Exploring ICU Nurses Knowledge, Attitude, and Self-Efficacy in Delivering Palliative Care: A Scoping Review
Sari
ABSTRACT
The integration of palliative care into intensive care units (ICUs) is increasingly recognized as vital in addressing the complex needs of critically ill patients. Nurses in ICUs play a key role in ensuring quality palliative care. However, disparities in knowledge, attitudes, and self-efficacy among ICU nurses remain barriers to optimal care delivery. This scoping review aimed to systematically explore the current evidence on ICU nurses’ knowledge, attitudes, and self-efficacy in delivering palliative care. A scoping review following PRISMA-ScR guidelines was conducted. Literature was systematically searched from CINAHL, PubMed, Scopus, Taylor & Francis, and Google Scholar using keyword combinations mapped with MeSH terms. A total of 11 eligible articles were included after applying predefined PCC (Population–Concept–Context) criteria. Quality appraisal was conducted using the JBI checklist. Data were analyzed descriptively qualitatively. 11 studies were analyzed in this review. The findings revealed that most ICU nurses had insufficient knowledge of palliative care, particularly in psychosocial and spiritual dimensions. Attitudes towards palliative care were mixed; while some studies reported favorable views, others indicated high rates of ambivalence or negativity. Self-efficacy levels also varied, though studies showed it was generally higher among nurses with formal training or greater experience. ICU nurses’ knowledge and attitudes significantly influence their confidence and ability to deliver effective palliative care. Despite moderate self-efficacy reported in some regions, widespread gaps in knowledge and inconsistent attitudes underscore the urgent need for targeted education, policy support, and ongoing competency development.
Keywords: Palliative Care, Intensive Care Unit, Nurses, Knowledge, Attitudes, Self-Efficacy.
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Abd El-Aziz Basal, A. (2017). Critical Care Nurses Knowledge, Practice, Obstacles and Helpful Measures Towards Palliative Care for Critically Ill Patients. American Journal of Nursing Science, 6(4), 293. https://doi.org/10.11648/j.ajns.20170604.13
Alshehri, H. H., Olausson, S., Öhlén, J., & Wolf, A. (2020). Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review. BMC Palliative Care, 19. https://doi.org/10.1186/s12904-020-00616-y
Alshehri, H. H., Wolf, A., Öhlén, J., & Olausson, S. (2022). Healthcare Professionals’ Perspective on Palliative Care in Intensive Care Settings: An Interpretive Descriptive Study. Global Qualitative Nursing Research, 9, 23333936221138076. https://doi.org/10.1177/23333936221138077
Araújo, M., Da Silva, D., & Wilson, A. (2022). Nursing interventions in palliative care in the intensive care unit: A systematic review. Enfermeria Intensiva, 34 3, 156–172. https://doi.org/10.1016/j.enfi.2022.04.001
Aslakson, R. A., Curtis, J. R., & Nelson, J. E. (2014). The changing role of palliative care in the ICU. Critical Care Medicine, 42(11), 2418–2428. https://doi.org/10.1097/CCM.0000000000000573
Awad, B., Batran, A., Malak, M. Z., Ayed, A., Shehadeh, A., Alassoud, B., & Ejheisheh, M. A. (2025). Knowledge, attitudes, and self-efficacy regarding palliative care among Palestinian nurses in intensive care units. BMC Nursing, 24(1). https://doi.org/10.1186/s12912-025-03092-y
Baker, M., Luce, J., & Bosslet, G. (2015). Integration of Palliative Care Services in the Intensive Care Unit: A Roadmap for Overcoming Barriers. Clinics in Chest Medicine, 36 3, 441–448. https://doi.org/10.1016/j.ccm.2015.05.010
Bandura, A. (1994). Self-Efficacy (Vol. 4). Academic Press.
