Background
Palliative care is a healthcare service aimed at alleviating the pain experienced by patients and their families and improve their quality of life through a team of experts, such as doctors, nurses, and social workers, to actively control the physical symptoms of patients with life-threatening diseases, and to help patients and their families in facing psychosocial and spiritual difficulties [1]. Nurses need to assess the needs of patients and families through a comprehensive initial evaluation of pain and physical symptoms, and provide physical, psycho-emotional, social, and spiritual care by seeking solutions to patients’ multiple needs in co-ordination with multidisciplinary team members [2, 3]. In particular, nurses who provide palliative care should assist in alleviating symptoms and pain caused by the disease rather than improve the disease, and should actively support in maintaining the rest of the patients’ lives while accepting the process of waiting for death as normal rather than postponing or promoting death [4]. Recently, with the aging population and increase in chronic diseases, as well as medical advances have made it possible to extend and sustain life, and interest in extended palliative care rather than hospice concept has emerged [5]. In particular, there is an increasing need for nurses to provide high-quality palliative care in clinical settings in the expanding specialised institutions that provide palliative care in South Korea.
Willingness refers to what one wants to do or what one’s mind is directed at or thinks [6], willingness to care among nurses is acceptance of the nursing needs of patients, with feelings of emotional attachment or empathy [7]. Although the care needs of patients cause a physical and emotional burden on nurses, nursing willingness increases when the expected emotional benefit to the patient, such as attachment or empathy, is greater [7]. Willingness in nursing practice can increase the likelihood of actual action occurring through interaction with other factors involved, and can be used to provide information on the benefits that can be expected through nursing practice, and can be a basis for providing education and interventions to improve empathy for patients [7]. A study was conducted to investigate nursing willingness for patients with infectious diseases such as COVID-19 and AIDS; the need for education to form positive perceptions and provide appropriate expertise increased nursing willingness [8‐11].
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In a previous study of nurses in China, only 27.5% of the participants indicated their willingness to provide hospice care, while in a Taiwanese study of community nurses, 93% of the participants expressed their intention to provide palliative care when they met end-of-life cancer patients, but most were limited to providing information on palliative care or services for referrals to palliative care institutions rather than direct nursing care [12]. The main reasons why nurses feel reluctant or uncertain about nursing for those who need hospice palliative care is lack of knowledge and experience; whether to complete hospice training and knowledge of hospice nursing are major related factors in hospice nursing care [13]. The level of knowledge about palliative care is also a significant predictor of willingness to provide palliative care [12]. In addition, the higher the nurses’ awareness of palliative care, the more positively it affects end-of-life nursing attitudes [14], suggesting that it is necessary to cultivate a positive attitude toward palliative care through systematic education, and ultimately provide high-quality palliative care [14, 15]. Therefore, nurses’ attitudes toward, and willingness to provide, palliative care may be influenced by their degree of knowledge and awareness of hospice and palliative care.
Nurses have also reported uncertainty or reluctance about hospice care due to sad working conditions and fear of patients dying [13], which can affect their willingness to palliative care, depending on how nurses caring for terminally ill patients think about life and death and accept the finiteness of life. Palliative care is complete care that includes physical, psychosocial, spiritual, and post-bereavement care towards maintaining dignity and high quality of life for the remaining life of patients with love [16]. In addition, in palliative care, nurses need to look back on patients’ lives who are in the last stage of their lives, embrace their present lives, and help them pursue the meaning of the rest of their lives [17]. Meaning of life has been shown to be a major factor influencing the performance of spiritual nursing for meaning, love, and forgiveness towards terminally ill patients at a level they believe to be valuable and meaningful in relation to the world to which they belong [17]. Based on these previous studies, meaning of life is thought to be related to nurses’ willingness to provide and practice of palliative care.
In addition, for nurses performing palliative care, an attitude of deep compassion for patients in the face of their pain is a key element of a supportive relationship [18]. When a nurse communicates through interaction as a therapeutic tool, their empathy affects the quality of nurse-patient relationship and can affect the process and outcome of the disease [18]. Continuous nursing is needed with satisfaction in their relationship with the patient through good care [19]. The higher the compassion capacity or empathy ability to understand the patient and relieve the patient’s difficulties, the more important the factors affecting the performance of anthropocentric and end-of-life care [20‐22]. These competencies can be seen as factors influencing nursing performance. Therefore, nurses’ compassion competence and positivity can increase their potential acceptance of and willingness to provide palliative care.
