临床护士对预立医疗指示的知识、态度和实践：多中心横断面调查。

Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

J Clin Nurs. 2024 Feb;33(2):740-751. doi: 10.1111/jocn.16911. Epub 2023 Oct 27.

AIMS AND OBJECTIVES

This study aimed to describe the knowledge, attitudes and practices (KAP) of nurses in implementing advance directives (ADs) for older patients and analyze the influencing factors before the establishment of the first advance directives act in China.

DESIGN

Multicenter cross-sectional survey. The standards for reporting the STROBE checklist are used.

METHODS

This cross-sectional study developed a self-designed structured questionnaire to assess nurses' knowledge, attitudes and practices about ADs. Nurses were recruited by stratified random sampling through the Nursing Departments of 12 hospitals in southwest China and were asked to fill out the questionnaire face to face about knowledge, attitudes and practices. Data were analyzed following descriptive statistics, rank-sum test and multiple linear regression.

RESULTS

This study included 950 nurses. The study found that nurses were extremely supportive of ADs. Unmarried nurses had better knowledge of ADs than married ones. Nevertheless, there was a discrepancy between the participants' knowledge, attitude and practice. The participants' practice was lower (4.3%) compared with their attitude (81.9%) and knowledge (42.2%). Knowledge on, attitudes towards and standardized procedures for ADs in the workplace affected nursing practice.

CONCLUSIONS

The study recommends that courses on ADs and appropriate support from medical institutions should be provided to nurses to increase their knowledge and confidence in implementing ADs. Healthcare professionals should be sufficiently equipped to implement ADs and handle their execution appropriately to provide adequate end-of-life care corresponding to patients' wishes.

RELEVANCE TO CLINICAL PRACTICE

The study results inform rich insights as it discusses the numerous interrelating factors influencing these three fundamental aspects that affect the success of any AD policy by surveying the knowledge, attitudes and practices of clinical nurses. Furthermore, our results hint at distinct areas of improvement in the nursing practice to facilitate the wider implementation and acceptance of ADs in China.

PATIENT OR PUBLIC CONTRIBUTION

This study involved no patient.

目的

本研究旨在描述护士在实施老年患者预先指示（AD）方面的知识、态度和实践（KAP），并分析中国第一部预先指示法案颁布前的影响因素。

设计

多中心横断面调查。本研究采用 STROBE 清单报告标准。

方法

本横断面研究采用自行设计的结构化问卷评估护士对 AD 的知识、态度和实践。通过中国西南 12 家医院的护理部门进行分层随机抽样，招募护士进行面对面填写问卷，了解他们的知识、态度和实践情况。数据采用描述性统计、秩和检验和多元线性回归进行分析。

结果

本研究共纳入 950 名护士。研究发现，护士对 AD 非常支持。未婚护士对 AD 的知识比已婚护士更好。然而，参与者的知识、态度和实践之间存在差异。参与者的实践（4.3%）低于他们的态度（81.9%）和知识（42.2%）。对 AD 的知识、对 AD 的态度以及在工作场所实施 AD 的标准化程序影响护理实践。