Chen, X., Zhang, Y., Arber, A., Huo, X., Liu, J., Sun, C., Yuan, L., Wang, X., Wang, D., Wu, J., & Du, J. (2022). The training effects of a continuing education program on nurses’ knowledge and attitudes to palliative care: a cross sectional study. BMC Palliative Care, 21(1). https://doi.org/10.1186/s12904-022-00953-0
Choi, P., & Murn, M. (2020). Palliative Care in the ICU. Evidence-Based Critical Care. https://doi.org/10.1007/978-3-030-26710-0_107
Cox, S., Handy, J., & Blay, A. (2012). Palliative Care in the ICU. Journal of the Intensive Care Society, 13, 320–326. https://doi.org/10.1177/175114371201300411
Fadaei, S., Azizzadeh Forouzi, M., Miyashita, M., Faleh, A. J., & Dehghan, M. (2024). Palliative care knowledge and self-efficacy: a comparative study between intensive care units and general units nurses. BMC Palliative Care, 23(1), 246. https://doi.org/10.1186/s12904-024-01580-7
Fernández-Gutiérrez, M. del C., Benavente-Fernández, I., Jiménez-Luque, N., Lubián-López, S., López-Fernández, C., & Picardo-García, J. M. (2024). Nurses’ Perception of Caring and Attitudes toward Caring for Dying Patients: Exploring the Relationship Using a Descriptive Cross-Sectional Design. Healthcare (Switzerland), 12(13). https://doi.org/10.3390/healthcare12131331
Hamdan, K. M., Al-Bashaireh, A. M., Al-Dalahmeh, M., Saifan, A. R., Albqoor, M. A., & Shaheen, A. M. (2023). Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan. Acute and Critical Care, 38(4), 469–478. https://doi.org/10.4266/acc.2023.00430
He, X., Cai, H., Zhang, J., Chen, W., & Zhu, B. (2025). Knowledge , Attitude , and Practice of Palliative Knowledge , Attitude , and Practice of Palliative Care Among Physicians and Nurses in Intensive Care Units in Shanghai , China. Journal of Multidisciplinary Healthcare, 18(May), 2441–2449. https://doi.org/10.2147/JMDH.S507175
Heo, S., Kim, M., You, H., Hong, S. W., An, M., Yang, J., Kim, H. J., Shim, J., Chon, S., & Kim, J. (2022). Reliability and validity of the Self-Efficacy in Palliative Care Scale among nurses. Palliative and Supportive Care, 1–7. https://doi.org/10.1017/s147895152200164x
Joanna Briggs Institute (JBI). (2022). JBI’s critical appraisal tools. Joanna Briggs Institute. https://jbi.global/critical-appraisal-tools
Kim, J. S., Kim, J., & Gelegjamts, D. (2020). Knowledge, attitude and self-efficacy towards palliative care among nurses in Mongolia: A cross-sectional descriptive study. PLoS ONE, 15(7 July), 1–15. https://doi.org/10.1371/journal.pone.0236390
Kirkpatrick, A. J., Donesky, D. A., & Kitko, L. A. (2023). A Systematic Review of Interprofessional Palliative Care Education Programs. Journal of Pain and Symptom Management, 65(5), e439–e466. https://doi.org/10.1016/j.jpainsymman.2023.01.022
Korsah, E. K., & Schmollgruber, S. (2023). Barriers and facilitators to end-of-life care in the adult intensive care unit: A scoping review. International Journal of Africa Nursing Sciences, 19(October), 100636. https://doi.org/10.1016/j.ijans.2023.100636
Kurnia, T. A., Trisyani, Y., & Prawesti, A. (2019a). Factors Associated with Nurses’ Self-Efficacy in Applying Palliative Care in Intensive Care Unit. Jurnal Ners, 13(2), 219–226. https://doi.org/10.20473/jn.v13i2.9986
Kurnia, T. A., Trisyani, Y., & Prawesti, A. (2019b). The relationship between nurses’ perceptions and self-efficacy in implementing palliative care in the intensive care unit. Belitung Nursing Journal, 5(1), 41–46. https://doi.org/10.33546/bnj.607
Kyeremanteng, K., Beckerleg, W., Wan, C., Vanderspank-Wright, B., D’Egidio, G., Sutherland, S., Hartwick, M., Gratton, V., & Sarti, A. (2019). Survey on Barriers to Critical Care and Palliative Care Integration. American Journal of Hospice and Palliative Medicine®, 37, 108–116. https://doi.org/10.1177/1049909119867658
Langley, J., Urquhart, R., Tschupruk, C., Christian, E., & Warner, G. (2024). Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study. BMJ Open, 14(1), 1–13. https://doi.org/10.1136/bmjopen-2023-079234
Mercadante, S., Gregoretti, C., & Cortegiani, A. (2018). Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiology, 18(1), 106. https://doi.org/10.1186/s12871-018-0574-9
Metaxa, V., Anagnostou, D., Vlachos, S., Arulkumaran, N., Bensemmane, S., van Dusseldorp, I., Aslakson, R. A., Davidson, J. E., Gerritsen, R. T., Hartog, C., & Curtis, J. R. (2021). Palliative care interventions in intensive care unit patients. In Intensive care medicine (Vol. 47, Issue 12, pp. 1415–1425). https://doi.org/10.1007/s00134-021-06544-6
