Evaluation of Knowledge and Attitudes Toward Palliative Care Among Critical Care Nurses in Tertiary Hospitals of South Punjab, Pakistan

Abstract

Background: Palliative care (PC) is essential in intensive care, yet nurses’ readiness for symptom control, communication, and family engagement varies widely in low- and middle-income settings. Empirical data from South Punjab’s tertiary ICUs/HDU remain limited. Objective: To quantify critical care nurses’ knowledge and attitudes toward PC in tertiary hospitals of South Punjab, Pakistan, and identify priority domains for education. Methods: A cross-sectional study was conducted from 1 November 2024 to 21 April 2025 among ICU/HDU nurses in public and private tertiary hospitals. Using a structured, expert-reviewed questionnaire, demographics, knowledge, and attitudes were collected on 5-point Likert scales. Knowledge items were polarity-coded and reverse-scored where appropriate; total knowledge and attitude scores were expressed as percentages of scale maxima and categorized a priori (Excellent >80%, Good 65–80%, Average 50–64%, Poor <50%). Results: Of 151 nurses (97.4% female; 43.7% >30 years; 43.7% >5 years’ experience), mean knowledge was 68.8% (“Good”) and mean attitude 60.58% (“Average”). High item accuracy was observed for “patient is best judge of pain” (76%) and “chronic vs acute pain differ” (79%). Misconceptions persisted for placebo appropriateness (20% correct) and emotional detachment (33% correct). Attitudes favored family involvement (educating families 77%; extending care to families 78%; family participation in care 73%) but showed discomfort with end-of-life care (change topic when asked about dying 59%; not wanting to care for dying 42%; not wanting to attend a dying patient 40%). Conclusion: ICU/HDU nurses exhibited solid pain-assessment knowledge but gaps in psychosocial/ethical domains and communication openness. Targeted, simulation-supported education and embedded ICU triggers for early PC consultation are warranted.