There is lack of research that directly investigates nurses’ willingness to provide palliative care and factors affecting this willingness; previous studies have examined nurses’ knowledge, perceptions, end-of-life nursing attitude [14, 15, 23], meaning of life, spiritual care performance [17], empathy capacity, and the degree of end-of-life care performance [20, 24]. To our knowledge, no study to date has investigated the factors affecting willingness to provide palliative care by considering the knowledge and perception of nurses’ palliative care, their meaning of life, and compassion competence. Therefore, this study aimed to identify the factors influencing nurses’ willingness to provide palliative care. Specifically, the purpose of this study is to identify the knowledge and perception of palliative care, meaning of life, compassion competence, and degree of willingness to provide palliative care among nurses in South Korea, and to explore the factors affecting willingness to provide palliative care across time. This study’s findings could be helpful for improving nurses’ role as palliative care providers and providing basic data for education to promote the performance of palliative care in clinical nursing practice.
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Methods
Study design and participants
This study used a descriptive survey design. The inclusion criteria for participants were nurses who work in general hospitals or higher and have more than one year of clinical experience, regardless of one’s department or position, who understand the purpose of the study and agree to voluntarily participate. Participants were nurses employed in five general hospitals in the S, K, and C provinces of South Korea. They were explained the purpose of the study and voluntarily agreed to participate. The sample size was determined using G* Power 3.1.9 software (Heinrich Heine University Düsseldorf, Düsseldorf, Germany). With a medium effect size of 0.15, significance level of 0.05, power of 0.95 and eight predictors in a multiple linear regression analysis, it was determined that at least 136 participants would be required. Considering a dropout rate of 15%, 161 participants were finally recruited. After excluding one participant who responded insincerely, 160 participants were included in the final analysis.
Research instruments
General characteristics
The general characteristics of the participants assessed were: gender, age, religion, marital status, education, type of hospital, clinical experience, clinical position, work department, educational experience in palliative care, experience in providing palliative care while working, experience of palliative care of a family member or a close person, and bereavement experience of a family member or a close person.
Knowledge of palliative care
The Korean version of the Palliative Care Quiz for Nursing (PCQN) developed by Ross et al. [25] and translated by Kim et al. [26] was used to assess nurses’ knowledge of palliative care. The questionnaire’s sub-concepts consist of ‘philosophy and principles of palliative care’, ‘management of pain and other symptoms’, and ‘psychosocial and spiritual care of individuals and families’. It comprises 20 questions, with a score of one for correct answers and zero for incorrect answers. Higher scores indicate a greater level of knowledge about palliative care. Kuder-Richardson 20(KR-20) by Ross et al. [25] was 0.78, and in this study, it was 0.29.
Perceptions of palliative care
Perception Scale of Hospice Palliative Care adapted from Kim [27] was used to assess nurses’ perceptions of palliative care. The sub-concepts of this scale consist of ‘definition and philosophy of hospice’, ‘criteria of hospice’, ‘contents of hospice service’, ‘necessary of pain and symptom control’, ‘ethical and psychological problems in hospice’, and ‘necessary of public information and education’. It is a 22-item scale, measured on a 4-point Likert scale, ranging from 1 (‘not at all’) to 4 (‘very much so’). Higher scores indicate a greater perception of palliative care. Cronbach’s alpha in the study by Kim [27] was 0.84, and in this study, it was 0.80, indicating good reliability.
Meaning of life
The Meaning of Life Version II (MIL-II), developed by Choi [28], was used to assess nurses’ presence of meaning of life. The scale comprises 46-items scored on a 4-point Likert scale, ranging from 1 (‘not at all’) to 4 (‘very much so’). Higher scores indicate a higher level of finding meaning in life. In the original study by Choi [28] as well as in this study, Cronbach’s alpha was 0.94, indicating good reliability.
