| Objectives:A cross-sectional survey was conducted on the knowledge,attitude,and practice of advanced instruction of clinical nurses in Chongqing,and the factors affecting the knowledge,attitude,and practice of clinical nurses were analyzed and discussed,to provide reference and basis for the training and promotion of advance directive(ADs)in clinical nurses.Methods:Part Ⅰ: to obtain the research materials through the literature method and inquiring a large number of domestic and foreign literature.Based on the results of interviews with 8 medical staff in domestic cancer hospitals,the experience and views of foreign nurses on the implementation of ADs for the elderly,and the Knowledge Survey on Advance Directives,the initial items of the questionnaire were formed and revised by the focus group discussion of 8 experts.A total of 308 clinical nurses were conveniently selected for investigation,and 30 of them were selected for retest to determine the reliability and validity of the questionnaire.Part Ⅱ: The stratified sampling method was adopted to select nurses from 2 tertiary hospitals,2 secondary hospitals,and 8 community hospitals in Chongqing.According to the "Chongqing Health Statistics Yearbook2019",the sample size to be selected from each level hospital was calculated.390 nurses in tertiary hospitals,372 nurses in secondary hospitals,and 188 nurses in community hospitals were surveyed by questionnaire.Results:Part Ⅰ: The Nurse knowledge-attitude-practice Survey on Advance Directives questionnaire consists of 8 dimensions,a total of 33 items,the Cronbach’s α of the total table is 0.854,Cronbach’s α coefficient of each dimension is 0.603-0.923.Factor analysis extracted 8 common factors which are rulemaking,institutional advantages,supporting factors,self-impediments,external obstacles,traditional concepts,clinical behaviors,which were different in specific content and their corresponding items.The KMO value was 0.885,and the cumulative variance contribution rate was 70.831%.the test-retest coefficient was 0.996,and the retest reliability of each factor is 0.750～1.000.The questionnaire has good reliability and validity.Part Ⅱ: 950 clinical nurses serving elderly patients in Chongqing were surveyed,899 of which were valid.Clinical nurses scored 4.63±3.90 on advance instruction knowledge,ranging from 0 to 12 points.286 nurses(31.8%)had a zero score and a complete lack of knowledge.605 nurses(67.4%)had partial knowledge,and only 8 nurses(0.8%)had complete knowledge.48.6% of nurses understood the meaning of ADS.Nurses Those who were unmarried,knew of ADs,had received ADs training,had EOL care,experienced bereavement,and whose medical institutions had standardized procedures,storage of ADs files,and privacy protection had better knowledge of ADs.The score of advance instruction attitude was55.09±5.33,and 86.8% of nurses supported the use of advance instruction.The practice score of nurses was 5.43±3.12.Only 16.7% of nurses participated in the formulation and implementation of ADs.Nurses who had a positive attitude.knew the advance instructions and had standard procedures in their medical institutions were more willing to participate in the implementation of advance instructions.The study found barriers to policy,knowledge,teamwork,culture,time,and confidence.Conclusions:The questionnaire has good reliability and validity,and it can be used in the research of nurse knowledge-attitude-practice of Advance directive performance.The approval rating for ADs among nurses in China is very high,but the knowledge and participation rates are low.policy,training,time,and team support are the primary needs of nurses. |
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