Introduction
Canada’s aging population, characterized by rising life expectancy and increasing prevalence of complex comorbidities, presents significant challenges to the healthcare system (Steffler et al. Reference Steffler, Li and Weir2021). Healthcare institutions are becoming increasingly overwhelmed by workforce shortages and limited bed capacity, particularly in home care, where more Canadians prefer to receive care in their homes (Canadian Cancer Society 2023; Canadian Hospice Palliative Care Association 2024). This is especially important for palliative care (PC) services, where the demand for compassionate, individualized care often exceeds institutional capacity. PC represents a holistic approach focused on improving the quality of life through physical, psychological, spiritual, and social support for both patients and families (World Health Organization 2023). However, as global health systems struggle to meet the demands, only 14% of the 56.8 million people worldwide needing PC receive it (World Health Organization 2020). To address this gap, community-based PC has emerged as an important resource, with home care nurses serving as key providers. However, they face unique challenges in this independent setting that requires a high level of autonomy. Unlike team-based hospital environments, they must adapt to varied home conditions, manage limited resources, and make independent decisions under pressure (Furåker and Nilsson Reference Furåker and Nilsson2012). These conditions, combined with travel time and workload demands, often constrain opportunities for reflection and holistic care (Sawatzky et al. Reference Sawatzky, Roberts and Russell2021). In such contexts, both competence and self-efficacy become critical, as nurses must rely on their knowledge, skills, and confidence to respond effectively to unpredictable clinical and emotional situations.
Unpacking the constructs of perceived competence and self-efficacy
Despite distinct definitions, the 2 constructs are often used interchangeably. Perceived competence is one’s belief in their ability to complete a task through possession of knowledge, skills, and attitudes, while self-efficacy is one’s belief in their ability to complete a task under certain circumstances (Bandura Reference Bandura1977; Desbiens and Fillion Reference Desbiens and Fillion2011). The concept of self-efficacy is shaped by 4 sources: one’s own experiences (i.e., past clinical experiences), vicarious experiences (i.e., learning through observing others’ successful performance), verbal persuasion (i.e., encouragement or feedback from others), and emotional arousal (i.e., emotional or physical states that affect confidence). High self-efficacy without sufficient competence can lead to suboptimal and unsafe care, while competence without confidence can lead to ineffective care.
Perceived competence in nursing traditionally focuses on knowledge, skills, and attitude as core attributes that are often developed through practice (Fukada Reference Fukada2018). However, comparatively fewer studies have explored self-efficacy, especially in the context of home care where nurses must possess high self-efficacy to complete tasks under stressful circumstances (Abdal et al. Reference Abdal, Alavi and Adib-Hajbaghery2015; Iacono et al. Reference Iacono, Amodio and Vella2024; Tomita Reference Tomita2024). This gap could be due to the concept’s complex and abstract nature, making it difficult to measure (Abdal et al. Reference Abdal, Alavi and Adib-Hajbaghery2015). In addition, much of the existing literature on nursing competence or self-efficacy primarily focuses on hospital settings (Hayter Reference Hayter2016; Shen et al. Reference Shen, Nilmanat and Promnoi2019; Levine Reference Levine2020; Fadaei et al. Reference Fadaei, Forouzi and Miyashita2024), and the context of home care presents unique challenges that may influence the development of these 2 constructs.
Perceived competence and self-efficacy in home-based PC
While moderate pressure can enhance learning capacity, excessive stress can impair critical thinking and performance (Zhang et al. Reference Zhang, Guo and Wang2024). These stress-related challenges are particularly relevant in home-based PC where nurses operate with limited access to readily support and face emotionally charged situations. These stressors may contribute to variations in perceived competence and self-efficacy. The literature highlights that nurses demonstrate conflicting competence in pain assessment, communication skills, and advanced care planning, which impacts their self-efficacy in providing effective PC (Furåker and Nilsson Reference Furåker and Nilsson2012; Sawatzky et al. Reference Sawatzky, Roberts and Russell2021). Lack of knowledge and confidence deters nurses from teaching patients and families about disease progression, leading to skill avoidance that further compromises care (Glajchen and Bookbinder Reference Glajchen and Bookbinder2001).