Compassion competence
The Compassion Competence Scale (CCS) for nurses developed by Lee [29] was used to assess their level of compassion. The sub-concepts of this scale consist of ‘communication’, ‘sensitivity’, and ‘insight’. The scale comprises17-items, measured on a 5-point Likert scale, ranging from 1 (‘not at all’) to 5 (‘very much so’), with higher scores indicating greater compassion competence. In the original study by Lee [29], Cronbach’s alpha was 0.91, and in this study, it was 0.89, indicating good reliability.
Willingness to provide palliative care
To assess the degree of willingness to palliative care for nurses, our research team translated the Nurses’ Willingness to Engage in Palliative Care Scale, developed by Zhu et al. [30]. The scale’s sub-concepts consist of ‘intention’, ‘attitude toward the behaviour’, ‘perceived behavioural control’, and ‘subjective norms’. Forward translation was conducted by researchers fluent in English and Korean. Backward translation was performed by one doctor and one nurse fluent in Korean and English. The researchers conducted a pilot test of the final version with three nurses who had clinical careers of over seven years, and confirmed it. The final scale included 20-items scored on a 5-point Likert scale, ranging from 1 (‘not at all’) to 5 (‘very much so’). Higher scores indicate a higher level of willingness to palliative care. In the original study by Zhu et al. [30], Cronbach’s alpha was 0.90, whereas in this study, it was 0.91.
Data collection
After obtaining approval from the Institutional Review Board of K University, data were collected from January to February 2023. First, after asking the nursing departments of hospitals for cooperation in data collection, the research notice was posted to each ward of the hospital or announced through a URL. Data were collected through an online questionnaire survey using the Korean Social Science Data Center database (KSDC DB). The participants were informed regarding the purpose and necessity of this study, and only those who agreed to participate were asked to respond by sending an online survey URL. The survey took approximately 15 min to complete, and a beverage coupon for participation in the study was provided. The participants’ personal information was deleted after the coupons were provided.
Data analysis
Data were analysed using the IBN SPSS Statistics 29 program (IBM Corp.) The general characteristics of the participants were analysed using frequencies, percentages, means, and standard deviations. We analysed differences in the willingness to palliative care based on general characteristics using an independent t-test and one-way analysis of variance. The Scheffé test was used for post hoc analyses. Correlations between the research variables and the willingness to palliative care were analysed using Pearson’s correlation coefficients. Hierarchical regression was conducted to explore the factors affecting willingness to palliative care, which allows for the confirmation of the change in explanatory power according to the input of major research variables .
Ethical considerations
This study was approved by the university’s Institutional Review Board (KWNUIRB-2022-11-004). Before conducting the online survey, the participants were provided with research information, including the purpose, method, and content of the research. The participants were also informed that they had the right to withdraw from the study at any time and that their individual information would be replaced with numbers in the study fields to protect their privacy. The survey was conducted only for participants who read the documented explanation and consent form for research participation and responded that they agreed to participate in the study. After the survey, the participants received a gift as an expression of gratitude.
Results
Knowledge and perception of palliative care, meaning of life, compassion Competence, and willingness to provide palliative care among nurses
Table 1 shows the general characteristics of participants. Of the 160 participant nurses, 92.5% were women and participants’ average age was 33 ± 6.27 years. Of the total, 40.6% were religious, 39.4% were married, 96.2% had a bachelor’s degree or higher, and 76.2% were staff nurses in hospitals. The average clinical experience of participants was 8.95 ± 5.69 years, and 43.7% had education in palliative care. A total of 56.2% had provided palliative care and 18.1% had provided palliative care for a family member or close person. A total of 61.2% of the participants had experienced bereavement of family members or close persons (Table 1).
