivery.
Aims of the study:
1) To determine the knowledge of nursing toward the role in end of life care in intensive care unit (ICU) and
oncology departments in Nablus city.
2) To determine the factor that impacts nursing toward the role in end of life care in ICU and oncology
departments.

6. Research question:
1. What are the knowledge of nursing toward the role in end of life care in ICU) and oncology departments in
Nablus city?
2. What are the factors that impacts nursing toward the role in end of life care in ICU and oncology
departments?
Study Hypothesis:
 Null Hypothesis (H0): The demographic data have no effect on nursing knowledge toward EOLC.
 Alternative Hypothesis (H1): The demographic data have an effect on nursing knowledge toward EOLC.

7. Study Variable:
1.7.1: Dependent variables:
Knowledge of nursing toward the end of life of care.
1.7.2: Independent Variables:
1) Age.
2) Gender.
3) Current position.
4) Experiences years.

8. study aim methodology Results
(Mengual et al., 2023) The study aimed to assessed
the knowledge and attitude of
nurses in primary health centers
toward end of life care.
Using the Palliative Care Quiz
for Nurses—Spanish Version
(PCQN-SV) to gauge nursing
knowledge toward end of life
care, 244 participants—196
female and 48 male—
participated
. The study's findings show that
60% of participants correctly
answered the question about
nursing toward end of life
care.also that nurses with
training and experience in
palliative care and end of life
care have a positive knowledge
toward end of life care
(Hao et al., 2021). The study aimed to measure
the nurses' knowledge about
palliative care and end of life
care before and after the
program was introduced.
. The study used the Palliative
Care Questionnaire for Nursing
(PCQN) Out of the 97
participants, 94 were female
and only 3 were male
The results of the study show a
significant difference in the
nurses' knowledge about end of
care before and after the
program
(Kim et al., 2020). The study aimed to examined
nurses' attitudes, knowledge,
and self-efficacy regarding
palliative care
The study used PCQN
questionnaires to assess
nurses' knowledge of palliative
care; consest of Of the 141
participants, 139 were female
and only 2 were male.
the findings demonstrate a
strong correlation between
nursing knowledge toward end
of life care and years of
experiences as oncology nurse

9.  Study Design:
Cross sectional study was used to explore the role of nursing in end of life care, because it is the most
suitable type of design as the study aims to estimate the role of nursing in end life care.
 Study site and setting:
The research conducted in Nablus city hospitals encompassed both governmental and private
institutions. The governmental hospitals involved were Al-watani and Rafedia, while the private
hospitals included Al-Najah National University Hospital and Nablus Specialty hospital. The focus of
the study was on the Intensive Care Unit (ICU) and Oncology departments in these healthcare
facilities.
 Study population:
The population of this study included all nurses who work in the departments of oncology and ICU in
the targeted hospital, regardless to their age, gender and educational level, which included 340
nurses distributed on hospitals.

10. Sampling and Sample size:
Convenience Sampling will be used, in which nurses will be chosen in a non-regulated method, one
nurse after another. The minimum number of nurses required to participate in a study was 151.
By adding nursing alteration rate 10% = 166 nurse. The total sample size that included in present
study 130 participants distribution on four hospital with response rate was 80.7%.
Inclusion criteria:
All nurses who works in departments of oncology and ICU in the selected hospitals.
 Exclusion criteria:
1. Nurses who works in other departments in selected hospitals.
2. Nurses who refused to participate.
 Period of the Study:
The study is scheduled to take place in the first semester of the researchers' fourth academic year,
commencing from September to December 2023. This timeframe has been chosen due to its ample
availability, which allows for sufficient time for data collection.

11.  Data collection tool and procedure:
Data were collected using a self-administered questionnaire that was taken from previous literature. The
tool employed was the End-of-Life Professional Caregiver Survey (EPCS).
The total score on this 5-point Likert scale, which ranges from zero (not at all) to four (very much). 112 are
considered as the greater score which mean have better knowledge and comfort in providing EOLC. This
instrument has 28 items total, divided into three subscales: effective care delivery (ECD) (8 items), cultural
and ethical values (CEV) (8 items), and patient- and family-centered communication (PFCC) (12 items).
 Validity and Reliability:
The EPCS tool was developed and validity by (M. Lazenby et al., 2012) For reliability, Cronbach’s Alpha
using Statistical Package for Social Sciences (SPSS) will be calculated for reliability with an acceptable cut
point of 0.7 (70%).
 Pilot study:
 A pilot study, involving 17 nurses (10% of the sample), precedes the main data collection to gauge questionnaire
reliability and gather participant feedback.
 Objectives include identifying obstacles in data collection, evaluating questionnaire readability, and assessing clarity,
suitability, and flexibility.
 The study aims to pinpoint unclear or ambiguous items, address participant concerns, and optimize questionnaire
efficiency.
 Feedback on questionnaire wording, formatting, and language will inform necessary adjustments.
 Estimated completion time for questionnaires is 15-20 minutes.

12. Data analysis:
Analysis performed by using SPSS version 21, descriptive statistics conducted, the continuous
variables were analyzed using mean and standard deviation, frequency categorical calculated, Mann–
Whitney U test and Kruskal–Wallis test performed to know the relation between continuous and
frequency variables.
 Ethical Considerations:
• Verbal consent obtained from each participant.
• Participants assured of anonymity, confidentiality, and the right to withdraw from the study at any
time.
• institutional Review Board (IRB) Approval obtained.
• Participants reassured that information provided wouldn't be used against them.

