Skip to main content

Advertisement

Log in

Effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients

Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Introduction

This study aimed to investigate the effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions regarding supplying artificial nutrition and hydration (ANH) to terminal cancer patients.

Materials and methods

A quasi-experimental design was adopted. A structured questionnaire evaluated the effects of educational intervention. From April to June 2005, 88 nurses were enrolled in the gastroenterology, general surgery, and intensive care unit of Taipei Veterans General Hospital in Taiwan. The nurses were randomly assigned into experimental and control groups in equal numbers (44 nurses in each group). After the experimental and control groups completed the pretest, the experimental group participated in a 50-min lecture. Both groups received a post-test 2 weeks after the lecture.

Results

This study showed that prior to educational intervention, nurses have possessed experiences of ANH use in routine caring for terminal cancer patients. However, due to the lack of knowledge about supplying ANH to terminal cancer patients, the nurses trended toward the negative behavioral intention, although they realized the burdens of ANH in these patients. After educational intervention, mean scores of knowledge, attitudes and behavioral intentions of the experimental group increased significantly (z = −5.255, p < 0.001; t = −5.191, p < 0.001; z = −3.274, p ≦ 0.001). Mean score changes of knowledge and attitude between these two groups reached significant differences (t = −7.306, p < 0.001; t = −4.165, p < 0.001), but no significant difference was observed in the mean score change of behavioral intention (z = −1.943, p > 0.05).

Conclusion

The educational intervention remarkably improved nurses’ knowledge and attitudes regarding supplying terminal cancer patients with ANH. As for the changes in the behavioral intentions, it requires long-term moral and ethical training and communication. The results of this research emphasized the importance of educational interventions, which should be considered seriously in future reference nursing education program.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Andrews MR, Levine AM (1989) Dehydration in the terminal patient: perception of hospice nurses. Am J Hosp Care 6:31–34

    Article  PubMed  CAS  Google Scholar 

  2. Asch DA, Christakis NA (1996) What do physicians prefer to withdraw some forms of life support over others? Intrinsic attributes of life-sustaining treatments are associated with physicians’ preferences. Med Care 34:103–111

    Article  PubMed  CAS  Google Scholar 

  3. Bruera E, Franco JJ, Maltoni M, Watanabe S, Suarez-Almazor M (1995) Changing pattern of agitated impaired mental status in patients with advanced cancer: association with cognitive monitoring, hydration, and opioid rotation. J Pain Symptom Manage 10:287–291

    Article  PubMed  CAS  Google Scholar 

  4. Burge FI, King DB, Willison D (1990) Intravenous fluids and the hospitalized dying: a medical last rite? Can Fam Physician 36:883–886

    Google Scholar 

  5. Chang HH, Hu WY, Chiu TY et al (2003) An interventional study assessing palliative care learning amongst junior medical students undertaking the course “the human side of medicine”. J Med Educ 7:150–160

    Google Scholar 

  6. Chiu TY, Hu WY, Chuang RB et al (2004) Terminal cancer patients’ wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan. J Pain Symptom Manage 27:206–214

    Article  PubMed  Google Scholar 

  7. Chiu TY, Hu WY, Chuang RB, Chen CY (2002) Nutrition and hydration for terminal cancer patients in Taiwan. Support Care Cancer 10:630–636

    Article  PubMed  Google Scholar 

  8. Department of Health, Executive Yuan, Taiwan, R.O.C. 2006 Statistical summary of the main causes of death in Taiwan. Available at http://www.doh.gov.tw/statistic/index.htm. Accessed Sep 23, 2007

  9. Ellershaw JE, Sutcliffe JM, Saunders CM (1995) Dehydration and the dying patient. J Pain Symptom Manage 10:192–197

    Article  PubMed  CAS  Google Scholar 

  10. Fainsinger R, Miller MJ, Bruera E, Hanson J, Maceachern T (1991) Symptom control during the last week of life on a palliative care unit. J Palliat Care 7:5–11

    Google Scholar 

  11. Fainsinger RL, Bruera E (1997) When to treat dehydration in a terminally ill patient? Support Care Cancer 5:205–211

    Article  PubMed  CAS  Google Scholar 

  12. Hu WY, Tseng CN, Wang Y, Ueng RS (2004) The effects of clinical practice program toward palliative care for nursing students’ education in school of nursing. Taiwan J Hosp Palliat Care 9:1–20

    Google Scholar 

  13. Ke LS, Chiu TY, Lo SS, Hu WY (2007) Knowledge, attitudes, and behavioral intentions of nurses toward providing artificial nutrition and hydration for terminal cancer patients in Taiwan. Cancer Nurs 31:67–76

