Nurses’ palliative care behaviors among patients with heart failure in the 4th Public Health Region

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Unchisa Rattanakunuprakarn
Borwarnluck Thongthawee
Buntarika Chatreewatanakul


This descriptive research design aimed to investigate nurses' palliative care behaviors for heart failure patients. Participants included 203 registered nurses among the five hospitals in Health Region 4, Thailand. The inclusion criteria were 1) nurses who had been working for at least one year and 2) nurses who had experience caring for heart failure patients with New York Heart Association Functional Classification class III - IV at least three patients. Data was gathered by 1) demographic form and 2) nurses’ behavior palliative care for heart failure patient’s questionnaire (NBPC-HF) with Cronbach's alpha of 0.94. Data were analyzed by using descriptive statistics. The findings indicated that nurses' palliative care behaviors among patients with heart failure were moderate level (gif.latex?\bar{x} = 88.08, S.D. = 19.89). When considered each aspect,it was observed that some aspects were found to be at a low level: 1) the assessment of disease progression (gif.latex?\bar{x} = 5.24,
S.D. = 1.86), with the lowest score for the Palliative Performance Scale (PPS) (gif.latex?\bar{x} = 1.94, S.D. = 0.66); and 2) advance care planning (gif.latex?\bar{x} = 9.24, S.D. = 2.75), with the lowest score for seeking the last wishes and the needs of the patients and their families (gif.latex?\bar{x} = 1.95, S.D. = 0.57). The findings can be used to enhance the quality of palliative care nursing services for heart failure patients. Especially in the assessment of disease progression and advance care planning for efficient care that fulfills the needs of patients and their families.

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Rattanakunuprakarn U, Thongthawee B, Chatreewatanakul B. Nurses’ palliative care behaviors among patients with heart failure in the 4th Public Health Region. JMPH4 [Internet]. 2024 Jun. 11 [cited 2024 Jul. 17];14(2):13-24. Available from:
Original Articles


World Health Organization. The top 10 causes of death 2020 [Internet]. 2020 [cited 2023 Jun 10]. Available from: the-top-10-causes-of-death

Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail 2020; 22(8): 1342-56. Available from: /ejhf.1858

Van Nuys KE, Xie Z, Tysinger B, Hlatky MA, Goldman DP. Innovation in heart failure treatment: life expectancy, disability, and health disparities. JACC Heart Fail 2018; 6: 401–9. doi: 10.1016/j.jchf.2017.12.006

Bureau of Policies and Strategy, Ministry of Public Health. Report on public health resource 2020 [Internet]. 2020 [cited 2023 June 11]. Available from: resource2563_100160

Taylor CJ, Ordóñez-Mena JM, Roalfe AK, Lay-Flurrie S, Jones NR, Marshall T, Hobbs FDR. Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study. BMJ. 2019; 13; 364: l223. doi: 10.1136/bmj.l223

Koshy AO, Gallivan ER, McGinlay M, Straw S, Drozd M, Toms AG, Gierula J, Cubbon RM, Kearney MT, Witte KK. Prioritizing symptom management in the treatment of chronic heart failure. ESC Heart Failure. 2020 ;7(5): 2193-207.

European Society of Cardiology. Guidelines for the diagnosis and treatment of acute and chronic

heart failure are published online today. Eur Heart J Open 2021, 42(32). Available from: https://www.escar lines-on-heart-failure-management-launched-today

Lowey SE. Palliative Care in the Management of Patients with Advanced Heart Failure. Adv Exp Med Biol 2018; 1067: 295–311. doi:10.1007/5584_2017_115

Rogers JG, Patel CB, Mentz RJ, Granger BB, Steinhauser KE, Fiuzat M, et al. Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial. JACC Adv 2017; 70(3): 331–41. doi:10.1016/j.jacc.2017.05.030

Kumwong K, Kanpakdee T, Sukunnee K. Factors associated with service of non-communicable clinics in public hospitals during coronavirus disease 2019 outbreak, Region 4, 2020. Journal of Medical and Public Health Region 4 2021; 11(2): 13–27. (in Thai)

Matchim Y, Thongthawee B, Raetong P, Kanhasing R. Quality of death and its related factors in terminally ill patients, as perceived by nurses. Int J Palliat Nurs 2022; 28(10): 491-6.

Mularski RA, Rosenfeld K, Coons SJ, Dueck A, Cella D, Feuer DJ. Measuring outcomes in randomized prospective trials in palliative care. J Pain Symptom Manage 2017; 34(1): 7-19.

