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Article

Knowledge and Attitude toward End-of-Life Care of Nursing Students after Completing the Multi-Methods Teaching and Learning Palliative Care Nursing Course

by
Hartiah Haroen
1,*,
Ristina Mirwanti
2 and
Citra Windani Mambang Sari
1
1
Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
2
Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
*
Author to whom correspondence should be addressed.
Sustainability 2023, 15(5), 4382; https://doi.org/10.3390/su15054382
Submission received: 8 January 2023 / Revised: 27 February 2023 / Accepted: 28 February 2023 / Published: 1 March 2023
(This article belongs to the Section Sustainable Education and Approaches)
Browse Figure
Versions Notes

Abstract

:
Introduction: This study aims to assess the palliative care nursing (PCN) knowledge and attitude of nursing students toward end-of-life care (EoLC) after completing the multi-methods PCN courses. Methods: A quasi-experimental study with a pre-and post-palliative survey was conducted. One hundred and sixty five nursing students from a faculty of nursing in Indonesia were enrolled, and knowledge and attitude were assessed using the palliative care quiz for nurses (PCQN) and the Frommelt Attitude Toward Care of the Dying and Death (FATCOD). Paired t-test and ANOVA were applied in this study. Results: After being involved in the PCN course, the mean score of PCN knowledge of the students increased significantly (p < 0.001). According to sub-domain analysis, the knowledge increased significantly in pain and symptom management (p < 0.001) and not significantly in the domains of theory and principle of the palliative, psychosocial, and spiritual care (p = 0.053; p = 0.080). Moreover, students’ attitude toward EoLC also increased significantly (p < 0.001), and positive attitudes increased from 75.6% to 91.5%. According to the ANOVA test, knowledge in two different groups (witnessed dying people and GPA) is not statistically meaningful (FWDP (1158) = 0.817, p = 0.367; FGPA (2.158) = 1.143, p = 0.322). Similarly, attitudes toward EoLC in two different groups are not statistically meaningful (FWD (1158) = 0.971. p = 0.326, FGPA (1157) = 1.278, p = 0.281). Conclusion: PCN courses with multi-method learning and teaching are effective to increase PCN knowledge, particularly in pain and symptom management knowledge, and also effective in increasing the positive attitudes toward EoLC.

1. Introduction

Death is one of the most intense emotional events anyone encounters, regardless of culture, ethnicity, or religion [1]. As a natural process, death is also a painful experience for individuals and their families which might impact both on physical and psychological aspects [2]. It is argued that providing nursing care for end-of-life patients may be challenging for nurses and nursing students, especially in their first encounter with death.
End-of-life care (EoLC) can affect nursing students in various ways which may create a feeling of unpreparedness to provide EoLC [3]. The fears and responses encountering a deceased person, as well as the distress of not being prepared to assist patients and their families, were of the concern of nurses and nursing students [4]. A previous study showed that negative attitudes from nurses, such as fear and anxiety in providing nursing care, could decrease the quality of care given to dying patients [5]. Nurses may avoid death-related issues, death acceptance, and palliative care due to uncertainty about death [6]. Therefore, working with dying patients, such as in palliative care (PC) facilities, demands more knowledge and attitudes through a more acceptance of death and the dying process [7]. This requires that nurses acquire the relevant information and abilities during their undergraduate and internship studies and should not avoid nor ignore death and dying-related topics.
Improving PC knowledge and attitudes through PC education is essential to prepare the students to provide EoLC. Positive attitudes toward PC are vital for nurses, and it can be improved through professional education and clinical work experiences [8]. Grubb and Arthur argued that positive attitude among nursing students toward caring for people who are dying can be an indication of an effective therapeutic relationship with people who are dying [5]. Moreover, Jeffers concluded that positive attitudes toward dying patients is a core component of providing EoL care [9]. As such, it is suggested that improving nursing students’ attitudes toward EoLC should be an essential focus in designing curricula for EoLC in nursing education.
A current meta-analysis of 26 cross-sectional studies from 13 countries concluded that nursing students reported insufficient knowledge regarding EoLC [10]. The knowledge was demonstrated as deficient especially in the context of philosophy and principle; pain and symptoms management; and psychosocial and spiritual care. To the best of our knowledge, only one study has been conducted in Indonesia that assessed the attitudes of 192 nursing students toward EoLC; the findings revealed a correlation between the experiences and academic levels of students and their attitudes toward EoLC [2]. The findings from this area will provide crucial information for this area’s knowledge gap, enabling the relevant bodies to address this issue.
Palliative care is one of the compulsory subjects in the undergraduate and graduate level of nursing education. This course is offered with traditional methods involving bed-side teaching, case discussion, and student presentations. Multi-methods and comprehensive PCN courses are urgently required and must be formally incorporated into the curricula of nursing schools in Indonesia. Therefore, this study was conducted to investigate the level of knowledge about PCN and the attitudes towards the EoLC among nursing students after involving them in multi-methods of teaching and learning PCN; this study will provide a pool of evidence to help in improving teaching and learning methods to improve palliative care knowledge and attitude toward EoLC among nursing students in Indonesia. The alternative hypothesis (Ha) is that the significant effect multi-methods are for both learning and teaching PCN knowledge and attitude towards EoLC among nursing students.

