美籍华人对预立医疗指示的态度：基于护理主导干预的结果评估。
Chinese Americans' attitudes toward advance directives: An assessment of outcomes based on a nursing-led intervention.
机构信息
Salisbury University School of Nursing, 1101 Camden Avenue, Salisbury, MD 21801, USA (formerly); Institute of Nursing Research and Evidence-Based Practice, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
University of Maryland School of Nursing, Organizational Systems and Adult Health, 655 West Lombard Street, Room 311T, Baltimore, MD 21201, USA.
出版信息
Appl Nurs Res. 2019 Oct;49:91-96. doi: 10.1016/j.apnr.2019.04.003. Epub 2019 May 11.
BACKGROUND
The process of advance care planning (ACP) encompasses learning about and planning for end-of-life (EOL) decisions, documenting preferences through legal forms known as Advance Directives (ADs), and having discussions with loved ones to share these preferences. While most ethnic minority groups have low ACP engagement and AD completion rates, Chinese Americans face additional challenges related to cultural beliefs and ACP.
PURPOSE
The purpose of this study was to estimate the impact of a culturally tailored nurse-driven educational intervention on the relationship between attitudes toward ADs and AD completion and ACP discussions.
DESIGN
Pre-posttest, repeated measures non-experimental design.
METHODS
A convenience sample of Chinese Americans participated in a culturally tailored nurse led AD and ACP workshop in English and Mandarin in a Chinese Community Center. Participants completed surveys before and after the workshop and at one-month follow-up.
RESULTS
Seventy-two Chinese Americans participated in this study. Most were female and born in China. Attitudes toward ADs improved after participating in the workshop and remained consistent at one-month follow-up. There was a significant positive relationship between attitudes and AD completion and ACP discussions.
CONCLUSIONS
Nurse-driven interventions improved engagement in the ACP process in Chinese Americans, a population thought to be averse to discussing death and dying and one with lower than average AD completion rates. Using culturally tailored interventions improves engagement in the ACP process.
背景
预先医疗照护计划（ACP）涵盖了对生命末期（EOL）决策的了解和规划、通过被称为预先指示（AD）的法律形式记录偏好、并与亲人进行讨论以分享这些偏好。尽管大多数少数族裔群体的 ACP 参与度和 AD 完成率较低，但美籍华人还面临与文化信仰和 ACP 相关的额外挑战。
目的
本研究旨在评估基于文化的护士主导的教育干预对 AD 态度与 AD 完成和 ACP 讨论之间关系的影响。
设计
前后测试、重复测量非实验设计。
方法
在一个华人社区中心，采用便利抽样法，选取美籍华人参加英语和普通话的基于文化的护士主导的 AD 和 ACP 研讨会。参与者在研讨会前后以及一个月的随访时完成了调查。
结果
本研究共纳入 72 名美籍华人。他们大多数是女性，出生在中国。参加研讨会后，对 AD 的态度有所改善，并在一个月的随访时保持一致。态度与 AD 完成和 ACP 讨论之间呈显著正相关。
结论
护士主导的干预措施提高了美籍华人参与 ACP 过程的积极性，这一人群被认为对讨论死亡和临终问题持回避态度，而且 AD 完成率低于平均水平。使用基于文化的干预措施可以提高 ACP 过程的参与度。
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