Learning Objective #1: Describe general knowledge that nursing personnel have concerning advance directives

Learning Objective #2: Describe general attitudes and practices of nursing personnel concerning advance directives

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Mounting evidence over the past decade reflects that the Patient Self-Determination Act is not adequately fulfilling its purpose of facilitating autonomous, independent advance end-of-life care decision making in the event that the individual were to eventually be unable to do so. A sense of discomfort felt by health care professionals has been proposed as one of several barriers contributing to the low rate of individuals who formulate advance directives. The purpose of this descriptive study was to describe attitudes and practices of nursing personnel working in two 500-bed acute care facilities regarding advance directives. The sample consisted of 101 respondents: registered nurses (93%), and licensed vocational nurses (7%). Content validity and test-retest reliability measures were adequate for the Update on Advance Directives Questionnaire. Results reflected a lack of basic understanding and a lack of technical knowledge concerning advance directives. Although the majority of nurses understood that an advance directive was to withhold life-sustaining treatments, the majority incorrectly thought that nutrition and hydration should be included in “comfort care.” About half of the participants indicated that they had assisted a patient in developing an advance directive, but just less than a third of them indicated they did not feel comfortable discussing advance directives. Nurses are a population who support the formulation of advance directives, are interested in learning more about advance directives, and desire that the healthcare institution provide further information and instruction on advance directives. Implications for future nursing research include determining the nurse's role as part of the multidisciplinary health care team in facilitating advance directive formulation and conducting predictive level research to increase proactive (as opposed to circumstantial) advance directive formulation.