2. Methods

2.1. Study Design

A pre-and post-intervention study was conducted in this study. This study was following the Transparent Reporting of Evaluation Non-randomized Design (TREND) guidelines. Ethical approval was gathered from the Ethical Committee of Health Research, Faculty of Health Science and Technology, Universitas Jendral Achmad Yani, Indonesia (with ethical number 067/KEPK/FIKTKES-UNJANI/VIII/2022).

2.2. Sampling and Participation

This study involved 165 nursing students from second semester of a clinical internship program in a university in Indonesia. Participants were enrolled in the Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia. The inclusion criteria of the participants were if they were enrolled in a nursing degree at Universitas Padjadjaran and understood the study’s goal. Moreover, the exclusion criteria of the participants included those who experience serious illnesses that can be harmful for students during study and students who do not attend and who not appreciate order. G-Power 3.1.2 was utilized to demonstrate that the sample size was adequate for a statistical power of 0.80, an effect size of 0.15, and a p-value of 0.05 when ten independent variables were included in a multiple regression analysis. The minimum sample size computed was 24, thus the number of samples in the study met the minimum number for analysis.

2.3. Procedure

One-hundred-and-sixty-five clinical internship students were enrolled in this study, and they were assigned to three groups which received the same intervention. All students were involved in the PCN course with multi-methods learning. This study was conducted from 5 October to 14 December 2022. Each group started the study on 5 October, 20 October, and 30 November. Before being involved in the course, the students were assessed on their knowledge and attitude toward EoLC. This course is divided into two parts, namely the preparation part, which is carried out for 3–4 days, and providing palliative care for patients through telenursing for 8–9 days. In each part, there were various learning methods. including lectures, problem-based study, real case study, project based, role play, and discussion (see Table 1). Telenursing is the utilization of a virtual, technology-based platform to give health information, monitoring, and nursing care [11]. The platforms used in this study were WhatsApp and Zoom. The nursing process was carried out virtually both synchronously and asynchronously by students under the supervision of academics. Asynchronous activities were carried out through text messaging for monitoring the patient’s condition and further assessment or confirmation of the patient. Meanwhile, synchronous methods were used in conducting the assessments and interventions of the patients.
After the students had completed the PC course, the palliative care knowledge was measured using the palliative care quiz for nurses (PCQN), and the attitude EoLC was measured using the Frommelt Attitudes Toward Care of the Dying (FATCOD).

2.4. Outcome and Measurement

The PC knowledge was measured using the 20-item PCQN [12]. The PCQN consisted of three subscales, which were as follows: (1) Four points about the “theory and principles of palliative care”; (2) Three items on “psychosocial and spiritual care”; and (3) Thirteen items on “pain and other symptom management”. Each item had a “true”, “false”, or “do not know” response. A correct response was worth 1 point, while incorrect or “do not know” responses were worth 0 points. The total of the subscale scores yielded an overall score ranging from 0 to 20.
Form B of the FATCOD was used to measure attitudes regarding EoLC [13]. The FATCOD Form B examined students from several PC-related fields. On a 5-point Likert scale, respondents were asked to rate their attitudes about EoLC, with 15 negative items reversed scored. A total score was determined, and it ranged from 30 to 150. Higher ratings indicated more favorable attitudes regarding end-of-life care. The overall score was converted to a percentage score ranging from 0 to 100 percent, and scores greater than 65% reflected positive attitudes regarding EoLC. Scores below 65% indicated a negative attitude [5]. With a Cronbach’s alpha of 0.94, this scale had shown excellent internal consistency [13].

