Advance Directives

Abstract

This study assessed nurses' knowledge, attitudes, experience, and confidence in discussing advance directives with patients. Concepts were measured using a questionnaire administered to 87 acute care registered nurses. Results indicated lack of knowledge about laws regarding advance directives, moderately negative attitudes toward advance directives, moderate confidence, and moderate experience with advance directives. The study supports the need to explore ways to assist nurses to be comfortable with advance directives discussions to improve quality patient care.

Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

“…The principal categories used in this form were knowledge, attitudes and practice. Nine (Beck, McIlfatrick, Hasson, & Leavey, 2017;Downe-Wamboldt, Butler, & Coughlan, 1998;Jezewski & Feng, 2007;Jezewski, Meeker, & Schrader, 2003;Lipson, Hausman, Higgins, & Burant, 2004;Putman-Casdorph, Drenning, Richards, & Messenger, 2009;Scherer, Jezewski, Graves, Wu, & Bu, 2006;Sellars, Detering, & Silvester, 2015;Zhou, Stoltzfus, Houldin, Parks, & Swan, 2010) of the eleven studies divided either the questionnaire or their results sections into these categories which guided data extraction. For those which did not, the authors placed answers in the category they felt was most appropriate.…”

“…Case managers, in collaboration with the client and family, coordinate and review the care services the clients receive. -Casdorph et al, 2009;Scherer et al, 2006;Zhou et al, 2010). In contrast, nursing home managers and home care package case managers scored poorly and lacked confidence in their levels of knowledge (Beck et al, 2017;Sellars et al, 2015).…”

“…In contrast, nursing home managers and home care package case managers scored poorly and lacked confidence in their levels of knowledge (Beck et al, 2017;Sellars et al, 2015). Questions about specific legislation, whether that be national or state, were typically answered poorly by all (Beck et al, 2017;Downe-Wamboldt et al, 1998;Jezewski & Feng, 2007;Jezewski et al, 2005;Putman-Casdorph et al, 2009;Scherer et al, 2006;Zhou et al, 2010).…”

“…However, one study involving acute care and outpatient oncology nurses reported moderately negative attitudes (Putman-Casdorph et al, 2009). Three studies (Jezewski & Feng, 2007;Jezewski et al, 2005;Lipson et al, 2004) found that nurses agreed that patients should have the right to refuse treatment even if to do so would lead to death and that patients should always be informed of their condition and treatment alternatives.…”

“…However, three other studies (Jezewski & Feng, 2007;Jezewski et al, 2005;Scherer et al, 2006) found a high level of agreement for the principle that nurses should uphold patients' decisions even if they disagree. Two studies (Downe-Wamboldt et al, 1998;Putman-Casdorph et al, 2009) found agreement that nurses consider ACP discussions as part of their role, whilst the studies involving home care package case managers (Sellars et al, 2015) and nursing home managers (Beck et al, 2017) found around half agreeing that it was part of their responsibilities. Interestingly, the one study which focussed on physicians found that they felt that it was patients and/or families who erect barriers to successful ACP discussions (Snyder et al, 2013).…”