Table 1
General characteristics of the participants (N = 160)
Characteristics | Categories | N (%) | M ± SD |
|---|---|---|---|
Gender | Male | 12(7.5) | |
Female | 148(92.5) | ||
Age (years) | < 25 | 3(1.9) | 33.00 ± 6.27 |
25–29 | 41(25.6) | ||
30–34 | 67(41.9) | ||
≥ 35 | 49(30.6) | ||
Religion | Yes | 65(40.6) | |
No | 95(59.4) | ||
Marital status | Single | 97(60.6) | |
Married | 63(39.4) | ||
Education | College degree | 6(3.8) | |
Bachelor’s degree | 95(59.4) | ||
Master’s degree | 59(36.8) | ||
Type of hospital | Certified tertiary hospital | 118(73.7) | |
General hospital | 42(26.3) | ||
Clinical position | Staff nurse | 122 (76.2) | |
Charge nurse | 28 (17.5) | ||
Unit manager | 10 (6.3) | ||
Clinical experience (in years) | 1–4 | 38(23.8) | 8.95 ± 5.69 |
5–9 | 69(43.1) | ||
10–19 | 43(26.8) | ||
≥ 20 | 10(6.3) | ||
Work department | Medical ward | 49(30.6) | |
Surgical ward | 48(30.0) | ||
Intensive care unit | 17(10.6) | ||
Emergency room | 6(3.8) | ||
Operating room | 12(7.5) | ||
Other | 28(17.5) | ||
Educational experience in palliative care | Yes | 70(43.7) | |
No | 90(56.3) | ||
Experience in providing palliative care while working | Yes | 90(56.3) | |
No | 70(43.7) | ||
Experience of palliative care of a family member or a close person | Yes | 29(18.1) | |
No | 131(81.9) | ||
Bereavement experience of a family member or a close person. | Yes | 98(61.2) | |
No | 62(38.8) |
Mean scores of the research variables are presented in Table 2. The mean score of knowledge of palliative care was 9.09 ± 2.22, perception of palliative care was 72.82 ± 5.92, meaning of life was 143.99 ± 15.09, compassion competence was 65.46 ± 7.28, and willingness to provide palliative care was 74.43 ± 9.73 (Table 2).
Table 2
Knowledge & perception of palliative care, meaning of Life, compassion competence, and willingness to provide palliative care (N = 160)
Variables (Range) | Total score (M ± SD) | Min | Max |
|---|---|---|---|
Knowledge of Palliative Care (0–20) | 9.09 ± 2.22 | 3.00 | 16.00 |
Perception of Palliative Care (22–88) | 72.82 ± 5.92 | 60.00 | 87.00 |
Meaning of Life (46–184) | 143.99 ± 15.09 | 110.00 | 179.00 |
Compassion Competence (17–85) | 65.46 ± 7.28 | 47.00 | 85.00 |
Willingness to Palliative Care (20–100) | 74.43 ± 9.73 | 50.00 | 100.00 |
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Factors affecting nurses’ willingness to provide palliative care
Among the general characteristics of the participants, those with master’s degrees were more willing to provide palliative care than those with bachelor’s degrees (F = 4.32, p = .015) (Table 3). Participants’ willingness to provide palliative care had a significant and positive correlation with age (r = .28, p < .001), clinical experience (r = .25, p = .002), perception of palliative care (r = .36, p < .001), meaning of life (r = .37, p < .001), and compassion competence (r=.57, p<.001) (Table 4).
Table 3
Differences in willingness to provide palliative care according to general characteristics (N = 160)
Characteristics | Categories | M ± SD | t or F (p-value) | Scheffe |
|---|---|---|---|---|
Gender | Male | 77.5 ± 10.26 | 1.14(0.257) | |
Female | 74.18 ± 9.68 | |||
Religion | Yes | 74.47 ± 10.36 | -1.52(0.134) | |
No | 46.75 ± 9.27 | |||
Marital status | Single | 73.69 ± 10.04 | -1.19(0.233) | |
Married | 75.57 ± 9.18 | |||
Education | College degree a | 77.50 ± 12.52 | 4.32(0.015) | b < c |
Bachelor’s degree b | 72.60 ± 9.65 | b < c* | ||
Master’s degree c | 77.07 ± 9.02 | |||
Type of hospital | Certified tertiary hospital | 73.59 ± 9.72 | -1.84(0.068) | |
General hospital | 76.78 ± 9.45 | |||
Clinical position | Staff nurse | 73.66 ± 9.37 | 2.50(0.086) | |
