الفهرس 
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Abstract
Intensive care unit nurses are the ones who work most closely with the patient and the patient’s family; therefore, they are in a distinctive situation to give emotional, physical, and spiritual support and act as an advocate for the patient and family in end of life period. (Harris, Gaudet & Reardon, 2014). End of life care is a significant component of work in intensive care. Limited research has been undertaken in the provision of end of life care by nurses in the intensive care setting ( Ranse, Yates & Coyer, 2012).
Self-learning package (SLPs) provide an educational format that is easily portable and can be incorporated into the nurse’s day at the nurse’s convenience. The Self-learning Package is a flexible teaching modality than can enhance not only nurse’s knowledge and skill but also the unit’s educational programs. (Clifford, Goldschmidt & O’Connor, 2007).
Aim of the study:
This study aims to assess the effect of the self learning package on critical care nurses’ performance regarding end of life patient.
Research hypothesis:
Self learning package was affecting positively on critical care nurses’ knowledge, practices and attitude regarding end of life patient care.
Research design:
A quasi-experimental research design is utilized to meet the aim of this study.
Subjects and Methods
Technical Design:
The technical design includes setting, subjects, and tools for data collection.
C. Research setting:
The study was conducted in critical care units, including Medical Care Units (MCU), Surgical Care Units (SCU), and Neurological Care Units (NCU) at Ain- Shams University Hospitals.
Subjects:
A convenience sample of sixty nurses was recruited from the previously mentioned settings for those available nurses, (27) from medical) MCU (, (21) nurses from Surgical (SCU (and (12) from neurological) NCU (, from both sexes, different ages, and different levels of qualification.
C- Tools for data collection:
Three tools were used to collect data:
• Self-administered Critical Care Nurses’ knowledge questionnaire.
• End of life Care Observational Checklist &end of life care plan.
• Nurses’ Attitude Toward Care for dying Patient.
Results:
The results of the current study revealed that:
58.3% of the study group subjects were less than thirty years old with a mean age of (27.8±5.9) and 83.3% were female. As well, 75.0% are diploma nurses, 45.00% working in medical ICU and 91.7% are staff nurse.
Also the highest percentages of them were having ten or more years of experience, and did not attend any training sessions related to end of life nursing care (46.7%, and 81.7%) respectively.
There were highly statistically significant differences between total scores of nurses’ level of knowledge pre/post implementation of the self learning package, and pre/follow up phase at (p<0.01). Also, there was a statistically significant difference between total scores of nurses’ level of knowledge post/ follow up phase at (p<0.05).
There were a highly statistically significant difference between total scores of nurses’ level of practice pre/post implementation of the self learning package, and post/follow up phase at (p<0.01). Also, there was a statistically significant difference between total scores of nurses’ level of practice pre/ follow up phase at (p<0.05).
The highest percentages of nurses (88.3%) don’t inform the patients what he/she is going to do and followed by don’t help him to relax & don’t defends about his right in the pain management in percentage of (83.3% & 83.3%) respectively.
The total of the study sample (100.0%) had an unsatisfactory practice level regarding end of life care plan in the care for EOL patients in pre phase (before the implementation of SLP).
The majority of the total study sample had a negative attitude toward the care of dying patient pre the SLP in percentage of (83.3%), as well (80.0%) of the study sample were positive attitude toward the care of dying post the SLP.
There are highly statistically significant differences between total scores of nurses’ attitude pre/post implementation of the self learning package, and pre/follow up phase at (p<0.01). Also, there was a highly statistically significant difference between total scores of the nurses’ attitude post/ follow up phase at (p<0.01).
There are no statistically significant differences between total scores of the nurse’s knowledge pre & post implementation of SLP and total score of nurse’s practice at (p > 0.05). But found statistically significant differences between total scores of nurse’s knowledge and total score of nurse’s practice regarding care for end of life patient in follow up phase at (p<0.05).
There are highly statistically significant differences between total scores of nurse’s knowledge and total score of nurse’s attitude regarding care for end of life patient in post & follow up phase at (p<0.01).
Also, a statistically significant difference between total scores of the nurse’s knowledge pre & follow up implementation of SLP and total score of nurse’s attitude at (p < 0.05).
There are highly statistically significant differences between total scores of nurse’s practice and total score of nurse’s attitude regarding care for end of life patient in the pre, post & follow up implementation of SLP at (p<0.01).
There are no statistically significant relation between total scores of nurses’ practice and their age pre and post implementation of the self learning package and pre/follow up phase and post/follow up phase of implementation at (p> 0.05).
• Conclusion
The present study concluded that:
The results of the study supported the hypothesis of the study; there was no statistically significant correlation between total scores of nurses` knowledge and total score of nurses` practice in pre phase of SLP implementation.
The current study result revealed that, there was no statistically significant correlation between total scores of nurses` knowledge pre-phase and total scores of nurses` practice post-phase. Also, there was a statistically significant correlation between total scores of nurses` knowledge in follow up phase and total score of nurses` practice post phase.
The finding of this study showed that, there was a highly statistically significant positive correlation between total scores of nurse’s knowledge and total scores of nurse’s attitude regarding care for end of life patient in post & follow up phase. Self Learning package (SLP) has a positive effect on nurses` knowledge, practice and attitude to attain research hypothesis.
• Recommendations
In the light of the current study, findings the following recommendations are suggested.
Establish in-service training programs for continuous updating of nurses` knowledge about end of life nursing care and improve their practice to gain a positive attitude toward care for dying and their families.
Educational programs and self learning packages must be carried out for nurses in critical care units to improve their skills and performance regarding care for end of life patient.
Critical care units in hospitals should be supplied by the end of life &palliative care articles, Arabic illustrated books about all dimensions of this care.
Hospitals must expand protocols and rules to begin nurses on how to learn and practice end of life care.
Additional studies should be carried out in different settings and on a larger sample for wider utilization of the SLP, in turn to attain generalization of the results.