There continues to be a prioritization of physical care over spiritual and psychological support within the literature, highlighting the persistent biomedical focus of nursing practice (Furåker and Nilsson Reference Furåker and Nilsson2012; Sawatzky et al. Reference Sawatzky, Roberts and Russell2021). Even with psychological assessments, nurses often confuse depression with normal grief, reflecting their tendency to rely on physical rather than psychological indicators (Hallford et al. Reference Hallford, McCabe and Mellor2012).
In the complex, unpredictable practice of PC, nurses face daily stressors that exacerbate compassion fatigue and burnout and contribute to workforce attrition and staffing shortages (Martens Reference Martens2009; Canadian Nurses Association 2024). These challenges in communication and holistic care delivery suggest significant variability in both competence and self-efficacy among home care nurses. However, the extent of these variations and how both constructs interact in this setting remain unclear. Therefore, understanding the levels of perceived competence and self-efficacy, as well as their relationship, is important for identifying gaps in nurses’ preparedness and guiding targeted interventions to support holistic, community-based PC.
Objective and research questions
This study explored Ontario home care nurses’ perceived competence and self-efficacy in delivering PC. The research questions were:
1. What are the perceived levels of competence and self-efficacy among home care nurses in PC delivery?
2. What is the relationship between perceived competence and self-efficacy among home care nurses providing PC?
Methods
Study design
A cross-sectional study was conducted using 2 validated survey tools, the Palliative Care Nursing Self-Competence (PCNSC) scale (Desbiens and Fillion Reference Desbiens and Fillion2011) and the Palliative Care Self-Efficacy scale (PCSES) (Phillips et al. Reference Phillips, Salamonson and Davidson2011), to assess home care nurses’ perceived competence and self-efficacy in PC delivery. This survey was administered through Qualtrics. Home care and professional nursing organizations were contacted to assist in distributing the recruitment flyer and survey link to their nurses through mass email. The survey link was sent to home care nurses in mid-December 2024, and they had 2 months to complete the survey. Through the same means of communication, one reminder email was sent 1 month after survey distribution, and the second reminder was sent 1 week before the end date.
Recruitment and sample
Recruitment
Home care nurses were recruited across 4 home care and 2 professional nursing organizations in Ontario using snowball and convenience sampling methods. We employed snowball sampling because of the specialized nature of palliative home care nursing and the harder-to-reach population within the broader nursing workforce.
Sample
Organizations were asked to distribute the study poster and the Qualtrics survey link to their nurses. Inclusion criteria included: (1) registered nurses (RNs) and registered practical nurses (RPNs), (2) currently working as a home care nurse in Ontario, regardless of full-time, part-time, or casual employment, (3) having at least 6 months of nursing experience, and (4) having provided PC in patients’ homes. Exclusion criteria included nurse practitioners, nursing students, and other healthcare providers (HCPs) due to the differences in the scope of practice.
Sample size estimation
Using G*Power analysis, an a priori sample size of 199 participants was calculated based on an anticipated medium effect size (r = 0.20), as reflected in similar studies in PC nursing (Gray et al. Reference Gray, Grove and Sutherland2021; Kang Reference Kang2021), an alpha level of 0.05, and a desired power of 0.80. After accounting for an estimated 10% attrition rate to allow for potential non-response or incomplete surveys, the target sample size was set at 219 participants.
Data collection
Data collection ended in March 2025, with a 2-month collection period per organization. The survey consisted of 6 sections: (1) a consent form that participants must accept prior to entering the survey; (2) 4 screening questions to confirm eligibility; (3) 6 demographic questions, such as age, gender, ethnicity, education level, RNs or RPNs, and location of practice; (4) the PCNSC scale (Desbiens and Fillion Reference Desbiens and Fillion2011); (5) the PCSES (Phillips et al. Reference Phillips, Salamonson and Davidson2011); and (6) 35 general questions developed based on findings from the literature, such as completion of any PC training and education. Participants who did not meet the eligibility criteria were automatically directed to the end of the survey. The estimated completion time was 15–20 minutes. Once completed, they were given a $10 electronic gift card.
