School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
Escola Universitària D'Infermeria I Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Calle de La Riba, 90, 08221, Terrassa, Barcelona, Catalonia, Spain.
BMC Med Ethics. 2021 Jun 22;22(1):75. doi: 10.1186/s12910-021-00646-y.
Implementing the routine consultation of patient advance directives in hospital emergency departments and emergency medical services has become essential, given that advance directives constitute the frame of reference for care personalisation and respect for patients' values and preferences related to healthcare. The aim of this study was to assess the levels and relationship of knowledge and attitudes of nursing and medical professionals towards advance directives in hospital emergency departments and emergency medical services, and to determine the correlated and predictor variables of favourable attitudes towards advance directives.
Observational, descriptive, and cross-sectional study. The study was conducted in the emergency department of a second-level hospital and in the emergency medical service. Data collection was performed from January 2019 to February 2020. The STROBE guidelines were followed for the preparation of the study.
A total of 173 healthcare professionals responded to the questionnaire. Among them, 91.3% considered that they were not sufficiently informed about advance directives, and 74% acknowledged not having incorporated them into their usual practice. Multinomial analysis indicated a statistically significant relationship between the variable emergency medical service and having more favourable attitudes towards consulting the advance directives in their practical application (OR 2.49 [95% CI 1.06-5.88]; p = 0.037) and compliance in complex scenarios (OR 3.65 [95% CI 1.58 - 8.41]; p = 0.002). Working the afternoon and night shift was a predictor variable for obtaining a higher score with respect to attitudes in complex scenarios.
There is an association between the level of knowledge that nursing and medical professionals have about advance directives and the scores obtained on the attitude scales at the time of practical implementation and in complex scenarios. This shows that the more knowledge professionals have, the more likely they are to consult patients' advance directives and to respect their wishes and preferences for care and/or treatment.
鉴于预先指示构成了个性化护理的框架，并尊重患者与医疗保健相关的价值观和偏好，因此在医院急诊科和急救医疗服务中实施常规咨询患者预先指示已变得至关重要。本研究旨在评估护理和医疗专业人员对医院急诊科和急救医疗服务中预先指示的知识和态度水平及其之间的关系，并确定对预先指示持有利态度的相关和预测变量。
观察性、描述性和横断面研究。该研究在二级医院的急诊科和急救医疗服务中进行。数据收集于 2019 年 1 月至 2020 年 2 月进行。遵循 STROBE 指南准备研究。
共有 173 名医护人员对问卷做出了回应。其中，91.3%的人认为他们对预先指示的了解不够充分，74%的人承认没有将其纳入常规实践。多项分析表明，变量急救医疗服务与在实际应用中对咨询预先指示持更有利态度之间存在统计学显著关系（OR 2.49 [95%CI 1.06-5.88]；p=0.037）和在复杂情况下的依从性（OR 3.65 [95%CI 1.58-8.41]；p=0.002）。上下午和夜班是在复杂情况下获得更高得分的态度的预测变量。
护理和医疗专业人员对预先指示的了解程度与实际实施和复杂情况下的态度量表得分之间存在关联。这表明，专业人员的知识越多，就越有可能咨询患者的预先指示，并尊重他们对护理和/或治疗的意愿和偏好。
