Discrepancies among knowledge, practice, and attitudes towards advance care planning among Chinese clinical nurses: A national cross-sectional study

Cheng, Qinqin; Liu, Xiangyu; Li, Xuying; Qing, Limin; Qin, Lin; Wen, Shi-Wu; Chen, Yongyi

doi:10.1016/j.apnr.2021.151409

Cited by 9 publications

(8 citation statements)

References 36 publications

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“…The present study found that nurses had a positive attitude towards ADs, with 780 (86.8%) nurses supporting the use of ADs, which is consistent with other studies (Cheng et al., 2021; Feng et al., 2020). Furthermore, we found that nurses, with less than 5 years of work experience, and nurse practitioners showed a positive attitude towards ADs.…”

Section: Discussionsupporting

confidence: 92%

Knowledge, attitudes and practices towards advance directives among clinical nurses: Multicenter cross‐sectional survey

Gong,

Ding,

Zhu

et al. 2023

Journal of Clinical Nursing

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Aims and ObjectivesThis 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.DesignMulticenter cross‐sectional survey. The standards for reporting the STROBE checklist are used.MethodsThis 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.ResultsThis 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.ConclusionsThe 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 PracticeThe 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 ContributionThis study involved no patient.

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Section: Discussionsupporting

confidence: 92%

Knowledge, attitudes and practices towards advance directives among clinical nurses: Multicenter cross‐sectional survey

Gong,

Ding,

Zhu

et al. 2023

Journal of Clinical Nursing

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“…Similarly, another integrative review [32] also indicated that HCPs reported moderate con dence helping patients and families with living wills, but they did not rate themselves as highly con dent regarding implementing the Patient Self-Determination Act and state laws. Furthermore, our study identi ed that receiving targeted training would enhance their con dence of implementing living wills, which echoes with a previous study [23].…”

Section: Discussionsupporting

confidence: 89%

The readiness and associate factors of implementing living wills among healthcare providers in Shenzhen: a cross-sectional study

Tang,

Li,

Zhu

et al. 2024

Preprint

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Background On January 1st, 2023, Shenzhen became the first city to legalize living wills in China. Although this unprecedented legalization, less was known about the readiness of Healthcare Professionals (HCPs) in Shenzhen in terms of implementing this Act. Our team aimed to timely examine the HCPs’ readiness in Shenzhen during the early stage of the regulation, including their knowledge, attitude and confidence to implement living wills. Methods A cross-sectional study was conducted across 16 hospitals in Shenzhen, Mainland Southern China, comprising 12 Grade III hospitals, 2 Grade II hospitals, and 2 Grade I hospitals selected for convenience. A total of 685 registered physicians or nurses participated in the study. Electronic questionnaires were employed to collect data on the demographics, knowledge, attitudes, and confidence levels of HCPs. Results Among 685 participants, less than half of them (315, 46.0%) had adequate knowledge (score ≥ 9), and the average correct rate of knowledge was 65.4%. Most (94.0%) of participants had a positive attitude (with a score ≥ 16). About 87.0% of the participants got the higher score (≥ 16) in the confidence-to-implement assessment. The significant predictors of knowledge included having cared for terminally ill patients (OR = 1.391), income less than $4,176 per month (OR = 1.628), holding administrative positions (OR = 0.611). HCPs with bachelor’s degree (OR = 3.348) and master’s degree or above (OR = 2.645), having cared for terminal ill patients (OR = 2.564) were more likely to get positive attitude. Additionally, HCPs who participated in specific training programs on living wills (OR = 1.703) and had cared for terminal ill patients (OR = 3.035) were more likely to hold higher level of confidence. Conclusions Although living wills have been legalized in Shenzhen, China, HCPs are not sufficiently prepared to implement it. They get general knowledge, hold positive attitude, but are lacking legal-related knowledge or enough confidence to implement living wills. Training programs addressing living will implementation, especially including legal awareness training, understanding the roles of different HCPs in executing living wills, and how to respect patient autonomy in Chinese culture should be planned at an early stage of a policy issued.

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“…Nevertheless, in China, there is not yet a complete subject system in palliative care, and the corresponding education and training systems are imperfect (Lu et al, 2018), thus, palliative nurses may suffer a lack of skills about emotion management, communication and stress relieving (Ercolani et al, 2020), which may influence their work performance and mental health. In addition, the Chinese traditional culture makes talking about death taboo (Lei et al, 2022), resulting in an irrational public understanding of palliative care, and some people hold the perspective that palliative care is a kind of negative treatment (Cheng et al, 2021), offspring may refuse it to comply with Chinese filial piety culture. These culture situations may make it difficult for palliative nurses to obtain a favourable support from patients and their families and aggravate them to a high risk of burnout.…”

Section: Introduction and Backg Roundmentioning

confidence: 99%

Mediating effect of resilience on the relationship between perceived social support and burnout among Chinese palliative nurses

Zhang

Guan

Jiang

et al. 2022

Journal of Clinical Nursing

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Aims and objectives:To detect the mediating effect of resilience on the relationship between perceived social support and burnout in Chinese palliative nurses.Background: Palliative nurses are a group that is vulnerable to burnout. Perceived social support may contribute to decreasing palliative nurses' burnout and facilitating their personal resilience, and resilience may be associated with lower levels of burnout. However, these relationships were unclear in the Chinese context. Design:A cross-sectional design. Methods:The STROBE guideline was performed to report this study. A mixed sampling method including convenience sampling and stratified sampling was used to recruit participants, and a total of 319 palliative nurses completed the Nursing Burnout Scale, the Perceived Social Support Scale and the Connor-Davidson Resilience Scale from May 2021 to September 2021. Influencing factors were primarily identified using independent-sample t tests and one-way ANOVA. Bootstrap method was used to detect the mediating effect of resilience. Results:The level of burnout in palliative nurses (23.4 ± 7.68) was higher than that of general nurses in China. Education level, health condition and monthly income were influencing factors of burnout. Resilience was detected as a mediator in the relationships between perceived social support and dimensions of burnout. Conclusions: Chinese palliative nurses experience a relatively high level of burnout, which may be influenced by several sociodemographic variables. Resilience could mediate the effect of perceived social support on the dimensions of burnout. Problemoriented and palliative-tailored strategies should be developed to further address burnout in Chinese palliative nurses. Relevance to clinical practice: Nurse managers and policy makers should support nurse ongoing education, adopt health-promoting interventions and optimise salary systems. In addition, perceived social support resources and resilience training programmes are also warranted.

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Discrepancies among knowledge, practice, and attitudes towards advance care planning among Chinese clinical nurses: A national cross-sectional study

Cited by 9 publications

References 36 publications

Knowledge, attitudes and practices towards advance directives among clinical nurses: Multicenter cross‐sectional survey

Knowledge, attitudes and practices towards advance directives among clinical nurses: Multicenter cross‐sectional survey

The readiness and associate factors of implementing living wills among healthcare providers in Shenzhen: a cross-sectional study

Mediating effect of resilience on the relationship between perceived social support and burnout among Chinese palliative nurses

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