Instruments
PCNSC scale
Based on Bandura’s Social Cognitive Theory (Reference Bandura1977), Desbiens and Fillion (Reference Desbiens and Fillion2011) developed the PCNSC scale to measure nurses’ perceived competence in caring for adult palliative patients across various settings. The 50-item PCNSC scale encompasses 10 domains, each with 5 items: (1) physical needs: pain, (2) physical needs: other symptoms, (3) psychological needs, (4) social needs, (5) spiritual needs, (6) needs related to functional status, (7) ethical and legal issues, (8) interprofessional collaboration and communication, (9) personal and professional issues related to nursing care, and (10) end-of-life care. The scale uses a 0–5 Likert-type response where 0 = not at all capable and 5 = highly capable for each item (Desbiens and Fillion Reference Desbiens and Fillion2011). This instrument was selected due to its comprehensive coverage of PC domains relevant to home care practice and established psychometric properties, with a Cronbach’s alpha of 0.98. Permission was obtained from the researcher to use the tool in this study.
PCSES
The PCSES was developed by Phillips et al. (Reference Phillips, Salamonson and Davidson2011) to assess nurses’ self-efficacy in PC delivery. The 12-item scale is separated into 2 domains: psychosocial support (items 1–6) and symptom management (items 7–12). This scale uses a 1–4 Likert-type response where 1 = needs further basic instruction and 4 = confident to perform independently (Phillips et al. Reference Phillips, Salamonson and Davidson2011). This scale was chosen for its focus on self-efficacy specifically and demonstrated high internal consistency with a Cronbach’s alpha of 0.95. The scale has shown validity across nursing populations with varying levels of experience, from students to practicing nurses (Kim et al. Reference Kim, Kim and Gelegjamts2020; Zhou et al. Reference Zhou, Li and Zhang2021; Briese Reference Briese2022; DeFusco et al. Reference DeFusco, Lewis and Cohn2023). Permission for its use was obtained from the scale developer.
Data analysis
Data were exported from Qualtrics to SPSS (version 29.0.2.0) for analysis. Prior to analysis, data were assessed for completeness, outliers, and distributional assumptions. Missing data patterns were examined, and cases with less than 50% completion were excluded using listwise deletion, as these were considered unlikely to provide meaningful responses (Kang Reference Kang2013). For demographic variables, age had 16 isolated missing values. Data were treated as missing completely at random and excluded from relevant analyses while retaining participants for other variables with complete data.
Research question 1
Descriptive analyses (frequencies, percentages, and means) were conducted to summarize participants’ demographic characteristics and overall scores on the PCNSC and PCSES scales. Given the absence of established cut-off scores for both scales and the non-normal distribution of the data, as confirmed by the Shapiro–Wilk test (p < .05), medians and interquartile ranges (IQRs) were computed to measure central tendency and dispersion (Desbiens and Fillion Reference Desbiens and Fillion2011; Phillips et al. Reference Phillips, Salamonson and Davidson2011).
Research question 2
Data screening revealed no significant outliers, and normality testing using the Shapiro–Wilk test confirmed non-normal distributions for both PCNSC and PCSES total scores (p < .05). Given the ordinal nature of the Likert-type data and the expectation of monotonic rather than linear relationships between variables, Spearman’s rank correlation coefficient was applied using SPSS. This non-parametric approach is less sensitive to outliers and does not assume linearity (Plichta et al. Reference Plichta, Kelvin and Munro2012). Furthermore, Cronbach’s alpha was calculated to assess the internal consistency of both instruments.
To examine domain-specific relationships, PCNSC and PCSES domains were conceptually aligned based on established PC frameworks (e.g., Comprehensive Advanced Palliative Care Education). Three domain pairs were constructed: pain management (PCNSC “physical needs: pain” with PCSES item 7), symptom management (PCNSC “physical needs: other symptoms” with PCSES items 8–12), and psychosocial care (combined PCNSC “psychological care” and “social care” domains with PCSES items 1–6). Combining psychological and social care domains was justified based on their conceptual overlap in clinical practice and alignment with the psychosocial support construct in the PCSES. The differing rating systems and construct definitions of both instruments were considered during this alignment to ensure conceptual consistency. The conceptual alignment was intended for interpretive purposes rather than to imply equivalence, and the constructed domain groupings represent post hoc conceptual alignment rather than psychometrically validated subscales. Without factor analysis, the results should be interpreted cautiously. In addition, the total scores of both scales, which differ in their distinct rating systems and construct definitions, were also compared to examine nurses’ overall perceived competence and self-efficacy. These total scores represent the most psychometrically sound indicators with established validity between both constructs.
Results
Sample characteristics
The total number of survey distributions was unknown; thus, a true response rate could not be calculated. Of the 184 surveys received, 39 (21.2%) surveys did not meet the criteria, and 35 (19.0%) surveys had less than 50% completed and were excluded, leaving a final sample size of 110.