Charge nurse | 75.71 ± 9.99 | |||
Unit manager | 80.30 ± 11.84 | |||
Work department | Medical ward | 73.69 ± 10.43 | 1.83(0.109) | |
Surgical ward | 73.39 ± 10.48 | |||
Intensive care unit | 80.94 ± 8.89 | |||
Emergency room | 73.83 ± 6.24 | |||
Operating room | 72.50 ± 9.40 | |||
Other | 74.50 ± 7.15 | |||
Educational experience in palliative care | Yes | 75.64 ± 10.16 | 1.39(0.165) | |
No | 73.49 ± 9.32 | |||
Experience in providing palliative care while working | Yes | 75.04 ± 9.72 | 0.90(0.368) | |
No | 73.64 ± 9.75 | |||
Experience of palliative care of a family member or a close person | Yes | 76.41 ± 8.53 | 1.22(0.226) | |
No | 73.99 ± 9.95 | |||
Bereavement experience of a family member or a close person. | Yes | 74.75 ± 9.58 | 0.51(0.610) | |
No | 73.94 ± 10.01 |
Table 4
Correlations among study variables (N = 160)
Variables | Age | Career (years) | Knowledge of Palliative care | Perception of Palliative care | Meaning of Life | Compassion Competence | Willingness to Palliative care |
|---|---|---|---|---|---|---|---|
r (p) | |||||||
Age | 1 | ||||||
Clinical experience (Year) | 0.92 (< 0.001) | 1 | |||||
Knowledge of Palliative care | 0.07 (0.382) | 0.11 (0.155) | 1 | ||||
Perception of Palliative care | 0.22 (0.005) | 0.22 (0.005) | 0.22 (0.005) | 1 | |||
Meaning of Life | 0.03 (0.705) | − 0.02 (0.794) | 0.13 (0.095) | 0.19 (0.014) | 1 | ||
Compassion Competence | 0.06 (0.436) | 0.03 (0.711) | 0.14 (0.086) | 0.25 (0.001) | 0.49 (< 0.001) | 1 | |
Willingness to Palliative care | 0.28 (< 0.001) | 0.25 (0.002) | 0.09 (0.233) | 0.36 (< 0.001) | 0.37 (< 0.001) | 0.57 (< 0.001) | 1 |
Table 5
Factors influencing willingness to provide Palliative Care (N = 160)
Independent variables | Model 1 | Model 2 | Model 3 | Model 4 | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
B | β | t | p | B | β | t | p | B | β | t | p | B | β | t | p | |
Constant | 70.49 | 18.06 | < 0.001 | 35.58 | 3.91 | < 0.001 | 12.91 | 1.27 | 0.203 | 2.93 | 0.32 | 0.745 | ||||
Education (Master’s degree = ref.) | ||||||||||||||||
College degree | 1.81 | 0.03 | 0.43 | 0.662 | 2.16 | 0.04 | 0.55 | 0.082 | 2.03 | 0.40 | 0.54 | 0.586 | 0.18 | 0.00 | 0.05 | 0.954 |
Bachelor’s degree | -2.91 | − 0.14 | -1.73 | 0.085. | -2.79 | − 0.14 | -1.74 | 0.082 | -1.29 | − 0.06 | − 0.83 | 0.407 | -2.51 | − 0.12 | -1.82 | 0.070 |
Clinical experience (Year) | 0.31 | 0.18 | 2.23 | 0.027 | 0.20 | 0.12 | 1.52 | 0.128 | 0.29 | 0.17 | 2.25 | 0.026 | 0.26 | 0.15 | 2.25 | 0.026 |
Knowledge of palliative care | 0.30 | 0.07 | 0.88 | 0.379 | 0.03 | 0.01 | 0.10 | 0.913 | -0.09 | − 0.02 | − 0.28 | 0.777 | -0.21 | − 0.05 | − 0.77 | 0.440 |
Perception of palliative care | 0.52 | 0.31 | 4.17 | < 0.001 | 0.42 | 0.26 | 3.54 | < 0.001 | 0.30 | 0.18 | 2.86 | 0.005 | ||||
Meaning of life | 0.20 | 0.31 | 4.30 | < 0.001 | 0.05 | 0.83 | 1.14 | 0.252 | ||||||||
Compassion competence | 0.64 | 0.48 | 6.78 | < 0.001 | ||||||||||||
F | 3.74 (p = .006) | 6.08 (p < .001) | 9.41 (p < .001) | 17.01 (p < .001) | ||||||||||||
R2 | 0.088 | 0.181 | 0.270 | 0.439 | ||||||||||||
AdjR2 | 0.065 | 0.154 | 0.241 | 0.414 | ||||||||||||
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As a result of testing the basic assumptions of the regression model, the variance inflation factor (VIF) was between 1.067 and 1.429, which was less than 10. Therefore, it was judged that there was no multicollinearity problem. In the residual analysis, the Durbin-Watson statistic was 1.860, which was close to 2, indicating that there was no problem with the assumption of independence of the residuals, and it was confirmed to be suitable for regression analysis.
