Lee Sangmin, Cui Naixue, Kim Hyejin
Chung-Ang University Hospital, Seoul, Republic of Korea.
School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.
J Clin Nurs. 2025 Jun;34(6):2149-2162. doi: 10.1111/jocn.17376. Epub 2024 Jul 29.
To describe and compare nurses' awareness of, attitudes toward, and participation in advance care planning, as well as related facilitators and challenges, in four types of healthcare settings.
A cross-sectional descriptive study.
Four hundred and ninety-eight registered nurses from tertiary, secondary and primary healthcare institutions, along with long-term care centres in South Korea, participated in an investigator-developed online survey. The collected data were analysed using descriptive statistics, chi-squared test, one-way ANOVA, and binary logistic regression.
Participants were on average 30.6 ± 7.3 years old, mostly female (95.4%), employed as staff nurses (95.4%), held bachelor's degrees or higher (84.1%), and had worked for less than 5 years at their current institutions (69.7%). Overall, 49% of the participants were familiar with advance care planning. While most participants supported nurse involvement in advance care planning with patients and surrogates, fewer were willing to engage or recommend it. Less than half were actively engaged in advance care planning practices. A notable challenge was the lack of time due to excessive workload. Compared to those from tertiary healthcare institutions, participants from secondary and primary healthcare institutions and long-term care centres were less likely to be aware of advance care planning. Participants from secondary and primary healthcare institutions had lower odds of checking for the presence of advance directives and the physician orders for life-sustaining treatment.
Nurses demonstrated low awareness and participation in advance care planning. Nurses' insufficient time and competency to conduct advance care planning in their practice should be addressed.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Educational programs, initiatives (e.g. guidelines, position statements) and legal and policy-level efforts (e.g. nurse staffing, role clarification, reimbursement) are crucial to incorporate advance care planning into routine nursing practice.
What problem did the study address? Nurses play an important role in advance care planning; however, limited is understood about their readiness and involvement in such practices. What were the main findings? Nurses' awareness of advance care planning practices and their participation in such practices is low across care settings. Although nurses have a positive attitude toward advance care planning, there are challenges (e.g. insufficient time to conduct advance care planning discussions and lack of relevant knowledge and skills) that impede their participation in practice. Where and on whom will the research have an impact? This study may serve as a foundation for nursing societies in countries, where advance care planning is emerging, to discuss strategies to increase nurses' competency in advance care planning and promote their participation in the practice.
The STROBE checklist was followed.
No patient or public contribution.
描述和比较护士在四种医疗环境中对预先护理计划的认知、态度和参与情况，以及相关的促进因素和挑战。
横断面描述性研究。
来自韩国三级、二级和一级医疗机构以及长期护理中心的498名注册护士参与了一项由研究者开发的在线调查。使用描述性统计、卡方检验、单因素方差分析和二元逻辑回归对收集的数据进行分析。
参与者的平均年龄为30.6±7.3岁，大多数为女性（95.4%），担任护士（95.4%），拥有学士及以上学位（84.1%），且在当前机构工作不到5年（69.7%）。总体而言，49%的参与者熟悉预先护理计划。虽然大多数参与者支持护士参与患者及替代决策者的预先护理计划，但愿意参与或推荐该计划的人较少。不到一半的人积极参与预先护理计划实践。一个显著的挑战是工作量过大导致时间不足。与三级医疗机构的参与者相比，二级和一级医疗机构以及长期护理中心的参与者对预先护理计划的认知可能性较低。二级和一级医疗机构的参与者检查预先医疗指示和维持生命治疗医嘱的可能性较低。
护士对预先护理计划的认知和参与度较低。应解决护士在实践中进行预先护理计划的时间不足和能力问题。
对专业和/或患者护理的启示：教育项目、倡议（如指南、立场声明）以及法律和政策层面的努力（如护士人员配置、角色明确、报销）对于将预先护理计划纳入常规护理实践至关重要。
该研究解决了什么问题？护士在预先护理计划中发挥着重要作用；然而，人们对他们在这些实践中的准备情况和参与程度了解有限。主要发现是什么？在不同护理环境中，护士对预先护理计划实践的认知及其参与度较低。尽管护士对预先护理计划持积极态度，但存在一些挑战（如进行预先护理计划讨论的时间不足以及缺乏相关知识和技能）阻碍了他们参与实践。该研究将对哪些方面和人群产生影响？这项研究可为预先护理计划正在兴起的国家的护理协会提供一个基础，以讨论提高护士在预先护理计划方面的能力并促进他们参与实践的策略。
遵循STROBE清单。
无患者或公众参与。
