Abstract

Despite the fact that nurses make up the largest group of healthcare professionals, little is known about their knowledge, practices, and challenges in palliative care across health services. This study was aimed at assessing nurse’s knowledge on practices and challenges face in rendering palliative care to the terminally ill in the BHM Specifically the investigate nurse’s knowledge on palliative care; nurse’s knowledge on palliative care practices and lastly, what challenges do nurses face when rendering palliative care. The study adopted a quantitative study with across sectional design. The population of the was made up of 34 nurses.

The convenient sampling technique was employed to select respondent of the study, questionnaires were as instruments for primary data collection. The finding of the study revealed that the majority (80%) had good knowledge on palliative care in the hospital. 50% new of palliative care practices, and 100% of 34 nurses each were able to identify at least a challenge nurses face in rendering palliative care in hospital setting.

The study went further to conclude there is adequate knowledge regarding palliative care in the hospital setting, the finding of the study recommends that Seminars should be organize so as to teach nursing on the way they can managed their challenges for better management on their patient.

CHAPTER ONE

INTRODUCTION

Background of study

Historically, Palliative Care has equated to that of death and dying; providing a negative connotation.  Therefore, providers tend to prolong implementation of services:  confusing Palliative Care with that of Hospice Care (Ramchandran, 2013).  The probable explanation for     such confusion relates to the introduction of Palliative Care within the oncology setting during the 1950’s, which molded the conceptual model (Clark, 2007).

During this time, the focus of care centered on treating patients who maintained a potential for cure and sending those without such potential home to die (Clark, 2007).  To compensate for the perception of abandonment, palliation of symptoms became the focus of care for this patient population.

Overtime, Dr. Cicely Sanders and various leaders in the social aspects of death and dying began to raise awareness of unmet needs, the consequences thereof (Hui, 2013), and the term “palliative care,” surfaced.  Created by Dr. Baulfor Mount, this term served to describe care provided within the hospice setting in Canada (Hui, 2013), hence the beginning of the associated stigmatism of the word “palliative” to death and dying.  In 1974, the concept of Hospice Care evolved in America, as a model of care to provide palliation of symptoms to terminal patients as they experienced a natural death within their home (Clark, 2007).

Palliative care is an essential part of nursing care that can be delivered at different levels of complexity (De Vlieger et al 2004). Terminal illness is a disease which cannot be cured and is likely to leads to death. People with this terminal illness may live for days, weeks, months, or sometimes years, it can be difficult for a doctor to predict how long someone will live for. Someone living with this condition is likely to receive treatment and care which focuses on managing their symptoms and maintaining their quality of life (palliative care). The aim is to make the person feel supported and give them a good quality of life rather than curing their illness.

Someone living with terminally illness doesn’t mean they cannot live a full life. Palliative care aims to help the person be as well and active as possible and it helps manage any pain or other symptoms they may have.   Palliative patients are cared for not only on specialized unit but also at home or general wards the hospitals and nursing homes, As a result, it is not only advanced nurses who come into contact with the palliative patient, recent nursing graduates must also be able to provide adequate care to them (De Vlieger et al 2004)..

Theoretically, we will be using Jean Watson theory of care. With Jean Watson theory also known as the philosophy and science of care, this theory addresses how nurses express care to their patients. She said in her theory that caring is central to nursing practice and promotes health better than simple medical cure and she believed a holistic approach to health is central to the practice.

Also, to Watson, caring which has manifested in nursing has existed in every society and this caring attitude is not transmitted from generation to generation but rather its transmitted by culture of the nursing profession as a unique way of coping with the environment. Again, according to her theory, caring can be demonstrated and practiced by nurses and caring environment is to accept a person the way he or she is and look forward to what he or she may become.  This theory seeks to explain holistic care which is accordance with palliative care.

In African countries, it was started that only 4of 53 countries have integrated palliative care in to health care policy or used it as part of a strategic plan focusing on cancer treatment. These include Kenya, south Africa,   Tanzania and Uganda, while Rwanda and Switzerland have taken a different approach by developing stand alone national palliative care  policies(Mwangi-powell Faith., 2011).

Apart from cancer and HIV infection, African is filled with other life threatening illnesses among which are sickle cell disease. The greatest burden of sickle cell anemia occurs in sub-Saharan Africa, where 75% of the 300,000 global births of affected children live and where 50-80% of the patients will die before adulthood (WHO., 2006).

A related study carried out by Dr Sumaya  Saye and the colleagues on the nurses knowledge and attitudes towards the palliative care was published in 2015 with the objective of assessing nurses knowledge and attitudes towards palliative care among nurses working in selected hospitals in Northern districts, Palestine.

A descriptive cross sectional study was used for conducting this study, with the result showing that 20.8% of the respondents had a good overall knowledge towards palliative care, 59.4% had training of palliative care, and 6.2% had good attitudes towards palliative care. Conclusively nurses had poor knowledge on palliative care but their attitude towards palliative care was moderate. which shows the indications of carrying out this research?

1.2 Problem Statement

Nurses find it difficult and emotionally heavy to deliver palliative care to patients and often do not feel competent enough according to(white et al ., 2004). Family and care givers of the deceased patient often feel that the end of life have poorly control symptoms and distress (Mani RK., 2005).

Back in the quarters we have come across so many families and caregivers of a deceased patient who keeps on debating on the fact that they can’t carry their patient to the hospital because the patient will not survive the disease, time and money is been wasted since nurses at palliative care unit and end of life care (PC and EOL) have poorly control symptom and distress.

The above limitations like incompetency, inappropriate life sustaining interventions and problem such as lack of trained health care providers among others trigger the mine of the researcher to carry out research on investigating nurses’ knowledge on palliative care practices and challenges of terminally ill patients in Mutegene Baptist Hospital.

1.3 Objectives

1.3.1 General Objective

To assess nurses’ knowledge on practice and challenges face in rendering palliative care to terminally ill-patients in the Mutegene Baptist Hospital.

1.3.2 Specific Objectives

1. Knowledge of nurses on palliative care in Baptist Hospital Mutengene.
2. Knowledge of palliative care practices in Baptist Hospital Mutengene.
3. Challenges nurses face in rendering palliative care to terminally ill-patient in Baptist Hospital Mutengene.

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