ABSTRACT
This study is conducted to evaluate the challenges of end-of life care in nursing at oncology ward in Federal Medical Centre Idi-aba Abeokuta, Ogun State. The study specifically examined the experiences and challenges in End-Of-life care among nurses in attending to patients in oncology ward in Federal Medical Centre Idi-aba Abeokuta, Ogun State. The research design adopted for this study is the descriptive research design. The study population consist of 481 nurses in working FMC, Abeokuta Ogun state that are willing to participate in the study. However, 378 nurses was able to responds to during the time of administration which forms the study sample size. The instrument used in data collection is the questionnaire. The data will be analyzed with the use of descriptive analysis. The results of this study indicated that it was important to understand the factors that influenced nurses' experience of end-of-life care. From the data generated and analysed, there were some clear findings that perception of elderly people towards nursing care is above average. The study found out that that there are challenges encountered among nurses rendering End-Of-life care in Nursing at oncology ward in Federal Medical Centre Idi-aba Abeokuta, Ogun State. In order to further develop end-of-life care, it was recommended that the nurses must strengthen their knowledge and skills related to end-of-life care, enhance the awareness of end-of-life care and constantly improve their level from the aspects of psychology, professional technology, comprehensive ability to deal with problems, master excellent operation technology and nursing theory knowledge.
TABLE OF
CONTENTS
Title Page
i
Declaration Page
ii
Certification iii
Dedication
iv
Acknowledgement v
Table of Contents
vi
Abstract ix
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study
1
1.2 Statement of the Problem
3
1.3 Objectives of the Study 3
1.4 Research Questions
4
1.5 Significance of the Study
4
1.6 Scope of Study
4
1.7 Operational Definition of Terms
5
CHAPTER TWO: LITERATURE
REVIEW
2.1 Conceptual Review 6
2.1.1 Concept of End-of-life Cycle
6
2.1.2 The Nurse’s Role 9
2.1.3 Nurses knowledge of care towards the End-of-life care patience 9
2.1.4 Nurses attitude and practice towards the care of End-of life care 11
2.1.5 Challenges associated with the End-of-life care for patients 13
2.2
Theoretical Review 14
2.2.1 Theory of Planned Behaviour and Theory of reasoned action 14
2.2.2 Application of
the Study 15
2.3
Empirical Review
16
2.4 Summary of Literature Review 25
CHAPTER THREE: RESEARCH
METHODOLOGY
3.1 Research Design
26
3.2 Research Settings
26
3.3 Research Population
27
3.4 Sampling Techniques 27
3.5 Instrument for Data Collection 27
3.6 Validity of the Research Instrument 27
3.7 Reliability of Research Instrument 28
3.8 Method of Data Collection 28
3.9 Procedure for Data Analysis 28
3.10 Ethical Consideration 28
CHAPTER FOUR: DATA
PRESENTATION AND ANALYSIS
4.1 Presentation
of Data 30
CHAPTER FIVE: SUMMARY,
CONCLUSION AND RECOMMENDATIONS
5.1 Discussion on Findings
34
5.2 Clinical implications for Nursing 35
5.3 Limitations of the Study 36
5.4 Summary of Findings 36
5.5 Conclusion
37
5.6 Recommendation
37
5.7 Suggestion for Further Research 38
REFERENCES 39
APPENDIX
43
CHAPTER
ONE
INTRODUCTION
1.1 Background
to the Study
End-of-life
care is provided to patients with cancer during the last days and weeks of
life. End-of- life care may also be required where people with major organ
failure are at risk of death. The end-of-life care provided by nurse is of
particular importance as they can focus on facilitating patient choice, and
managing symptoms such as pain, without increasing the risk of death (Laube, et
al, 2021). In such cases, end-of-life discussions with nurses are crucial
(Salifu, et al, 2021), particularly as those with heart failure often
experience sudden and unexpected changes and deteriorations in their condition
(Suwanabol, et.al, 2018). Nevertheless, it is often unclear how to best
approach such conversations from the perspective of clinicians.
A
recent review of the literature highlighted the importance of analyzing the
views of care professionals regarding the provision of end-of-life care for
people with cancer in order to understand how their care performance is
affected (Gedefaw, et al, 2021). Elsewhere, health professionals have
identified the lack of an accurate prognosis of advanced cancer a barrier to providing
quality end of-life care discussions (Sayed, et al, 2021). Family caregivers who provide care at home
for people with cancer also need to engage in high quality conversations about
end- of- life care (Kim,et al, 2020). Yet while the literature has explored
challenges relating to end-of-life care discussions for those with critical
health failure from the perspective of doctors and family caregivers, the
nurses’ point of view in this field has received less attention. Families’
perspectives and nurses ‘perceptions of the challenges in providing end-of-life
care and related discussions have not yet been analyzed in Nigeria at all. This
is concerning given that nurses provide the majority of end-of-life care and
more often initiate associated conversations, both of which can improve quality
of life of patients with cancer. Considering the above, the aim of this
research was to explore nurses ‘perceptions of the challenges involved in
providing of end-of-life care to patient with cancer.
