Attitudes and influencing factors of nursing assistants towards hospice and palliative care in Chinese nursing homes: a cross-sectional study

Background: Hospice and palliative care (HPC) in China are mainly available at public primary care institutions, where nursing homes (NHs) are rarely involved. Nursing assistants (NAs) play an essential role in the HPC multidisciplinary team, but little is known about their attitudes towards HPC. This study aimed to identify the attitudes and factors influencing HPC among NAs. Methods: : A cross-sectional study was designed to evaluate NAs’ attitudes towards HPC with an indigenized scale in Shanghai. A total of 165 formal NAs were recruited from 3 urban and 2 suburban NHs between October 2021 and January 2022. The questionnaire was composed of 4 parts, demographic characteristics, attitudes (20 items with 4 sub-concepts), knowledge (9 items), and training needs (9 items) for HPC. Descriptive statistics, independent samples t-test, one-way ANOVA, Pearson’s correlation, and multiple linear regression were performed to analyse NAs’ attitudes, influencing factors, and their correlations. Results: : In total, 156 questionnaires were valid. The mean score of attitudes was 72.44±9.56 (range: 55~99), with a mean item score of 3.6±0.5 (range: 1~5). The highest score rate was “perception of the benefits for the life quality promotion” (81.23%), and the lowest score rate was “perception of the threats from the worsening conditions of advanced patients” (59.92%). NAs’ attitudes towards HPC were positively correlated with knowledge score (r=0.46, p <0.01) and training needs (r=0.33, p <0.01). Marital status ( β =0.185), previous training experience ( β =0.201), area of NHs ( β =0.193), knowledge of HPC ( β =0.294), and training needs ( β =0.157) for HPC constituted the significant predictors of attitudes ( p <0.05), which explained 30.8% of the overall variance. Conclusion: NAs’ attitudes towards HPC were moderate, but the knowledge level still needs improvement. As integrated HPC in NHs can be achieved only with the participation of positive and enabled NAs, thus targeted training is highly recommended based on the significant factors identified in this study.