The majority of the sample identified as female (n = 96, 87.3%). Most were between 30 and 39 years old (n = 40, 42.6%) and primarily identified as Caucasian/White (n = 59, 53.6%). Most were RNs (n = 72, 65.5%) with a Bachelor of Science in Nursing (n = 61, 55.4%). The largest proportion of participants was from the western region of Ontario (n = 27, 24.6%; see Table 1 for demographics).
Sample characteristics
n refers to the number of participants who provided data for that variable. Percentages are calculated using the number of valid responses for each variable; missing responses were excluded from the denominator.
Research question 1
Overall PCNSC scale
Overall, nurses reported a high level of perceived competence in PC with a median PCNSC score of 197.5 out of a possible 250.0 (IQR = 174.0–218.0). “Needs related to functional status” had the highest median score among all 10 domains (median = 21.0, IQR = 18.0–24.0). The domain with the lowest perceived competence was “spiritual needs” (median = 17.0, IQR = 15.0–20.0; see Table 2 for more details).
Nurses’ scores in the PCNSC scale
Overall PCSES
Nurses’ overall self-efficacy was also high, with a median score of 41.0 out of a possible 48.0 (IQR = 36.0–46.3). Nurses scored slightly higher in the “psychosocial support” domain (median = 21.0, IQR = 18.8–23.0) than in “symptom management” (median = 20.0, IQR = 18.0–24.0; see Table 3 for more details).
Nurses’ scores in the PCSES
Research question 2
The highest statistically significant positive association was found between nurses’ overall perceived competence and self-efficacy (ρ = .69, p < .001). Domain-specific analyses showed that “symptom management” had the second highest association (ρ = .55, p < .001), followed by “psychosocial care” (ρ = .54, p <.001), and “pain management” (ρ = .35, p < .001). All correlations were statistically significant at p < .001, indicating consistent associations between the constructs (see Table 4 for details).
Association between nurses’ perceived competence and self-efficacy in PC delivery
Discussion
This study examined Ontario home care nurses’ perceived competence and self-efficacy in delivering PC and explored their relationship. Nurses demonstrated high competence and self-efficacy, though notable gaps remained. They felt most confident in addressing functional needs, least in spiritual care, and more comfortable with psychosocial care than with symptom management. The positive association between the 2 constructs indicates that confidence and skill develop together. These findings suggest that the realities of home care practice influence how nurses develop their skills in providing holistic PC.
While competence (Agoston Reference Agoston2014; Nguyen et al. Reference Nguyen, Yates and Osborne2014; Hayter Reference Hayter2016; Levine Reference Levine2020; Parajuli et al. Reference Parajuli, Hupcey and Kitko2021; Sawatzky et al. Reference Sawatzky, Roberts and Russell2021) and self-efficacy (Dehghani et al. Reference Dehghani, Barkhordari-Sharifabad and Sedaghati-kasbakhi2020; Briese Reference Briese2022; Fadaei et al. Reference Fadaei, Forouzi and Miyashita2024) have been studied separately, few studie have examined them together, particularly in palliative home care (Desbiens and Fillion Reference Desbiens and Fillion2011). This gap is critical given the growing demand for home-based care and the unique challenges of delivering PC in the community (World Health Organization 2023). This study addressed the gap by examining a dual perspective on their preparedness for PC and identifying priority areas for tailored education, mentorship, and system-level support.
Research question 1: understanding the domains
Home care nurses reported overall high levels of both perceived competence and self-efficacy in delivering PC, indicating a generally well-prepared workforce. However, domain-specific results revealed meaningful variation in confidence and capability.
An emphasis on functional status
The highest perceived competence was in supporting patients’ functional status, which differs from prior studies where pain or symptom management typically ranked highest (Hayter Reference Hayter2016; Shen et al. Reference Shen, Nilmanat and Promnoi2019; Parajuli et al. Reference Parajuli, Hupcey and Kitko2021). This difference may reflect the unique orientation of home care practice toward maintaining independence and preventing hospitalization, goals that require consistent attention to mobility and daily living support. These tasks are more concrete and frequently encountered in home visits, reinforcing nurses’ perceived clarity and comfort in addressing them.
