Weiler K, Eland J, Buckwalter K C
College of Nursing, University of Iowa, Iowa City 52242, USA.
J Prof Nurs. 1996 Jul-Aug;12(4):245-52. doi: 10.1016/s8755-7223(96)80100-1.
The principle of patient autonomy is well recognized in the nursing profession. This study extends the exploration of patient autonomy by examining nurses' knowledge about living wills. The questions addressed in this study included the following: (1) Were Iowa nurses aware of the living will statute? (2) What sources of information did nurses use to learn about this legislation? (3) What were nurses' perceptions of patients' rights? (4) What were nurses' perceptions of nurses' role involving living wills? (5) Were living wills followed? (6) If not followed, which factors contributed to the failure to honor a living will? and (7) Which communication mechanisms were used to alert nurses to a living will? A questionnaire was mailed to 10,000 actively licensed nurses in Iowa. Approximately 3,000 Iowa nurses responded to the questionnaire regarding Iowa living wills. Seventy per cent of the nurses knew that Iowa had living will legislation. No single educational source was a predominate choice for targeted information about the living will statute. Nurses were reluctant to suggest to patients that they should consider writing a living will. Nurses were also more willing to assume a passive role of suggesting that patients talk with relatives about the need for a living will but were less likely to be suggest that a patient write a living will for future health care treatment decisions. The majority of the nurses favored the patient having some control in health care treatment decisions. Three major factors were pertinent to the failure to follow a living will: family request, treating physician's refusal, and lack of information that the living will existed. The medical record was the primary means of communication regarding a living will. To enhance patient efforts at self-determination, nurses must recognize the advance directive legislation is available in their state and the potential impact that their nursing care may have on the implementation of the document.
患者自主原则在护理行业中已得到广泛认可。本研究通过考察护士对生前遗嘱的了解情况，进一步拓展了对患者自主的探索。本研究探讨的问题包括：（1）爱荷华州的护士是否知晓生前遗嘱法规？（2）护士通过哪些信息来源了解该法规？（3）护士对患者权利有何看法？（4）护士对自身在生前遗嘱方面的角色有何看法？（5）生前遗嘱是否得到遵循？（6）若未得到遵循，哪些因素导致未能尊重生前遗嘱？以及（7）通过哪些沟通机制向护士通报生前遗嘱？向爱荷华州10000名持有效执照的在职护士邮寄了问卷。约3000名爱荷华州护士回复了有关爱荷华州生前遗嘱的问卷。70%的护士知晓爱荷华州有生前遗嘱法规。对于生前遗嘱法规的定向信息，没有单一的教育来源是主要选择。护士不愿向患者建议他们应考虑撰写生前遗嘱。护士也更愿意扮演被动角色，建议患者与亲属谈论制定生前遗嘱的必要性，但不太可能建议患者为未来的医疗护理决定撰写生前遗嘱。大多数护士赞成患者在医疗护理决定中有一定的控制权。未能遵循生前遗嘱主要有三个相关因素：家属要求、主治医生拒绝以及不知道存在生前遗嘱。病历是关于生前遗嘱的主要沟通方式。为了增强患者的自我决定权，护士必须认识到本州有预先指示法规，以及他们的护理可能对该文件实施产生的潜在影响。