13. RESULTS
Demographic characteristics of the participants:
Frequency Percent
Age category
22-25 9 6.9
26-30 49 37.7
>30 72 55.4
Gender
Male 87 66.9
Female 43 33.1
Marital status
Single 30 23.1
Married 96 73.8
Divorced or widowed 4 3.1
Name of Hospital
NNUH 74 56.9
Rafedia hospital 17 13.1
Al-watani hospital 27 20.8
Nablus Specialty hospital 12 9.2
Educational level
Diploma 3 2.3
Bachelor 118 90.8
Master or Doctorate 9 6.9
Current position
Head nurse 5 3.8
Registered nurse 121 93.1
Practical nurse 4 3.1
Department work
Oncology work 53 40.8
ICU 77 59.2
Experience category
1-5 49 37.7
6-10 44 33.8
>10 37 28.5
Do you have any training in palliative care?
No 81 62.3
Yes 49 37.7
No 84 64.6

14. Minimum Maximum Mean Std. Deviation
Score for PFCC category 5.00 48.00 33.38 7.95
Score for CEV category 2.00 32.00 20.50 5.67
Score for ECD category 0.00 32.00 20.93 5.73
EOLC score 8.00 112.00 74.82 18.02
 The knowledge of nursing toward the EOLC
PFCC: Patient and family-centered communication. CEV: cultural and ethical values.
ECD: effective care delivery. EOLC: End of life care.
Frequency Percent
Knowledge category
Not at all 2 1.5
Little bit of knowledge and comfort 3 2.3
Some knowledge and comfort 32 24.6
Quite a lot of knowledge and comfort 70 53.8
Very high EOLC knowledge and comfort 23 17.7
 Distribution of nursing according to their knowledge toward EOLC

15.  Knowledge between two demographic levels by using Mann–Whitney U test
N Mean Rank Asymp. Sig. (2-tailed)
Gender
Male 87 64.74 .744
Female 43 67.03
Department work
Oncology work 53 64.22 .747
Intensive Care unit (ICU) 77 66.38
Do you have any training in palliative
care?
No 81 61.87 .158
Yes 49 71.50
Do you have any courses in end of life
care?
No 84 59.30 .011
Yes 46 76.83
 The significance only observed in nurses who took the EOLC courses p value= (0.011)

16.  Knowledge between three or more demographic levels demographic by using Kruskal–Wallis test
N Mean Rank
Asymp.
Sig.
Experience category
1-5 49 68.02 .573
6-10 44 60.63
>10 37 67.96
Age category
22-25 9 43.33 .187
26-30 49 67.16
>30 72 67.14
Marital status
Single 30 56.00 .278
Married 96 68.14
Divorced or widowed 4 73.50
Name of Hospital
Najah National university hospital (NNUH) 74 66.23 .111
Rafedia hospital 17 60.74
Al-watani hospital 27 75.80
Nablus Specialty Hospital 12 44.58
Educational level
Diploma 3 47.00 .205
Bachelor 118 64.50
Master or Doctorate 9 84.78
Current position
Head nurse 5 104.80 .031
Registered nurse 121 64.62
Practical nurse 4 42.88
 The significance only observed in current position p value= (0.031)

17.  Discussion:
 The results of present study illustrate that most of participant have moderate level toward
EOLC as mean score are 74.82. These results are consisting with study in Jordan by (Subih et
al., 2022). Also, the results are contrast to study done in china by (Subramanian & Chinna,
2013) which reports that 75% of nurses have good knowledge toward EOLC.
 The present study exhibits significant relation between having an end of life care courses with
knowledge of nursing toward EOLC, these results is consist with study done by (Subih et al.,
2022) and consist with study done in china by (Subramanian & Chinna, 2013), as special
knowledge toward EOLC was administered during courses that concern in EOLC.
 For experience years, the present findings indicate no significant relation between it with
knowledge toward EOLC. These findings consist with studies done by (Subih et al., 2022),
(Powazki et al., 2014) and (Bailey & Hewison, 2014). Also, these results contrast to finding for
study done in china by (Subramanian & Chinna, 2013) which reports that nurses who work for
more than 11 years have a good knowledge toward EOLC.
 Moreover, the present study illustrates no significant relation between department of work and
nurses knowledge toward EOLC. These finding is contrast to Jordanian study (Subih et al.,
2022), which reports that ICU nurses have high knowledge toward EOLC in comparison with
non ICU nurses.

18. Conclusion:
This study assesses the knowledge of 130 nurses who work in oncology wards and intensive
care units on EOLC in Nablus city. The results of this survey indicate a moderate level of EOLC
knowledge. Additionally, the current study shows a strong correlation between EOLC knowledge
and taking EOLC-related courses. Additionally, the current study demonstrates a substantial
relationship between EOLC knowledge and current position.
Limitation:
In our study we had some limitation which was restricted to Nablus city. Moreover, the time of
data collection was limited because the restricted time which included only the 1st semester of
academic year.
 Recommendation:
 For Ministry of Higher Education: The EOLC training should be a required component of
nursing school curricula in Palestine.
 For Ministry of Health: Establishing EOLC centers and services in Palestine.