Rural nurses? self-rated knowledge and skills in pain, medication, symptom and emergency management in community-based palliative care: A cross-sectional survey

Background: The assessment and management of pain and symptoms in community-based palliative care patients is a measure of quality in palliative care to indicate the quality of palliative care. Studies have identified rural community-based nurses are not always confident in this area of practice.Aim: To identify rural community-based nurses' strengths and gaps in palliative care knowledge and skills regarding pain, symptom and emergency management and to determine correlates of deficient knowledge.Methods: A cross-sectional study design was used. An electronic questionnaire was emailed to 165 community-based nurses in Gippsland, Australia. Participants rated their palliative care knowledge/skills on a five-point Likert scale ranging from 'No knowledge' (1) to 'Can teach others' (5) on the following topics: pain (2 items), medication (14 items), symptoms (26 items), palliative care emergencies (12 items) and assessment tools (2 items). For each item classified as a gap or consolidation, associations between nurse characteristics and no/basic knowledge were assessed using univariable and multivariable binary logistic regression.Findings: Overall, 122 nurses (response rate = 74%) completed the questionnaire. Seventy-one percent of items were identified as practice strengths. Strengths included pain (2/2), medication management (11/14), and symptom management (22/25). Twenty-nine percent of items were identified as gaps and consolidations. Gaps and consolidations related to management of opioid medications, symptom management of delirium, and the recognition and management of rare emergency situations within palliative care. Discussion: This study found that lack of experience and formal training in palliative care were associated with gaps in knowledge. Conclusion: This study found that lack of experience and formal training in palliative care were associated with gaps in knowledge. Targeted interventions such as training and peer mentoring have the potential to address identified gaps in rural community-based nurses' palliative care knowledge/skills and, ultimately, improve the care of palliative patients.