End-of-life
care aims at improving the quality of life for people with life-limiting
conditions (Kelley, 2015). This includes managing the patient’s pain and
symptoms and addressing the burden and psychosocial issues of both the patient
and family (Ascherfeld, et al, 2017). Other researchers have established that
palliative care goes beyond the patient’s physical and psychological health to
include the quality of life of the families of patients suffering from chronic
disease in order to promote physical and psychological health (Aparicio, et al,
2017). Evidence suggests that patients suffering from chronic and life-limiting
diseases such as prostate cancer and hepatocellular carcinoma receive
inadequate care which could be linked to inadequate palliative care training for
physicians and communication challenges (Sabih, et al, 2017). Similarly, poorly
trained palliative care nurses were found to have limited palliative care
knowledge and exhibited poor attitudes towards patients receiving palliative
care than trained nurses (Reichstein, et al, 2018). Some nurses possess the
skills to effectively manage the symptoms of patients with chronic conditions
despite the fact that their knowledge of palliative care may be lacking (Sayed,
et al, 2021
In
Africa, various obstacles have been recognized as barriers to the successful
implementation of palliative care, including late diagnosis, poverty, lack of
knowledge, and limited access to palliative care services (LaVigne, et al,
2018)
1.2 Statement
of the Problem
End-of-life
care delivery is more prevalent in industrialized Western countries, such as
the United States and the United Kingdom, than it is in African countries such
as Ghana (Adejoh, et al, 2021). In Ghana, there are only three hospitals that
deliver palliative care services (George, et al, 2020). These hospitals are the
Korle-Bu Teaching Hospital, Tetteh Quarshie Memorial Hospital, and Komfo Anokye
Teaching Hospital which are all located in urban areas. Thus, patients living
in rural areas often face barriers to accessing palliative care services as the
facilities and experts in this field are located in urban centers. In Africa,
including Nigeria, there is a lack of understanding about the experiences of
patients and nurses who provide palliative care services (Anyane, etal, 2021).
Understanding how palliative care can be successfully delivered and how it can
be improved will benefit patients, their families, and the healthcare providers
delivering this care. Therefore, the purpose of the study was to explore the
roles and challenges of nurses providing palliative care services for patients
with cancer and other co-morbidities at a tertiary hospital in Nigeria which is
one of the facilities providing palliative care. However, it is on this note
that this study is conducted to evaluate the challenges in End-Of-life care in
nursing, at oncology
ward in Federal Medical Centre Idi-aba Abeokuta, Ogun State.
1.3 Objectives
of the Study
The
objectives of this study therefore;
i.
To assess the experience
on End-of-life care among nurses at oncology ward in Federal Medical Centre Idi-aba
Abeokuta, Ogun State
ii.
To examine the challenges
in End-of-life care among nurses at oncology ward in
Federal Medical Centre Idi-aba Abeokuta, Ogun State
1.4 Research
Questions
The
research questions to be used in this study include;
i. What is the
experience on End-Of-life care among nurses at oncology ward in Federal Medical Centre
Idi-aba Abeokuta, Ogun State?
ii. What are the
challenges in End-Of-life care among nurses at oncology ward in Federal Medical Centre
Idi-aba Abeokuta, Ogun State?
1.5 Research Hypothesis
H₀: There is no significant
relationship between nurses’ experience and the quality of end-of-life care
provided in the Oncology ward at FMC Idi-aba Abeokuta, Ogun State.
H₁:
There is a significant relationship between nurses’ experience and the quality
of end-of-life care provided in the Oncology ward at FMC Idi-aba Abeokuta, Ogun
State.
1.6 Significance
of Study
The
results from this study will provide us with a valuable insight into some of
the views of End-of-life care in Nursing at Oncology ward at FMC Idi-aba
Abeokuta, Ogun State. The study will explore the various challenges encountered
by nurses attending to patients Oncology ward. The study will also enlighten,
nurses, doctors. The findings of this will also educate both nursing students
and other college of health student on the importance of providing quality
health care services to patients Oncology ward.
1.7 Scope of Study
The
study focuses on challenges in End-Of-life care in Nursing, in the Oncology
ward at FMC Idi-aba Abeokuta, Ogun State. Geographically, the study will be
carried out in FMC, Abeokuta Ogun state. The unit of analysis will be based on
nurses’ perspective and experience in the studied health center.
1.8 Operational
definition of terms
·
Nursing:
It is a
profession within the health care sector focused on the care of individuals,
families, and communities so they may attain, maintain, or recover optimal
health and quality of life.
· Oncology Ward: A specialized hospital unit focused on the
treatment and care of patients with cancer. For this study, it is the setting
in FMC Idi-Aba where the challenges of providing end-of-life care are evaluated.
·
Nursing
care: These refer to essential medical care
offered by professional nurses, which are also part of their primary
assignment.
· End-of-life
care: Care given to people who are near the
end of life and have stopped treatment to cure or control their disease.
End-of-life care includes physical, emotional, social, and spiritual support
for patients and their families.
·
Federal
Medical Centre (FMC) Idi-Aba, Abeokuta:
A tertiary healthcare institution in Abeokuta, Ogun State, Nigeria, where the
oncology ward is located. It serves as the setting for this study, focusing on
evaluating end-of-life care challenges within this specific hospital
environment.
· Ogun
State: A southwestern state in Nigeria, bordered
by Lagos State to the south, Oyo and Osun states to the north, Ondo State to
the east, and the Republic of Benin to the west. It is known for its diverse
ethnic groups, mainly the Yoruba, and serves as a major economic and cultural
hub. Abeokuta, the capital of Ogun State, hosts various significant institutions,
including the Federal Medical Centre Idi-Aba, where this study is conducted.
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