Beyond attitudes: The knowledge–competence gap in palliative care among nurses and nurse aides in long-term care facilities
Chi-Yin Kao, Wen-Chen Cheng, Mei-Chuan Huang, Hui-Chen Chao, Hua-Tsen HsiaoBackground
As Taiwan becomes a super-aged society, long-term care facilities play an increasingly vital role in end-of-life care. Palliative care requires frontline staff to address residents’ clinical, psychosocial, spiritual, communication, and family-related needs. However, evidence regarding the palliative competence of nurses and nurse aides remains limited.
Objectives
To explore the palliative care knowledge, attitudes, and competence of nurses and nurse aides in long-term care facilities, and factors associated with competence.
Design
A cross-sectional study using a questionnaire survey.
Methods
A total of 119 nurses and 91 nurse aides were recruited from 15 long-term care facilities between April 2021 and March 2022 in Taiwan. The survey included a demographic questionnaire, the Palliative Care Quiz for Nursing (PCQN), the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B), and the Palliative Care Competence Scale.
Results
The mean PCQN score of all participants was 9.1 (SD = 2.8; 45.5% accuracy), indicating a moderate to low level of palliative care knowledge, with the lowest scores observed in psychosocial and spiritual care. The mean FATCOD-B score was 105.7 (SD = 14.2; 70.5%), reflecting positive attitudes toward palliative care. Self-reported palliative care competence was highest in comfort care delivery and lowest in end-of-life situations management. Nurses reported significantly higher competence than nurse aides. Knowledge, attitudes, palliative care experiences, and comfort levels when caring for a terminal patient were associated with competence, explaining 28% of the variance.
Conclusion
Despite generally positive attitudes toward palliative care, nurses and nurse aides demonstrated knowledge gaps, particularly in psychosocial and spiritual care, while competence was lowest in managing end-of-life situations. These findings highlight distinct educational needs across the clinical, psychosocial, and spiritual dimensions of palliative care and support role-specific education that strengthens the complementary roles of nurses and nurse aides within interdisciplinary long-term care practice.