Campbell Mary Judy, Edwards M Jo, Ward Karen S, Weatherby Norman
Middle Tennessee State University, School of Nursing, Murfreesboro, TN 37132, USA.
J Nurs Scholarsh. 2007;39(2):165-71. doi: 10.1111/j.1547-5069.2007.00162.x.
To develop a theory-based model to assist nurses in promoting self-determination for completion of an advance directive (AD).
This descriptive study included data from a convenience sample of 118 community-dwelling older adults in Tennessee, USA. Multinomial logistic regression was used to estimate the influence of 15 factors and covariates on completion of an AD.
The parsimonious model had three significant factors: receiving AD information; attitude index; and health literacy score. Participants were highly likely to complete ADs if they had positive attitudes toward ADs and had received information on ADs. As health literacy increased, the likelihood that participants completed ADs was reduced. This model explained 25% of the variation in AD completion. Chi-square fit for the parsimonious model was highly significant.
Of 15 factors and covariates that could influence completion of an AD, only receiving information about ADs, having positive attitudes toward ADs, and health literacy significantly affected the likelihood of participants completing ADs. More study is needed on this model and how nurses can assist patients with end-of-life decisions.
建立一个基于理论的模型，以协助护士促进患者自主完成预先医疗指示（AD）。
这项描述性研究的数据来自美国田纳西州118名社区居住的老年人的便利样本。采用多项逻辑回归来估计15个因素和协变量对完成预先医疗指示的影响。
简约模型有三个显著因素：接受预先医疗指示信息；态度指数；以及健康素养得分。如果参与者对预先医疗指示持积极态度并收到相关信息，他们极有可能完成预先医疗指示。随着健康素养的提高，参与者完成预先医疗指示的可能性降低。该模型解释了预先医疗指示完成情况中25%的变异。简约模型的卡方拟合度非常显著。
在可能影响预先医疗指示完成的15个因素和协变量中，只有接受预先医疗指示信息、对其持积极态度以及健康素养显著影响参与者完成预先医疗指示的可能性。需要对该模型以及护士如何协助患者做出临终决策进行更多研究。
