Adaptación y validación de la versión en español del Palliative Care Quiz for Nurses (PCQN). Un análisis del nivel de conocimientos en cuidados paliativos de profesionales y estudiantes de enfermería españoles
INTRODUCTION. The increasing in life expectancy, together with the changes in the epidemiological pattern have caused an increase in the number of people who will need to receive palliative care. Nursing professionals must have adequate training in order to take care of people with chronic diseases in an advanced phase and / or at the end of life. Several organizations talk about the nurses’ key role in the provision of palliative care, as well as the fact that every professional must receive at least a basic training in this area, which should be given during their degree training. Even so, training in palliative care in nursing degree is very heterogeneous in our country, and not all Colleges have training in this area. A validated instrument to assess the level of nursing knowledge in palliative care is the Palliative Care Quiz for Nursing (PCQN), developed by professors from the University of Otawa and which has been used in several researches and translated into different languages (Korean, Persian, French and Thai). PURPOSES: - Develop a Spanish version of the PCQN (PCQN-SV) and analyze its psychometric properties. - Analyze the level of knowledge in palliative care of both Spanish registered nurses and nursing students, and develop a predictive model of this level of knowledge. - Analyze palliative care contents of the different nursing degree study plans. - Asses the utility of Internet and Internet-based social networks as a tool for data collecting and analysis in research processes. METHODS: To develop the Spanish version, a translation / back-translation process was followed, after which each question of the PCQN-SV was evaluated by a group of experts to determine the content validity indexes of every item and the global questionnaire. Subsequently, the questionnaire was piloted through a descriptive cross-sectional study conducted in a Spanish hospital, which also served to analyze the internal consistency and difficulty of such instrument. After the piloting and the implementation in the PCQN-SV of some modifications suggested, a study was designed to measure the level of knowledge in palliative care of nursing professionals, in which an online questionnaire was used. This questionnaire was disseminated using Facebook and Twitter. In addition, this diffusion was analyzed by measuring the correlation between the number of times the questionnaire was shared and the responses that were received. To measure the level of knowledge in palliative care of the group of nursing students, and after piloting the questionnaire among a group of students from the University of Valencia, a multicenter study in which five nursing faculties cooperated was designed. Finally, a content analysis of the Spanish nursing degree programs was carried out in order to show the frequency of appearance of several key concepts in the field of palliative care. In the studies designed to measure the level of knowledge in palliative care of both nursing professionals and students, some population descriptive variables were also collected. The subsequent bivariate analysis allowed us to analyze relationships between variables, as well as to identify which variables could be explanatory of the differences obtained, so as to elaborate with them a binary logistic regression model that could be used as a predictor of the final results in the PCQN -SV. RESULTS. The Spanish version of the PCQN has shown adequate levels of global content validity (CVI = 0.83) and internal validity (Cronbach's alpha= 0.64 and KR-20= 0.71), as well as an adequate distribution of items with high, low and medium difficulty. In the group of nursing professionals, we found a percentage of correct answers in the PCQN-SV of 61.38 %, with statistically significant differences according to their training and professional experience in palliative care, the type of training received and the scope in which they developed their activity assistance. Both previous experience and training in palliative care have been shown to be predictive variables of the results in the PCQN-SV: the subjects with experience or training in this area have about 50% probability of obtaining a percentage of correct answers in the questionnaire above the average of their population. In the group of nursing students, we found a percentage of correct answers in the PCQN-SV of 54.02%, with statistically significant differences depending on the course and the faculty in which they were enrolled, as well as having received training in palliative care. Both academic year and training in palliative care have been shown to be predictive variables of the results in the PCQN-SV: the students with training in this field have about a 70% probability of obtaining a percentage of correct answers in the questionnaire above the average of their population. Moreover, as they get enrolled into a superior course, the probability of obtaining results superior to the average increases by 35%. On the other hand, the analysis of the utility of social networks showed an important influence on the number of responses obtained (we found a correlation between the number of times the questionnaire was shared and the number of responses received), but it did not influence the results obtained in the PCQN-SV. The content analysis of the training programs identified the low presence of concepts such as "advanced disease" and "quality of life", and showed the heterogeneity of the training offered to nursing students. CONCLUSIONS. The PCQN-SV has shown to be a useful tool to measure the level of knowledge in palliative care of nursing professionals and students as well as to identify aspects to improve in their training. The groups of Spanish professionals and nursing students obtain results in the PCQN-SV, indicators of their level of training, that could be considered low-average and that would improve with both theoretical and practical training in this field.