| Summary: | 碩士 === 美和科技大學 === 護理系健康照護碩士班 === 106 === Lack of confidence in terminal medical care and insufficient knowledge about Advance directive, in clinical practicing , nursing staff is hard to make patients advance care planning practicable. So nowadays.Patients rarely have opportunity to participate in their own medical care.
This is a cross-sectional study, discussing hospital nurse knowledge, experience, attitudes, confidence and affecting factor toward Advance Directives in the east of Taiwan. Questionnaire survey was conducted, a total of 250 questionnaires were surveied, and 193 are valid, the effective recovery rate was 77.2%.
In this research, a structural questionnaire was made to collect data from these nurses, which included personal demographic information, palliative care experience, caring knowledge, attitudes, experience and self-confidence towards advance directives, and then statistically analyzed by using means of descriptive analysis, independent sample t-test, one-way ANOVA, nonparametric statistics, Pearson correlation analysis and stepwise regression with software SPSS 22.0 version.
The results of the study: (1) 96.4% of the subjects were female, with an average of 39.17 years old, Most of them were above university, married, with children, and nursing clinical ladder level N2, average working age was 13.68 years; most of them received training courses related to palliative care (56.5%) and having cared terminal patients or relatives or friends (74.6%). (2)advance directives knowledge：clinical training for more than 21 years (p=.015), nursing clinical ladder level N3 or higher (p=.036), training courses related to palliative care (p=.004) and having cared terminal patients or relatives or friends (p=.042), had higher scores in advance directives knowledge. (3)advance directives Experience: In emergency and critical care units (p=.005), rich clinical experiences 11-20 years (p=.046), nursing clinical ladder level N1 (p=.010), training courses related to palliative care (p=.015), having discussed with others about hospice medical choices (p=.001), relatives and friends who signed advance directives medical orders (p=.001) and having cared terminal patients or relatives or friends (p=.001), with more experience in advance directives medical advice.(4)Degree of self-confidence towards: head nursing (p=.001), rich clinical experiences 21 years more (p=.025), nursing clinical ladder level N1 (p=.001), and good self-rated health status ( p=.018), training courses related to palliative care (p=.002), certificate of tranquility nurse (p=.029), having discussed with others about hospice medical choices (p=.001), relatives and friends who signed advance directives medical orders (p=.001), having cared terminal patients or relatives or friends (p=.001), had higher scores in self-confidence towards. (5) The higher of advance directives knowledge of the nursing staff (p=.029), the more positive the attitude at the end of life (p=.005), the more experience the advance directives (p=.001), the more confident they are. The more experience the advance directives (p=.023), the more positive the attitude at the end of life. (6) The main influencing factors of nurses' advance directives knowledge are the training courses related to palliative care; the main influencing factors of advance directives experience are the having discussed with others about hospice medical choices, nursing clinical ladder level and service units; the main influencing factor of self-confidence is having discussed with others about hospice medical choices, self-rated health status and nursing clinical ladder level.
The results of this study can be used as a reference for future on-the-job education, and the hospital policy about Advance directives implementation.
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