Psychosocial support over symptom management
Despite its centrality to PC, self-efficacy in symptom management was rated lowest by home care nurses. In fact, nurses reported greater self-efficacy in psychosocial care compared to symptom management, which departs from trends observed in hospital settings (Briese Reference Briese2022). We posit that low confidence in symptom management may stem from both training and system issues. For example, documented delays in obtaining medications and supplies have, in some cases, led to patients being sent to emergency rooms for symptom management (Canadian Broadcasting Corporation 2024) during the timeframe that data were collected in this study.
Greater self-efficacy in psychosocial care may be reflected through the longer-term relationships and emotional connections that home care nurses build with patients and families (Danielsen et al. Reference Danielsen, Sand and Rosland2018; Joren et al. Reference Joren, Veer and Groot2021). Relational practice remains central to PC, as it emphasizes human connection, presence, compassion, and communication, ensuring that patients’ complex needs are addressed and holistic care is provided (Bertaud et al. Reference Bertaud, Wilkinson and Kelley2025). Through these relationships, nurses are repeatedly exposed to managing psychosocial needs, which can enhance their confidence over time. At the same time, it emphasizes the need for provider organizations to strengthen their education and support programs to prevent emotional fatigue among the home care nursing workforce. Even well-trained nurses may struggle to feel effective in home care when there is inadequate structural support. Together, these results highlight the importance of tailoring education and the care system to the realities of community-based palliative nursing.
A pervasive gap in spiritual practice
Home care nurses reported the lowest perceived competence in spiritual care, a consistent gap in PC literature (Pesut et al. Reference Pesut, McLean and Reimer-Kirkham2015; Levine Reference Levine2020; Parajuli et al. Reference Parajuli, Hupcey and Kitko2021; Sawatzky et al. Reference Sawatzky, Roberts and Russell2021). Despite spiritual care being a core component of PC (World Health Organization 2023), it is often neglected by HCPs and confused with religion (Borneman et al. Reference Borneman, Ferrel and Puchalski2010). This may reflect ambiguity in how spirituality is understood by nurses, limited clinical guidance, and practical challenges such as time constraints during visits (Griffiths et al. Reference Griffiths, Ewing and Rogers2007; Furåker and Nilsson Reference Furåker and Nilsson2012; Joren et al. Reference Joren, Veer and Groot2021; Sawatzky et al. Reference Sawatzky, Roberts and Russell2021).
In high-pressure environments, spiritual care can be deprioritized without structured training or resources (Rego et al. Reference Rego, Gonçalves and Moutinho2020). A practical and evidence-based resource is the Faith, Importance and Influence, Community, and Address (FICA) Spiritual History tool. This structured tool offers prompts that enable care providers to assess and address patients’ spiritual beliefs, practices, and needs (Borneman et al. Reference Borneman, Ferrel and Puchalski2010). Incorporating resources like FICA into education and clinical training can offer nurses concrete guidance on the abstract concept of spirituality, while also supporting the integration of spiritual assessment into routine visits, ultimately enhancing holistic care (Borneman et al. Reference Borneman, Ferrel and Puchalski2010).
Research question 2: bridging the constructs of competence and self-efficacy
Our findings reveal a positive association between both perceived competence and self-efficacy among home care nurses, suggesting that confidence and skill develop together in community-based PC. While this study’s findings align with the literature, much of this research has been conducted with nursing students in academic settings (Orkaizagirre-Gómara et al. Reference Orkaizagirre-Gómara, Miguel and Elguea2020; Tomita Reference Tomita2024). However, similar patterns regarding more experience and exposure helped increase their confidence, knowledge, and skills (Orkaizagirre-Gómara et al. Reference Orkaizagirre-Gómara, Miguel and Elguea2020; Tomita Reference Tomita2024). Our results reflected this relationship within the practical realities of home-based PC, where nurses work independently and with limited support. This finding supports Bandura’s (Reference Bandura1977) assertion regarding the interconnectedness of both constructs, highlighting the need to assess both within the context of nursing practice. It suggests that competence and confidence develop together and in the absence of either, even highly skilled nurses may feel uncertain or constrained. Strengthening both constructs in tandem may enhance readiness, quality of care, and nurse retention.
