Knowledge, Attitudes, Experiences, and Confidence of Nurses in Completing Advance Directives: A Systematic Synthesis of Three Studies

Diane Ryan; Mary Ann Jezewski

doi:10.1097/JNR.0b013e318256095f

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P131 - 141

医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学

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Knowledge, Attitudes, Experiences, and Confidence of Nurses in Completing Advance Directives: A Systematic Synthesis of Three Studies

护理人员对「预立医疗指示」的知识、态度、经验和信心：三项研究之系统性综合文献回顾

Diane Ryan ； Mary Ann Jezewski

The Journal of Nursing Research ； 20 卷 2 期 (2012 / 06 / 01) ， P131 - 141

英文 DOI： 10.1097/JNR.0b013e318256095f

预立医疗指示；临终；护理人员；系统性综合； advance directives ； end of life ； nurses ； systematic synthesis

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摘要 │ 参考文献 (46) │ 被引用文献 (3) │ 国际计量

摘要〈TOP〉

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Background: Advance directives (ADs) are one of the few means for patients to indicate their end-of-life (EOL) treatment option preference. An effective and consistent solution for increasing the AD completion rate remains elusive. A literature search revealed three studies completed in the United States that employed an identical methodology and focused on registered nurses (RNs). These studies examined a variety of concepts, including nurses’ knowledge, attitudes, experience, and confidence with regard to ADs. Purpose: This review completed a systematic synthesis of reported results from three survey studies that focused, respectively, on oncology, critical care, and emergency RNs who were members of various professional nursing organizations. Methods: Our investigation addressed the following research questions: What are the knowledge, attitudes, experience, and confidence of RNs with regard to ADs, and what is the relationship among these study variables? Each study used the Knowledge, Attitudes, and Experiential Survey on Advance Directives Instrument to obtain findings. Results: Findings indicated that level of knowledge of nurses was about 60% correct and that nurses reported a moderate level of confidence related to ADs. Nurses stated they were experienced in AD discussions and agreed with attitude statements indicating support of ADs. Advocacy was a theme in the findings of these studies, as most nurses agreed with the statement that nurses should uphold patients' wishes. Time was identified as an impediment to AD completion. Critical care nurses had higher levels of awareness of ADs, as compared with oncology and emergency room nurses, although the cause of this difference is unclear. Although RNs provided AD education and explanations and described the various types of EOL care, these study subjects suggested that discussions of patients’ prognoses may be an intervention more appropriate for nurses or other clinicians with advanced education and training. Conclusion/Limitations: The low Cronbach's alpha values in the attitude scales within the survey instrument posed limitations in the original research on the use of attitude scale scores in statistical analysis. The data examined in this study was obtained from published reports, which limited the synthesis and analysis of study findings. Nurses need to refine their role in AD discussions with patients. End-of-life discussions should be an interwoven process between RNs and the multidisciplinary team.

参考文献 ( 46 ) 〈TOP〉

American Nurses' Association. (2010a). Position on nursing care and do not resuscitate decisions. Retrieved from http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/ANAPositionStatements/EthicsandHumanRights.aspx
American Nurses' Association. (2010b). Position statement: Registered nurses roles and responsibilities in providing expert care and counseling at end of life. Retrieved from http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/ANAPositionStatements/EthicsandHumanRights.aspx
American Nurses' Association. (2010c). Position statement: The nurses' role in ethics and human rights: Protecting and promoting individual worth, dignity, and human rights in practice settings. Retrieved from http://www.nursingworld.org/MainMenuCate-gories/HealthcareandPolicyIssues/ANAPositionStatements/EthicsandHumanRights.aspx
U.S. Living Will Registry. (n.d.). U.S. living will registry fact sheet. Retrieved from http://www.uslwr.com/factsheet.shtm
Badzek, L. A.,Leslie, N.,Schwertfeger, R. U.,Deiriggi, P.,Glover, J.,Friend, L.(2006).Advanced care planning: A study on home health nurses.Applied Nursing Research,19(2),56-62.

被引用文献 ( 3 ) 〈TOP〉

曾焕棠,张沐晨(2021)。护理人员对病人善终医疗自主权认知及在职教育的需求。健康科技期刊，7(2)，1-12。
汤梦彬,洪宗杰,施妃娥,王玉芳(2016)。运用跨院际安宁共同照护协助一位呼吸器依赖个案进行伦理四象限之决策经验。安宁疗护杂志，21(2)，206-217。
(2023)。护理人员预立医疗决定知识与影响因素之探讨。嘉基护理，23(2)，1-11。

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