2.5. Data Analysis

Data were analyzed using Jamovie version 2.2.5 [14]. The data were analyzed using univariate and bivariate analyses. Univariate analyses were used to describe participants’ characteristics and bivariate analysis was used to examine the outcomes. After ensuring that the data fit the parametric test’s assumptions and testing for data normality, independent t-tests were used to analyze the difference between the pre-and post-PCN learning means of the score. Moreover, the ANOVA test was performed to assess the variance between the group of studies. Eta squared (η2) and Omega squared (ω2) are two effect sizes commonly used to measure the effect sizes in ANOVA tests. η2 equal to “x value (for example: x = 0.50)” or ω2 equal to “y value (for example: y = 0.20)” means that the variability of the score can be explained by the method followed equal to 50% or 20%. To account for statistical significance, we used a two-tailed p-value with a p < 0.05.

3. Results

3.1. Characteristic of Participant

A total of 164 students were involved in this study. Most of the students were female, with an average age of 23.3 (SD = 0.756). The average GPA of the students was 35.1 (SD = 1.96). Moreover, all participants had attended PCN courses previously in the pre-clinic program (Table 2).

3.2. Knowledge and Attitudes toward EoLC after the PCN Course with Multi-Methods Learning

There was a statistically significant increase in knowledge (p < 0.001) after the completion of the PCN course. The significant increase occurred in the context of knowledge about management of pain and other symptoms (p < 0.001). However, levels of knowledge regarding PC theory and principle, as well as regarding psychosocial and spiritual care, were found statistically not significant (p = 0.053; p = 0.080). In addition, students’ attitude toward EoLC was statistically increased after the course (p < 0.001). A comparison of pre-and post-course on knowledge and attitudes towards the EoLC course can be seen in Table 3. Based on Figure 1, the positive attitude toward PCN among nursing students increased from 75.6% to 91.5%.

3.3. ANOVA Test of Characteristics toward Knowledge and Attitudes

Table 4 shows that knowledge in two different groups (witnessed dying people and GPA) is not statistically meaningful (FWDP (1158) = 0.817, p = 0.367; FGPA (2.158) = 1.143, p = 0.322), with a small degree of difference (WDP: η2 = 0.005, ω2 = −0.001; GPA: η2 = 0.014, ω2 = 0.002). Additionally, the attitudes toward EoLC in two different groups are not statistically meaningful (FWD (1158) = 0.971. p = 0.326, FGPA (1157) = 1.278, p = 0.281), with a small degree of difference (WDP: η2 = 0.006, ω2 = -0.000; GPA: η2 = 0.016, ω2 = 0.003).

