Design
This study used a cross-sectional design. All methods were performed in accordance with the relevant guidelines and regulations
Sample and setting
G-power, version (3.0.10), was used to calculate the study sample; the total calculated sample needed (with alpha < 0.05, power set at 0.90, and medium size effect, predictors = 7), showed a minimum sample size was 130 participants. In this study, a convenience sample of 220 registered nurses out of 250 questionnaires distributed (response rate 88%), agreed to participate and fill the questionnaires over a 3-month period from June to August 2018.
The eligibility criteria for the study included being a registered Jordanian nurse who was; working in clinical settings, including intensive care units (ICUs), oncology departments, medical/surgical floors, and emergency room (ER); also working with terminally ill patients at a hospital setting for at least 12 months prior to data collection to ensure that the study subjects will provide relevant data in relation to EOLC. All health sectors in Jordan were involved in the sample from Amman, the capital, and Irbid (north), including governmental, private, military, and educational hospitals.
Measurements
The present study used a two-part questionnaire, which is described as follows:
1) Sociodemographic data
The sociodemographic questionnaire was developed by the researchers and based on the existing literature 4,7,15,16, and it is composed of questions about age, gender, type of university they graduated from (governmental or private), type of hospital, years of experience in nursing, unit they work at (ICU- ER-medical/surgical floor- oncology department), and having EOLC/palliative training courses or not.
2) The level of nurses’ knowledge about EOLC
The End-of Life Professional Caregiver Survey (EPCS) was used 17. This is a 5-point Likert scale with a response format from zero (not at all) to 4 (very much), with a total score of 112; the higher the score the better the knowledge and comfort in providing EOLC. This tool consists of 28 items with three subscales including: 1) patient and family-centered communication (PFCC), 12 items; 2) cultural and ethical values (CEV) eight items; and 3) effective care delivery (ECD), eight items 17.
The cut-offs for total score of EPCS regarding level of knowledge and comfort in providing EOLC used are as follows: 0–21, not at all; 22–44, a little bit of knowledge and comfort; 45–67, some knowledge and comfort; 68–90, quite a lot of knowledge and comfort; 91–112, a very high EOL knowledge and comfort 17. For subscale scores’ range, PFCC from 0–48, CEV scores from 0–32, and for ECD from 0–32. On a scale of 0–4, Category 0 represented perceptions of low EOL knowledge, whereas Category 4 represented perceptions of high EOL knowledge 4.
This scale was validated in a large multidisciplinary study among physicians, nurses, and social workers 17. Content validity of the EPCS in this study was confirmed by three palliative experts (two academic doctorate holders of palliative care in nursing, and one palliative physician) and yielded content validity index (CVI) 0.90, while reliability was measured by using Cronbach’s alpha, which was (α= 0.90). For each subscale, a Cronbach’s alpha was; PFCC (α= 0.80); CEV (α =0.80); ECD (α= 0.84).
Translation of the End-of-Life Professional Caregiver Survey (EPCS)
After acquiring permission to use the tool (EPCS) from the original authors, the translation was conducted by a panel of palliative care experts, two clinicians, two nurses who work with terminal ill patients, and two laypeople who are proficient in both the Arabic and English language were asked to translate the survey using the forward and backward technique. After that, the panel discussed any discrepancies that emerged between the original version and the translated version of the survey until consensus was reached and a final version of the Arabic EPCS was produced. The final Arabic version of the EPCS was piloted with 30 nurses who met the inclusion criteria for the participants in order to verify the feasibility and the practicality of the survey.
Ethical consideration
Permission was obtained from the Ethical Research Committee at Al-Zaytoonah University of Jordan (Institute Review Board (IRB) no: 19/170/2018) and by each participating hospital IRB committee. Datasets available in the corresponding author office on reasonable request.
Data collection procedure
The main researcher approached the head nurses of each unit to facilitate data collection and to identify the nurses eligible for the study. Thereafter, two of the researchers approached the potential participants at their clinical premises and explained the purpose of the study. Nurses who agreed to participate were provided with a self-sealed envelope that contained the questionnaires, a written consent form to sign, and a cover sheet that included clear instructions about the study, the participants’ rights, and the contact details of the main researcher. The researchers asked the study subjects to put the completed survey into the envelope and seal it to ensure the confidentiality and their anonymity. Researchers informed the participants that they would come back after 2 weeks to collect the survey. Researchers made a call two days before collecting the survey to make sure that the participants were ready to hand it in.
Data analysis
Data analysis and management was undertaken using SPSS version 21.0. Continuous variables were described using descriptive statistics (percentages, mean, and standard deviation (SD)). Correlation coefficient test was used to examine the direction and the magnitude of the relationship between specific demographic factors and EPCS scores. Then multiple regression hierarchy was used to find the predictors.