Implications
PC education
Both educational interventions and tailored training are essential to sustaining competence and confidence in this unique environment. While integration into undergraduate curricula can help assess and strengthen students’ competence and self-efficacy, limited curricular space may constrain implementation. Alternative strategies such as continuing professional development, mentorship programs, and simulation-based training could offer flexible avenues for reinforcing PC competence beyond formal education (Bandura Reference Bandura1977; Benner Reference Benner1984; Artino Reference Artino2012; Yoo and Park Reference Yoo and Park2015; Esteban-Burgos et al. Reference Esteban-Burgos, Moya-Carramolino and Vinuesa-Box2024). Organizations should also incorporate PC educators/champions to provide knowledge and resources tailored to local practice environments (Pereira et al. Reference Pereira, Giddings and Sauls2021). Finally, nurses should be allocated time and cost coverage for continuing education to ensure their knowledge and practice are up to date (Furåker and Nilsson Reference Furåker and Nilsson2012).
Enhancing home-based PC practice
Given our findings that symptom management showed the lowest self-efficacy scores while spiritual care had the lowest competence scores, home care organizations should prioritize support in these specific domains. This includes ensuring nurses have readily access to targeted mentorship and resources, along with general supportive infrastructures, including timely interdisciplinary consultations, and adequate time to manage complex care (Glajchen and Bookbinder Reference Glajchen and Bookbinder2001; Furåker and Nilsson Reference Furåker and Nilsson2012; Sawatzky et al. Reference Sawatzky, Roberts and Russell2021). Moreover, fostering peer support through mentorship, debriefing sessions, and clinical coaching can sustain self-efficacy and reduce emotional burden (Esteban-Burgos et al. Reference Esteban-Burgos, Moya-Carramolino and Vinuesa-Box2024). Together, these approaches can strengthen both competence and confidence, ultimately enhancing the quality and sustainability of PC in the home setting.
Future research
Future research should further explore the impact of targeted educational programs on the domain-specific gaps identified in this study – low competence in spiritual care and low self-efficacy in symptom management. Longitudinal studies are also needed to examine how both perceived competence and self-efficacy evolve throughout a nurse’s career. Additionally, extending this research into settings such as hospice, long-term care, and rural environments would offer comparative insights and help tailor educational and system-level strategies to diverse care contexts.
Study limitations
Several methodological limitations should be acknowledged when interpreting these findings. The cross-sectional design limits the ability to draw causal inferences about the relationship between perceived competence and self-efficacy. This study relied on self-reported data, which may introduce self-report biases. The final sample size of 110 participants was lower than the target of 219, reducing statistical power and reflects the anticipated challenge of recruiting from a specialized population. The unknown total number of survey distributions prevented calculation of a true response rate, introducing potential non-response bias through convenience and snowball sampling methods. The study’s geographic restriction to Ontario home care RNs and RPNs limits generalizability to other regions and HCPs. The use of 2 separate validated instruments (PCNSC and PCSES) (Desbiens and Fillion Reference Desbiens and Fillion2011; Phillips et al. Reference Phillips, Salamonson and Davidson2011) required conceptual alignment of domains for comparative analysis, as the instruments were not originally designed to be used together. The constructed domain groupings (pain management, symptom management, and psychosocial care) have not been psychometrically validated and were developed only for interpretive comparison, not as part of an exploratory statistical analysis.
Conclusion
In sum, this study highlights critical strengths and gaps in home care nurses’ preparedness for PC, revealing a workforce skilled in practical and physical aspects but less prepared to address spiritual needs, a gap that persists despite its central role in holistic care. The clear association between competence and self-efficacy indicates that improving one without the other is unlikely to produce confident, capable practice. Strengthening both through targeted, context-specific education, experiential learning, and system supports is essential to sustaining a workforce ready to meet the complex and growing demands of PC in the home.
Acknowledgments
The authors would like to thank all the nurses who took the time to complete the survey, along with HPCO, Saint Elizabeth Health, VHA, VON, and WeRPN for their support in disseminating the study.
Funding
This work was supported by the VHA Home HealthCare Graduate Research Award.
Competing interests
The authors have no conflicts of interest to disclose.
Ethical approval
Prior to data collection, ethical clearance was obtained from the Research Ethics Board of the University of Windsor (REB# 24-190), and ethics approval was received from all nursing organizations involved. Participants provided informed consent at the beginning of the survey prior to proceeding. The survey was anonymous. After submitting their responses, each participant was invited to submit their name and email address for compensation purposes, and they were collected on a separate Qualtrics landing page. No other identifying information was collected. This process protected the confidentiality and anonymity of the survey data.
Open access