4. Discussion

4.1. Principal Findings

PC aims to improve the quality of life of people with serious and life-limiting illnesses, such as cardiovascular disease, cancer, chronic respiratory disease, neurological disorders, or other disorders, as well as their families [15]. PC is regarded as one of the most holistic ways required to provide comprehensive healthcare and fulfill the needs of people of all ages with health-related suffering and make their lives more meaningful and serene [16]. The demand for PC services has increased due to the global population’s significant transitional demographic and disease pattern changes and the impact of the evolving pandemic on the national healthcare system’s services [17,18]. However, nursing education (schools) frequently fail to provide appropriate theoretical and clinical experience to prepare nurses to care for dying patients and their families, despite the growing need to include PC in nursing curricula [19]. This study aimed to enhance nursing students’ PCN knowledge and attitudes toward EoLC by developing a multi-method of teaching and learning strategy, and students dedicated a few weeks to this study.
To the best of our knowledge, the present study is the first pre- and post-palliative course study in nursing students’ knowledge with multi-methods of teaching and learning in Indonesia. This study found that PCN courses with multi-methods of learning and teaching were effective in increasing knowledge and positive attitudes toward EoLC. The present study demonstrated a high increase in mean knowledge, and a particularly higher increase in mean in the management of pain and symptoms than other domains. Considering the fact that one of the key principles of palliative care is to treat all bodily symptoms, including pain [20]. Palliative care focuses on pain and symptom treatment in addition to life-extending disease management (e.g., chemotherapy for cancer, dialysis) for persons with life-limiting illnesses. Moreover, nurses are necessary for palliative care due to the fact that pain and symptom control are essential nursing fundamentals [21].
The present study regarding PCN knowledge is consistent with the previous pre- and post-palliative course study by Berndtsson et al. in Sweden, which found the students’ knowledge and understanding about PC were deepened [4]. Another study, although using qualitative study, by Berndtsson reported that PCN course changes improve students’ knowledge about PC. These findings indicated that PCN courses, particularly those that use appropriate learning and teaching methods, are needed to increase knowledge regarding EoLC.
This study also found that PCN courses increased positive attitudes related to EoLC and the mean FATCOD score. Moreover, these outcomes were observed despite the fact that pre-course FATCOD scores were already high. The mean post-course FATCOD score in this study is comparable to what was previously reported by Berndtsson et al. This similar finding suggests that if students obtain education and training on PC, their views about caring for dying individuals are likely to shift in a more favorable direction [4]. This study had the same methods as a pre- and post- course design, where most studies were conducted cross-sectionally. However, this study differs from previous research conducted in Sweden by Berndtsson. This research was conducted on second semester nursing internship program students, while previous research was conducted on sixth-semester undergraduate students [4]. The level difference in this research sample proves that PCN consistently significantly increases PCN knowledge and attitudes towards EoLC.
A study by Henoch et al. reported that gender is associated with attitudes towards EoLC [22]. Moreover, females were predictors for the positive attitudes toward EoLC [1]. It was argued that several variables that contributed positively to attitudes, such as encountering a dying person, have been identified in the past [23]. However, the present study found that encountering a dying person in the family is not a statistically meaningful difference between groups. We also investigated and found that there was no meaningful difference in outcome in the GPA group, although a study by A’la concluded that the academic level and experience of the students become a key determinant of their attitudes toward providing care for terminally ill patients [2]. Other factors, such as religion, may contribute to attitudes. However, according to a study conducted in Turkey by Arslan et al., religion is not associated with their attitudes [24].
The disparities across studies may be related to educational, religious, and cultural variations between nations. In the previous study, the positive attitude of Palestinian nursing students validated Islamic religious views that recognize the inevitability of death and accept it as a natural process; however, the positive attitudes of Muslim students might be strengthened by increasing their understanding of PC. Culture can influence the creation of attitudes toward death and dying, as seen by the variation between countries [5].

4.2. The Implication to Clinical Practice

In an era of drastically expanding end-of-life care needs and demands, nursing students are expected to be the major providers of future high-quality end-of-life care. Palliative care nurses are in high demand during double-burden diseases and, particularly, during public health emergencies such as COVID-19 [25,26]. The PCN guidelines emphasize that all healthcare providers must be equipped to deliver basic palliative care in all clinical settings, including community and underserved areas. Nurses have a crucial role in the multidisciplinary palliative care team, and they are expected to spend time at the bedside of dying patients [27].
The eight domains apply to palliative care needs in any nation, culture, or location. Below, chronic burden disease, COVID-19, and future public health emergencies are linked to each of these eight palliative care categories and the significance of required palliative nursing education. Universal palliative care is an ethical mandate for all health systems [28]. Nurses and future nurses must be educated to provide primary and specialist palliative care to address today’s global health issues and future pandemics [29,30]. Global curricular integration of palliative care is urgently needed to effectively prepare our global nursing workforce and deliver holistic, person-centered care for patients and their families along the care continuum. A good curriculum in palliative care implies good palliative service that impacts on the quality of life of patients. The quality of life and satisfaction of patients and their families could be enhanced by nurses and clinical nursing students’ internships who are aware, skilled, and at ease in providing EoLC [31]. Studies have revealed that the knowledge and attitudes of nursing students regarding end-of-life care have a direct impact on the quality of their care [32,33]. Therefore, the palliative education method must be aware of increasing knowledge and attitudes toward EoLC.
Although this current study finds that attitudes toward EoLC and knowledge increased after students involved themselves in PCN courses, the knowledge only increased in the domains of pain and other symptom management. Palliative care is the use of methodological approaches to anticipate, treat, and prevent suffering in order to maximize both the quality of life for patients with serious illnesses and their families. The psychosocial, emotional, and spiritual requirements of seriously ill patients are all covered by this care, not only the physical. Therefore, the real challenge in PCN is how nursing educational institutions can improve students’ holistic nursing abilities in the palliative context of the learning and teaching methods of PCN [15,34].
Discussion about learning and teaching methods in palliative care is still rare. This related discussion will provide an overview of effective learning models or methods that can be adopted, especially for nursing schools and countries that are just starting to develop PCN education. Therefore, extensive discussion about the PCN model is needed.

