RELATIONSHIP BETWEEN KNOWLEDGE, ATTITUDES, AND BEHAVIORAL INTENTIONS OF ADVANCE DIRECTIVES AMONG CLINICAL NURSES

Chia-Chi Chen* ¹ , Pei-Ling Wu² 

1Department of Nursing, National Taiwan University Hospital Yun-Lin Branch, Yunlin City,

2Department of Nursing, Chung Shan Medical University, Taichung city,Taiwan

Objective: The aim of this study was to investigate the relationship between knowledge, attitudes, and behavioral intentions of advance directive among clinical nurses.

Methods: This study was approved by the institutional review board (file number:202009017RINA).This was a crosssectional study that employed convenience sampling. The questionnaires comprised the three scales of knowledge, attitudes, and behavioral intentions of advance directive. A total of 267 clinical nurses were recruited from a regional teaching hospital in central Taiwan. Descriptive statistics, t-test, one-way ANOVA, and Pearson’s correlation were employed for data analysis. Multiple  regression analyses were used to explore the behavioral intention predictors of advance directive.

Results: It was found that 97.8% of the participants refuse first aid when the disease did not respond well to treatment and the condition is critical; however, only 1.8% (n=5) actually completed an advance directive and recorded it on the health insurance card. "Age" (p=0.039), "marriage" (p=0.004), "work experience" (p=0.027) have significant differences in attitudes towards advance directives; in addition, younger age, shorter working years and being unmarried are positively correlated; age, years of work experience, and marital status were significantly negatively correlated with attitude. A positive correlation was between attitude and behavioral intention (r = 0.384, P = 0.000). Furthermore, respecting one’s own will for end-of-life medical treatment and care (r = 0.250, P = 0.000), representing domestic human rights progress (r = 0.138, P = 0.024), avoiding conflicts among family members (r = 0.219, P = 0.000), dying peacefully without regrets(r = 0.248, P = 0.000), and avoiding sufferings in family decision-making (r = 0.160, P = 0.009) were positively correlated with behavioral intention. Multiple regression analysis revealed the predictors of the behavioral intention to sign an advance directive. It was found that the overall regression model reached a significant level (F = 13.728, P = 0.000, R2 = 0.241, adjusted R2 = 0.223). The regression model explained a total of 22.3% of the variance; among them, attitude toward advance directives (β = 0.357, P = 0.000), willingness to choose one’s own end-of-life medical treatment and care (β = 0.357, P = 0.000), and avoidance of family conflicts (β = 0.127, p = 0.047) were predictors of the behavioral intention to sign an advance directive.

Conclusion: The more positive the attitude towards the advance directive, the higher the behavioral intention to sign it. Even if the nurses are willing to sign the advance directive, the actual number of nurses signing the directive is still low. It is recommended to take diversified and cross-team learning courses according to the learning needs, attributes, and qualifications of nursing staff. When promoting advance directive information, one should understand its spirit and connotation in order to improve the signing of advance directive wills.

Keywords: advance directives, attitudes, behavioral intentions.