Nelson, J., Cortez, T., Curtis, J., Lustbader, D., Mosenthal, A., Mulkerin, C., Ray, D., Bassett, R., Boss, R., Brasel, K., Campbell, M., Weissman, D., & Puntillo, K. (2011). Integrating Palliative Care in the ICU: The Nurse in a Leading Role. Journal of Hospice & Palliative Nursing, 13, 89–94. https://doi.org/10.1097/NJH.0b013e318203d9ff
Nelson, J. E., Bassett, R., Boss, R. D., Brasel, K. J., Campbell, M. L., Cortez, T. B., Curtis, J. R., Lustbader, D. R., Mulkerin, C., Puntillo, K. A., Ray, D. E., & Weissman, D. E. (2010). Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Critical Care Medicine, 38(9), 1765–1772. https://doi.org/10.1097/CCM.0b013e3181e8ad23
Neukirchen, M., Metaxa, V., & Schaefer, M. S. (2023). Palliative care in intensive care. Intensive Care Medicine, 49(12), 1538–1540. https://doi.org/10.1007/s00134-023-07260-z
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 372, 1–11. https://doi.org/10.1136/bmj.n71
Parekh de Campos, A., Levoy, K., Pandey, S., Wisniewski, R., DiMauro, P., Ferrell, B. R., & Rosa, W. E. (2022). Integrating Palliative Care into Nursing Care. The American Journal of Nursing, 122(11), 40–45. https://doi.org/10.1097/01.NAJ.0000897124.77291.7d
Peterson, J., Pearce, P. F., Ferguson, L. A., & Langford, C. A. (2017). Understanding scoping reviews: Definition, purpose, and process. Journal of the American Association of Nurse Practitioners, 29(1), 12–16. https://doi.org/10.1002/2327-6924.12380
Puntillo, K., Nelson, J. E., Weissman, D., Curtis, R., Weiss, S., Frontera, J., Gabriel, M., Hays, R., Lustbader, D., Mosenthal, A., Mulkerin, C., Ray, D., Bassett, R., Boss, R., Brasel, K., & Campbell, M. (2014). Palliative care in the ICU: relief of pain, dyspnea, and thirst--a report from the IPAL-ICU Advisory Board. Intensive Care Medicine, 40(2), 235–248. https://doi.org/10.1007/s00134-013-3153-z
Rafiee, S., Azizi-Fini, I., Banihashemi, Z. S., & Yadollahi, S. (2024). Knowledge and attitude towards palliative care and associated factors among nurse: a cross-sectional descriptive study. BMC Nursing, 23(1), 1–9. https://doi.org/10.1186/s12912-024-02598-1
Rao, S. R., Salins, N., Remawi, B. N., Rao, S., Shanbaug, V., Arjun, N. R., Bhat, N., Shetty, R., Karanth, S., Gupta, V., Jahan, N., Setlur, R., Simha, S., Walshe, C., & Preston, N. (2023). Stakeholder engagement as a strategy to enhance palliative care involvement in intensive care units: A theory of change approach. Journal of Critical Care, 75, 154244. https://doi.org/https://doi.org/10.1016/j.jcrc.2022.154244
Salikhanov, I., Katapodi, M. C., Kunirova, G., & Crape, B. L. (2023). Improving palliative care outcomes in remote and rural areas of LMICs through family caregivers: lessons from Kazakhstan. Frontiers in Public Health, 11, 1186107. https://doi.org/10.3389/fpubh.2023.1186107
Sesma-Mendaza, A., Aranguren-Sesma, M., Estraviz-Pardo, F., Lizarazu-Armendáriz, E., & Goñi-Viguria, R. (2022). Nurses’ knowledge about palliative care in a critical care unit. Enfermería Intensiva (English Ed.), 33(4), 197–205. https://doi.org/10.1016/j.enfie.2021.10.003
Stephens, M. T., & Rochmawati, E. (2022). Palliative care education and training in Liberia: A qualitative exploration of current state and challenges to further development. Belitung Nursing Journal, 8(5), 453–461. https://doi.org/10.33546/bnj.2237
Subih, M., Al-Amer, R., Malak, M. Z., Randall, D. C., Darwish, R., Alomari, D., & Mosleh, S. (2022). Knowledge of Critical Care Nurses about End-of-Life Care towards Terminal Illnesses: Levels and Correlating Factors. Inquiry (United States), 59, 1–9. https://doi.org/10.1177/00469580221080036
Theresia Avila Kurnia, Yanny Trisyani, & Ayu Prawesti. (2020). The relationship between nurses’ knowledge and self-confidence in implementing palliative care in an intensive care unit. International Journal of Palliative Nursing, 26(4), 183–190.
Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., … Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850
Tripathy, S., Routray, P., & Mishra, J. (2017). Intensive care nurses’ attitude on palliative and end of life care. Indian Journal of Critical Care Medicine, 21(10), 655–659. https://doi.org/10.4103/ijccm.IJCCM_240_16
DOI: https://doi.org/10.33024/mahesa.v6i5.22286
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