As a result of inputting knowledge of educational background, clinical experience, and palliative care in Model 1, it was found that clinical experience influenced the willingness to provide palliative care (β = 0.18, p = .027). The explanatory power of Model 1 was 6.5% (F = 3.74, p = .006). As a result of additionally introducing perception of palliative care in Model 2, it was found that the perception of palliative care influenced the willingness to provide palliative care (β = 0.31, p < .001). The explanatory power of Model 2 was 15.4%. (F = 6.08, p < .001). As a result of additionally inputting the meaning of life in Model 3, it was found that the perception of palliative care (β = 0.26, p < .001), clinical experience (β = 0.17, p = .026), and meaning of life (β = 0.31, p < .001) influenced willingness to provide palliative care. The explanatory power of Model 3 was 24.1% (F = 9.41, p < .001). As a result of the additional input of empathy competency in Model 4, it was found that the willingness to provide palliative care was affected in the order of compassion competence (β = 0.48, p < .001), perception of palliative care (β = 0.18, p = .005), and clinical experience (β = 0.15, p = .026). The explanatory power of Model 4 was 41.4% (F = 17.01, p < .001) (Table 5).
Discussion
This study was conducted to ascertain the knowledge and perception of palliative care, meaning of life, compassion competence, and willingness to provide palliative care among nurses in South Korea, and to explore the factors influencing nurses’ willingness. In particular, the change in explanatory power was confirmed by inputting the research variables in this study through a hierarchical regression analysis.
Consequently, when education, clinical experience, and knowledge of palliative care were introduced in Model 1, clinical experience significantly influenced the willingness to provide palliative care. When the perception of palliative care was additionally introduced in Model 2, it significant influenced willingness to provide palliative care. When meaning of life was added in Model 3, clinical experience, perception of palliative care, and meaning of life were all significant factors influencing willingness to provide palliative care, with an explanatory power of 24.1%. Finally, as a result of adding compassion competence in Model 4, clinical experience, perception of palliative care, and compassion competence were identified as factors influencing the willingness to provide palliative care, and the explanatory power of the model increased from 24.1 in Model 3 to 41.4%.
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In the final model, compassion competence had the greatest influence on nurses’ willingness to provide palliative care. Compassion competence is the ability of a nurse to listen to and communicate with the patient, sensitively understand the patient’s changes or emotions, and assess the patient’s needs and condition based on nursing expertise [31]. The ability to deeply empathise with the pain of patients in need of palliative care is also at the core of the therapeutic relationship between nurses and patients in the palliative care field [18]. One study confirmed the relationship between the compassion competence of nurses and palliative care; however, in some previous studies, the compassion competence of nurses was also found to be a major factor influencing end-of-life care performance of nurses [20, 22]. Therefore, education and training to increase nurses’ compassion competence and forming in-depth therapeutic relationships with patients can increase their willingness to provide palliative care and help them prepare to provide such services.
The perception of palliative care was the second factor that influenced nurses’ willingness to palliative care. In fact, the higher the perception of palliative care, the higher was the willingness to provide palliative care, which is consistent with the results of a previous study of medical staff in China that found that the higher the degree of awareness of palliative care, the more actively they were willing to participate in palliative care [32]. This emphasises the importance of nurses correctly recognising that palliative care refers to ‘total care to help patients who are about to die, and their families, maintain dignity and high quality of life as humans, to provide physical, psycho-emotional, social and spiritual care to face the last moments of life in peace, and to alleviate the sadness and pain of families left behind in bereavement’ [33]. Therefore, various efforts are needed to first increase nurses’ awareness of palliative care to accept and participate in palliative care.
