Emergency Healthcare Providers’ Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department

Abstract

This study aimed to explore and compare knowledge levels about advance directives (ADs) and life-sustaining treatment (LST) plans in end-of-life patients between emergency nurses and emergency medical technicians (EMTs). Using a cross-sectional study design and convenience sampling, 96 nurses and 68 EMTs were recruited from 12 emergency medical centers. A survey on knowledge about and attitudes toward ADs was performed using both online and offline methods between November and December 2019. Emergency healthcare providers were conceptually knowledgeable regarding ADs and LST, although approximately half or fewer had knowledge about ADs (such as the legal process for preparation, family or healthcare providers’ role, and the healthcare proxy). The knowledge levels of nurses and EMTs were moderate. Nurses had significantly greater knowledge relative to EMTs about ADs and LST. Positive attitudes of emergency healthcare providers were also moderately low, with nurses having less positive views than EMTs. Significant differences regarding ADs were found, with younger emergency healthcare providers having fewer career years, no personal end-of-life experiences, and less need for ADs having less knowledge. Emergency healthcare providers’ knowledge about and attitudes toward ADs were moderately low, with EMTs demonstrating a greater knowledge deficit and nurses exhibiting lower positive attitudes. Younger and novice providers had lower knowledge, but younger providers had more positive attitudes, implying that professional education and training should begin early in their careers to enhance their confidence for emergency delivery of advanced care planning.

Factors associated with attitudes toward advance directives in nurses and comparisons of the levels between emergency nurses and palliative care nurses

“…Attitudes toward ADs in nurses, especially in emergency nurses, have not been frequently assessed quantitatively. Even though the attitudes of emergency nurses and palliative care nurses in this study were more positive than those of emergency nurses and emergency medical technicians of a prior study (Hong et al, 2021), they were still only moderately positive according to the interpretation of the scores using the 16-items of this instrument (the Advance Directive Attitude Survey) by the developers (Nolan & Bruder, 1997). In the prior study using the 17-item instrument, the mean score of patient attitudes toward advance directives was 50.38 on a 17-68 scale (Nolan & Bruder, 1997), and the developers interpreted the score as indicative of moderately positive attitudes.…”

“…Further, during the current COVID pandemic period, the role of emergency nurses is more important than before because urgent need for or delivery of an AD is often encountered in emergency settings (Gupta et al, 2021). However, attitudes toward ADs among emergency healthcare providers have been found not positive, and even less positive than the attitudes of emergency medical technicians (Hong et al, 2021).…”