    Article  Google Scholar 

  14. Lai YL (2004) Hospice palliative care in Taiwan. Formosan J Med 8:653–656

    Google Scholar 

  15. Lynn J, Childress JF (1983) Must patients always be given food and water? Hastings Cent Rep 13:17–21

    PubMed  CAS  Google Scholar 

  16. Mc Inerney F (1992) Provision of food and fluids in terminal care: a sociological analysis. Soc Sci Med 34:1271–1276

    Article  Google Scholar 

  17. Micetich KC, Steinecker PH, Thomasma DC (1983) Are intravenous fluids morally required for a dying patient? Arch Intern Med 143:975–978

    Article  PubMed  CAS  Google Scholar 

  18. Morita T, Hyodo I, Yoshimi T et al (2005) Association between hydration volume and symptoms in terminally ill cancer patients with abdominal malignancies. Ann Oncol 16:640–647

    Article  PubMed  CAS  Google Scholar 

  19. Morita T, Shima Y, Adachi I (2002) Attitudes of Japanese physicians toward terminal dehydration: a nationwide survey. J Clin Oncol 20:4699–4704

    Article  PubMed  Google Scholar 

  20. Morita T, Tei Y, Inoue S, Suga A, Chihara S (2002) Fluid status of terminally ill cancer patients with intestinal obstruction: an exploratory observational study. Support Care Cancer 10:474–479

    Article  PubMed  Google Scholar 

  21. Morita T, Tei Y, Tsunoda J, Inoue S, Chihara S (2001) Determinants of the sensation of thirst in terminally ill cancer patients. Support Care Cancer 9:177–186

    Article  PubMed  CAS  Google Scholar 

  22. Morita T, Tsunoda J, Inoue S, Chihara S (1999) Perceptions and decision-making on rehydration of terminally ill cancer patients and family members. Am J Hosp Palliat Care 16:509–516

    Article  PubMed  CAS  Google Scholar 

  23. Musgrave CF, Bartal N, Opstad J (1995) The sensation of thirst in dying patients receiving i.v. hydration. J Palliat Care 11:17–21

    PubMed  CAS  Google Scholar 

  24. Musgrave CF, Bartal N, Opstad J (1996) Intravenous hydration for terminal patients: what are the attitudes of Israeli terminal patients, their families, and their health professionals? J Pain Symptom Manage 12:47–51

    Article  PubMed  CAS  Google Scholar 

  25. Philip J, Depczynski B (1997) The role of total parenteral nutrition for patients with irreversible bowel obstruction secondary to gynecological malignancy. J Pain Symptom Manage 13:104–111

    Article  PubMed  CAS  Google Scholar 

  26. Printz LA (1988) Is withholding hydration a valid comfort measure in the terminally ill? Geriatrics 43:84–88

    PubMed  CAS  Google Scholar 

  27. Smith SA (1997) Controversies in hydrating the terminally ill patient. J Intraven Nurs 20:193–200

    PubMed  CAS  Google Scholar 

  28. Solomon MZ, O’Donnell L, Jennings B et al (1993) Decisions near the end of life: professional views on life-sustaining treatments. Am J Public Health 83:14–23

    PubMed  CAS  Google Scholar 

  29. Tsai PJ (2004) The ethical dilemma and social work ethical justification for terminal medical communication. Taiwan J Hosp Palliat Care 9:141–152

    Google Scholar 

  30. Tsai SL, Hu WY, Chiu TY et al (2004) The knowledge of palliative care amongst senior medical students undertaking the course “family, society and medicine”. Formosan J Med 8:313–322

    Google Scholar 

  31. Weissman DE, Ambuel B, Norton AJ, Wang-Cheng R, Schiedermayer D (1998) A survey of competencies and concerns in end-of-life care for physician trainees. J Pain Symptom Manage 15:82–90

    Article  PubMed  CAS  Google Scholar 

  32. Wurzbach ME (1995) Long-term care nurses’ moral convictions. J Adv Nurs 21:1059–1064

    Article  PubMed  CAS  Google Scholar 

  33. Zerwekh JV (1983) The dehydration question. Nursing 13:47–51

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank the nurses of gastroenterology, general surgery, and intensive care unit of Taipei Veterans General Hospital for their full support.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wen-Yu Hu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ke, LS., Chiu, TY., Hu, WY. et al. Effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients. Support Care Cancer 16, 1265–1272 (2008). https://doi.org/10.1007/s00520-008-0426-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-008-0426-0

Keywords

Navigation