The third factor influencing nurses’ willingness to provide palliative care was their clinical experience. The higher the clinical experience, the higher was their willingness to provide palliative care, which is likely due to their increased understanding of patients through more caring experiences. In addition, a clinical nurse’s career was found to influence end-of-life nursing performance in a previous study [20]. However, more research is needed to confirm the relationship between clinical experience and actual palliative care performance.
Meaning of life was a significant influencing factor in Model 3, but not in Model 4; it should be considered that the correlation coefficient between meaning of life and empathy competency was r = .49, which was a moderate correlation. This study confirmed that the nurse’s level of meaning of life had a positive correlation with willingness to provide palliative care. These results are similar to those of previous studies, in that the higher the degree of meaning of life for a nurse, the higher the performance of spiritual care for meaning and purpose, love and interest, and forgiveness [17]. Considering that palliative care is a holistic care that also includes psychological and spiritual care, the higher the level of meaning of life of an individual nurse, the higher the potential acceptance of psychological and spiritual care that helps the recipient of palliative care discover the meaning of life. Therefore, in the future, it will be necessary to conduct studies to confirm the relationship between nurses’ meaning of life and their intention to provide palliative care.
In this study, knowledge of palliative care was not a significant influencing factor for the willingness to provide palliative care. However, in some previous studies, level of knowledge about palliative care was a major predictor of palliative care [12], and the reason for feeling reluctant or uncertain about palliative care was lack of knowledge and experience in palliative care [13]. Therefore, this aspect should be further explored in future research considering the various characteristics of nurses. In addition, one study reported that nurses choose end-of-life care when they have experienced the death or loss of a close person [34], and an in-depth study on whether nurses’ bereavement experience affects their willingness to provide palliative care is recommended.
This study found that the higher compassion competence of nurses, the higher the awareness of palliative care, and the more clinical experience, the greater the willingness to provide palliative care. To increase nurses’ willingness to provide palliative care, it is necessary to increase their ability to empathize with patients receiving palliative care, reduce the patient’s difficulties based on their understanding of palliative care, and provide education and training to nurses to raise awareness of palliative care. In addition, we recommend employers provide an opportunity for professional practice reflection so that the accumulated experience in clinical practice can accommodate patients in need of palliative care as well as nurses’ individual growth.
This study has several limitations. First, because this study relied on convenience sampling, there are limitations in generalising the research results. Second, the tool used to assess knowledge of palliative care, the KR-20, had a reliability coefficient of 0.29. Since the KR-20 value of the original tool was 0.78 [25], it is necessary to reexamine the Korean version of the questionnaire and reconfirm its reliability and validity with different samples in the future. The development of other reliable tools that can measure palliative care knowledge more appropriately would further advance this field of research. Finally, the willingness to provide palliative care tool used in this study was developed abroad and has not been verified for reliability or validity after translation into Korean. Therefore, we propose a study to verify the validity and reliability of this tool. However, the strength of this study lies in the fact that it identified the effects of nurses’ knowledge and perceptions of palliative care, meaning of life, and compassion competence on their willingness to provide palliative care, and its findings are expected to inform various educational programs towards increasing nurses’ intention to provide palliative care and to lay the foundations for providing high-quality palliative care.
Conclusion
This descriptive study aimed to identify the knowledge and perception of palliative care, meaning of life, compassion competence, and the willingness to provide palliative care among nurses in South Korea, and to explore the factors that influence this willingness. The results show that nurses’ willingness to provide palliative care was significantly and positively correlated with their perceptions of palliative care, meaning of life, and compassion competence. Perceptions of palliative care, clinical experience, and compassion competence were identified as influencing factors to willingness to provide palliative care. Based on this study, it is necessary to provide education and training that includes content that can increase nurses’ awareness of palliative care and improve their compassion competence to promote their willingness to provide palliative care.
Acknowledgements
Not applicable.
Declarations
Ethics approval and consent to participate
This study was approved by the Institutional Review Board of Kangwon National University (KWNUIRB-2022-11-004). Prior to the survey, the participants were informed of the purpose process of the study. They were also informed that they had the right to withdraw from the study at any time point. The participation in this study was voluntary. The survey was conducted only for participants who read the documented explanation and consent form for research participation and responded that they agreed to participate in the study. All research materials were coded with numbers, and did include their personal details, to ensure participants’ confidentiality.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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