Background and Significance
The authors used the introduction to contextualize the problem using published research, stating the importance of palliative care and its need by the aging population. They discuss how the increase of chronic non-communicable disease and increased population aging leads to the global need for palliative care. Overall, the background gives a clear indication for conducting the study.
Research Questions and Hypothesis
The authors do not state the hypothesis nor research questions; nonetheless, these have been presented in the form of the research objective, “to evaluate the nurses’ knowledge about palliative care and attitude towards end-of-life care among nurses working in public hospitals in Wollega zones” (Etafa et al., 2020). This has been sufficiently supported by the problem statement and literature review.
Literature Review
The authors adequately summarized research that had been previously conducted regarding the assessment of nurses’ knowledge on palliative care using the Palliative Care Quiz for Nursing (PCQN) and Frommelt Attitude Toward Care of the Dying Scale (FATCOD) tools (Etafa et al., 2020). They also summarized the probable factors affecting nurses’ attitude towards palliative care, including the availability of palliative care curriculum content, training in palliative care, years of nursing experience, institution, individuals’ level of education, and work units. The authors reported gaps in previous studies, which was that no study evaluated the nurses’ knowledge about palliative care and attitude toward end-of-life care among nurses working in public hospitals in Wollega zones.
Methods of Internal and External Validity
Potential sources of bias in the study included translating the items in the questionnaires into the local language. However, this potential threat to validity was minimized by the authors having a team of experienced researchers with a minimum of an assistant professor rank review the cultural and linguistic validity of the tools (Etafa et al., 2020). As a result, the degree of impact of the threat on validity was minimized.
Research Design
The authors used a facility-based multicenter cross-sectional study design. The design is justifiable as the study intended to ascertain nurses’ knowledge across the 15 public hospitals in Wollega zones (Etafa et al., 2020). However, the design allows determining associations but not causal relationships in the analysis of potential predictors of nurses’ knowledge and attitude.
Sampling
Out of 15 public hospitals in the Wollega Zone, nine were randomly selected, containing 568 nurses. The required sample size was determined using a single population proportion formula that yielded a final sample size of 422 (Etafa et al., 2020). A simple random sampling technique, the lottery approach, was utilized to select study participants. This was followed by using the proportionate population sampling method. This compressive technique justifies the proportion of selected participants.
Legal-ethical Issues
The study clearly stated that ethical approval was obtained from the ethical review committee of Wollega University. Moreover, it is indicated that the nursing staff was given an oral explanation regarding the purpose, inclusion and exclusion criteria and procedures of the study. Finally, participants were acknowledged on the confidentiality of data, a guarantee of voluntary and anonymous participation.
Data Collection Methods and Procedures
Translated versions of the PCQN and FATCOD were utilized in evaluating the nurses’ knowledge regarding palliative care and attitude towards end-of-life care, respectively. A self-administered questionnaire consisting of three different parts was used for data collection (Etafa et al., 2020). The first part constituted collecting demographic characteristics of nurses. The second part was adopted from the PCQN and comprised 20 questions. Finally, the third part, adopted from the FATCOD, consisted of 30 items scored on a Likert scale ranging from strongly disagree to strongly agree. PCQN and FATCOD are internationally standardized tools, hence maintaining their fidelity.
Reliability and Validity
It is indicated in the study that PCQN has high content validity and reasonable reliability, as reviewed by previous studies. Additionally, the content validity of both the PCQN and FATCOD were evaluated by five experienced researchers from the school of nursing and midwifery. These individuals also held a minimum of an assistant professor rank. Items from the FACOD scale were removed due to their complexity. The internal consistency reliability was determined to be 0.75 and 0.77 for the PCQN and FATCOD scales, which was acceptable (Etafa et al., 2020). However, it is essential to note that translation of the questionnaire into a local language influenced its validity.
Data Analysis
The authors performed data analysis using SPSS. The knowledge and attitudes of nurses towards palliative care were summarized using the mean and standard deviation. Binary logistic regression was applied to determine the association between variables. The basis for using such inferential statistics was explained by the authors in a simplified manner. On the other hand, in regards to descriptive statistics, the authors used frequency tables to illustrate the demographic characteristics of nurses, nurses’ knowledge regarding palliative care, nurses’ attitude towards end-of-life care, and factors associated with nurses’ knowledge about palliative care and attitude towards end-of-life care. These tools aligned with the research objective, and the tables had precise headings and no-repeat texts.
Conclusions, Implications, and Recommendations
The results of the research question were concisely and objectively presented. The findings were declared to be generalizable as they constituted many participants from different public hospitals. Nonetheless, the authors did not provide a discussion on how the theoretical framework was supported. The authors finalized the study by determining the strengths and limitations of the study based on the research design and data collection tools. Finally, the authors failed to discuss the relevance of the study findings on clinical practice and recommendations for future research.
Applications to Nursing Practice
The results of the study are essential to clinical practice as its strength outweighs the weaknesses. Furthermore, it appears to be replicable. When it comes to feasibility, the study forms the basis through which nurses will be enlightened on knowledge on palliative care via the curriculum. Moreover, programs aiming to change their attitude towards palliative care would be conducted. Overall, increased knowledge and changed attitude will lead to better healthcare delivery, reducing hospital stay and concurrently the burden of cost on the patient.
References
Etafa, W., Wakuma, B., Fetensa, G., Tsegaye, R., Abdisa, E., et al. (2020). Nurses’ knowledge about palliative care and attitude towards end- of-life care in public hospitals in Wollega zones: A multicenter cross-sectional study. PLOS ONE 15(10), 1-14. Web.