4.3. Limitations

Although the current study is the pre-and post-course study that reported the multi-methods learning and teaching with a relatively high pooled sample, we have to acknowledge some limitations of this study. First, as stated, this study did not analyze the FATCOD scores and religious views. Religion may be important variable that should be involved in the analysis considering that Indonesia is a highly religious society and one of the largest Muslim nations in the world. Second, this study was conducted during the COVID-19 pandemic, and palliative care was carried out by the students through telenursing. Thus, this finding cannot be generalized to the new normal context, but learning and teaching methods can be applied to pre-clinical students. Finally, this study has not been able to describe how students experience qualitatively after being involved in learning; thus, explanatory studies are needed for deeper reflection on PCN learning.

5. Conclusions

After completing a two-week course on palliative care during their clinical internship program, the study demonstrates that knowledge about PCN increased. It appears that education in palliative care improves nursing students’ knowledge of PCN and attitudes toward end-of-life care. Hence, there was a significant enough change (with the alternate hypothesis) to be able to reject the null hypothesis. These findings are essential since all nurses working in health care may face end-of-life care and be required to provide care for dying patients and their families. Moreover, the multi-methods of the teaching and learning of PCN, including lectures, problem-based study, real case study, project-based learning, role play, and discussion, are effective in enhancing student outcomes. However, these methods may not be effective to apply in a clinical internship program in the new normal and may be applied in undergraduate programs. Therefore, further studies to assess the model for undergraduate students are needed. Moreover, the qualitative study explores the students’ experience and also the patients’ satisfaction with receiving palliative care through telenursing in the context of the PCN course, which is needed to investigate.

Author Contributions

Conceptualization, H.H. and R.M.; methodology, H.H. and R.M.; software, H.H. and R.M.; validation, H.H., R.M. and C.W.M.S.; formal analysis, H.H. and R.M.; investigation, H.H., R.M. and C.W.M.S.; resources, H.H., R.M. and C.W.M.S.; data curation, H.H.; writing—original draft preparation, H.H. and R.M.; writing—review and editing, H.H., R.M. and C.W.M.S.; visualization, H.H.; supervision, H.H.; project administration, R.M.; funding acquisition, H.H. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the Hibah Inovasi Pembelajaran Daring (HIPDU) with funding number 2042/UN6.RKT/Kep/HK/2021, Universitas Padjadjaran. Moreover, the APC was funded by the Directorate Research and Community Engagement of Universitas Padjadjaran.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethical Committee of Health Research, Faculty of Health Science and Technology, Universitas Jendral Achmad Yani, Indonesia (with ethical number 067/KEPK/FIKTKES-UNJANI/VIII/2022.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Not applicable.

Acknowledgments

We would like to thank all the students who participated in this study in the clinical nursing internship program of Universitas Padjadjaran.

Conflicts of Interest

The authors declare no conflict of interest.

