This quasi-experimental, randomized, controlled study was performed with a pretest-posttest design.
This study was conducted in the ICU of Golestan and Imam Khomeini hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences, Iran, from July 2019 to October 2019. Using convenience sampling method, 80 individuals were selected from among nurses who had the study inclusion criteria. Then, they were randomly assigned to intervention and control groups. Due to the limited number of nurses who had the study inclusion criteria and were willing to participate in the study, random sampling was not possible and randomization was done only in the distribution of samples into intervention and control groups (Fig. 1). The inclusion criteria included employment at the ICU for at least 1 year, a minimum education of bachelor's degree in nursing, and no history of passing an ELNEC-based training course. The exclusion criteria included reluctance to participate in the study at any time during the study, and participation in and full-time attendance at any briefing or training course.
Data collection tools
The data collection tools used in this study included a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR). The demographic information questionnaire including questions on age, sex, and work experience of the participants. ELNEC-KAT consists of 50 four-choice questions. The scale focuses on 9 issues related to nurses' knowledge of end-of-life care. Each of these 50 questions has a more correct option, which is considered the correct answer [5, 11]. The PCEP-GR examines participant's performance in end-of-life palliative care. This tool is used for the final evaluation of palliative care training courses. This scale consists of 36 items, and its total score varies between 0 and 144. The total score obtained is classified into poor performance (0 to 36), average performance (37 to 72), acceptable performance (73 to 108), and optimal performance (109 to 144) [12, 13].
Pretest was performed on all participants in the intervention and control groups. The intervention was performed 1 week after the pretest. The designed intervention had two parts. In the first part, nurses in charge of patient care participated in a briefing session on the importance, basics, and application of end-of-life care based on the ELNEC. The study method and stages were explained to the nurses. Then, in the next stage, the nurses of the intervention group were divided into 4 groups of 10 individuals and 5 training classes were held for each group, the duration of each session varied between 60 and 90 minutes. In this course, the complete basics of end-of-life palliative care were discussed by the researcher based on the ELNEC. Subsequently, the posttest was performed by the researcher in both groups. The posttest was performed 1 month after the end of the intervention. Finally, in both parts of the tool (knowledge and performance), the score of each subscale in each test was determined and the total score of each participant was calculated in the scale through the aggregation of scores.
This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (decree code: IR.AJUMS.REC.1398.129). Ethical considerations were in accordance with the Helsinki Declaration 1995, revised 2001. The aim and method of the study were explained to the nurses and their questions were answered by the first researcher. They could withdraw from the study at any time without any effect on their caring process. The written informed consent form was signed by those nurses who willingly agreed to take part in this study. Their confidentiality and anonymity were ensured throughout the study process.
In this study, descriptive and analytical statistical analysis methods were used in SPSS software (version 16, SPSS Inc., Chicago, IL, USA). Quantitative variables were reported as mean, standard deviation, and minimum and maximum, and qualitative variables were reported as number (percentage). The normality of quantitative variables was assessed using the Shapiro-Wilk test. Independent t-test, paired sample t-test and Analysis of covariance (ANCOVA) were used to data analysis. The statistical significance level was considered to be 0.05.