European Society of Cardiology. Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology. Eur Heart J Open 2009; 11: 433-43. doi:10.1093/eurjhf/hfp041

Bierle RS, Vuckovic KM, Ryan CJ. Integrating Palliative Care Into Heart Failure Management. Crit Care Nurse 2021; 41(3): e9–18. doi:10.4037/ccn2021877

Kim S, Hwang WJ. Palliative care for those with heart failure: nurses' knowledge, attitude, and preparedness to practice. European journal of cardiovascular nursing. Eur J Cardiovasc Nurs 2014; 13(2):24-33. doi:10.1177/474515113519521

Ziehm J, Farin E, Schafer J, Woitha K, Becker G, Koberich S. Palliative care for patients with heart failure: facilitators and barriers - a cross sectional survey of German health care professionals.BMC Health Serv Res 2016;16:361-7. doi:10.1186/s12913-016-1609-x

Prakhongpun, J. The factors related to nurses’ behaviors in providing palliative care for patients with chronic obstructive pulmonary disease [Master’s thesis Adult and Older adult]. Pathum Thani: Thammasat University;2022. (in Thai)

Prachyakoon N, Somrongthong R, Sitthi-Amorn C. Healthcare providers’ knowledge and perception in the provision of palliative care in patients with non-cancer life-limiting chronic disease in the private hospital in Bangkok, Thailand. JHR 2017, 31, 33-40. doi:10.14456/jhr.2017.65

Kim S, Lee K, Kim S. Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study. BMC Palliat Care 2020, 19(105), 1-14. doi:10.11 86/s1 2904-020-00581-6

Polit DF, Beck CT. Nursing research : generating and assessing evidence for nursing practice. 11th ed. United States: Wolters Kluwer Health;2021

Wongrattana, C. Techniques for using statistics for research. 9th ed. Bangkok: Srinakharinwirot University, Prasarnmit; 2017. (in Thai)

Chanaphon P, Junda T, Hanprasitkam K. Perception on Palliative Care Competencies among Professional Nurses at Beginner’s Level in a Tertiary Hospital under the Jurisdiction of the Ministry of Public Health, Journal of Nursing and Health Care 2020; 38(3): 61-9. Available from: https:// jnat-ned/article/view/242336. (in Thai)

Panuraj S. The factors related to nurses’ caring behaviors in providing care for end-of-life patients. [Master’s thesis Adult and Older adult]. Pathum Thani: Thammasat University;2022. (in Thai)

Nupinit W, Nilmanat K, Matchim Y. Selective Factors Related to Intensive Care Units’ Registered Nurses’ Competency in Caring for Terminally Ill Patients. JTNMC 2017;32(4):94-106. Available from https://he (in Thai)

Satsin T. Emergency nurses’ competency in the provision of palliative care and related factors [Master’s thesis Adult and Older adult]. Pathum Thani: Thammasat University;2022. (in Thai)

Tipseankhum N. Palliative care in nursing education. KJN 2020; 27(1):98-115. Available from: (in Thai)

Department of Medical Services. Handbook for Palliative and End-of-Life Care. Nonthaburi: Department of Medical Services, Ministry of Public Health;2020

Chaiviboontham S, Pokpalagon P. Palliative care model in Thailand. Int J Palliat Nurs 2021;27(3):132-46. doi:10.12968/ijpn.2021.27.3.132

Xanthopoulos, A, Butler J, Parissis J, Polyzogopoulou E, Skoularigis J, Triposkiadis F. Acutely decompensated versus acute heart failure: two different entities. Heart Failure Reviews 2020;25. doi:10.1007/ s10741-019-09894-y

Singh GK, Ferguson C, Hickman LD. Integrating Heart Failure Palliative Care Delivery in an Uncertain Disease Trajectory. Heart Lung Circ 2022, 31(6), 755-6. doi:10.1016/j.hlc.2022.04.001

Strategy and planning division. Service Plan 2019 [Internet]. 2019 [cited 2023 June 10]. Available from

Fairlamb HJ, Murtagh F. Health professionals' perceptions of palliative care for end-stage cardiac and respiratory conditions: a qualitative interview study. BMC Palliat Care 2021; 20(1): 103-14. doi:10.1186/s12904-021-00805-3

Cavanagh CE, Rosman L, Chui P, Minges K, Desai NR, Goodlin S. Advance Care Planning and End-of-Life Education in Heart Failure: Insights From the NCDR PINNACLE Registry. Circ Cardiovasc Qual Outcomes 2023;16(1).doi:10.1161/CIRCOUTCOMES.1 22.008989