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Sustainability 15 04382 g001 550
Figure 1. Bar plot of comparison attitudes pre- and post-PCN course.
Figure 1. Bar plot of comparison attitudes pre- and post-PCN course.
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Table
Table 1. The multi-methods of PCN course.
Table 1. The multi-methods of PCN course.
MethodDescriptionPeriod
LecturesLectures were delivered using the Flipped classroom method, synchronously and asynchronously. Synchronous through the Zoom meeting application, and teaching videos and materials uploaded at the Massive Open Online Course (MOOC) platform, powered by LiVE Unpad. Lectures were given by academic lecturers, hospital practitioners, and community practitioners, both from within and outside the country, and lecturers from Universitas Padjadjaran. 4 days
(day 1–4)
Problem-based study/case studyStudents strengthened the concept of PCN through pre-designed cases. This strategy was aimed to prepare the students before they encounter with the real patients.1 day
(day 4)
Real case studyStudents provided palliative patients through telenursing under the supervision of the assigned academics (one for each group). Students carried out nursing care, which included assessment, determining nursing diagnoses, developing nursing care planning, and implementing, evaluating, and writing documentation. 5 days
(days 5–11)
Project-based Students learned to provide health education to their patients and the patients’ families through project-based study. Students were asked to compile educational media that has been used in providing health education to patients. The media was then shared with other students and lecturers through an exhibition event. Media used for health education include posters, booklets, android applications, videos, and others.4 days
(day 8–12)
RoleplayStudents were asked to do a role play about how to communicate with palliative patients.1 day
(day 4)
DiscussionDiscussions and questions and answers were held at any time as needed either synchronously or asynchronously.Every day if needed
Table
Table 2. Characteristics of participants (n = 164).
Table 2. Characteristics of participants (n = 164).
Characteristicn%
Gender
  Male2213.4
  Female14286.6
Age (year); Mean (SD)23.3 (0.756)IR (21–26)
  <2515594.2
  ≥2595.5
GPA (4.00); Mean (SD)35.1 (0.196)IR (3.06–3.940)
  <3.251911.6
  3.26–3.7011670.7
  >3.702917.7
NPC course in undergraduate (pre-clinic)
  Yes163100
  No00
Attitudes towards PCN
  Positive12475.6
  Negative4024.4
Witnessed dying people in family
  Yes14286.6
  No2213.4
Note. GPA = Grade point average; PCN = Palliative care nurses; SD = Standard deviation.
Table
Table 3. Comparison Pre- and Post-Knowledge and Attitudes toward the EoLC Course.
Table 3. Comparison Pre- and Post-Knowledge and Attitudes toward the EoLC Course.
VariablePre-
(Mean, SD)		Post-
(Mean, SD)		MD95% CI
(Lowe; Upper)		tp Value
Knowledge10.24 (1.83)10.98 (1.88)−0.738−0.484; −0.170−4.20<0.001
  Theory and principles of PC1.94 (0.80)2.09 (0.82)−0.152−0.306; 0.002−1.950.053
  Psychosocial and spiritual care0.54 (0.67)0.62 (0.72)−0.086−0.291; −0.016−1.760.08
  Pain and other symptom management7.76 (1.40)8.26 (1.30)−0.500−0.464; −0.151−3.95<0.001
Attitudes103.35 (8.57)108.29 (8.94)−4.933−0.776; −0.443−7.82<0.001
Note. Statistical significance used a two-tailed p-value with a p < 0.05. Paired t-test was conducted. SD = Standard deviation; MD = Mean difference; CI = Confidence Interval; PC = Palliative care.
Table
Table 4. Variance analysis of GPA and Witnessed dying people toward knowledge and attitudes.
Table 4. Variance analysis of GPA and Witnessed dying people toward knowledge and attitudes.
VariableSum of SquaresdfMean SquaresFpη2ω2
Knowledge
WDP2.86912.6760.7580.3850.005−0.001
GPA8.02724.2541.2050.3220.0150.003
WDP × GPA0.25020.1730.0490.9520.001−0.012
Residuals554.9211573.529
Attitudes
WDP77.7177.70.9710.3260.006−0.000
GPA204.52102.21.2780.2810.0160.003
WDP × GPA205.72102.91.2860.2790.0160.003
Residuals12558.515780.0
Note. Statistical significance used a two-tailed p-value with a p < 0.05. An ANOVA test was conducted; the homogeneity of variance test (Levene’s) for knowledge was F = 1.17, df1 = 5, dDf2 = 157, p = 0.328. The homogeneity of variance test (Levene’s) for attitudes was F = 1.35, df1 = 5, dDf2 = 157, p = 0.246. WDP = Witnessed dying people; GPA = Grade point average.
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Haroen, H.; Mirwanti, R.; Sari, C.W.M. Knowledge and Attitude toward End-of-Life Care of Nursing Students after Completing the Multi-Methods Teaching and Learning Palliative Care Nursing Course. Sustainability 2023, 15, 4382. https://doi.org/10.3390/su15054382

AMA Style

Haroen H, Mirwanti R, Sari CWM. Knowledge and Attitude toward End-of-Life Care of Nursing Students after Completing the Multi-Methods Teaching and Learning Palliative Care Nursing Course. Sustainability. 2023; 15(5):4382. https://doi.org/10.3390/su15054382

Chicago/Turabian Style

Haroen, Hartiah, Ristina Mirwanti, and Citra Windani Mambang Sari. 2023. "Knowledge and Attitude toward End-of-Life Care of Nursing Students after Completing the Multi-Methods Teaching and Learning Palliative Care Nursing Course" Sustainability 15, no. 5: 4382. https://doi.org/10.3390/su15054382

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