The Attitude of Canadian Nurses Towards Advance Directives

Abstract

This article seeks to shed light on the beliefs that influence nurses' intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses' beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients' wishes, nurses should be aware that they do not systematically guarantee respect of a patient's autonomy, nor do they replace a relationship based on trust between patients and health care professionals.

The content of advocacy in procedural pain care – patients’ and nurses’ perspectives

“…It is important that both nurses and patients recognize the existence and quality of that relationship (Curtin 1979, Vaartio et al 2006). However, nurses did not attach as much importance to recognition of the patient-nurse relationship as patients, but instead emphasized their own role identification (Blondeau et al 2000, Schroeter 2000. This was particularly true for nurses with good pain care skills, with some influence over pain care plans or some knowledge about advocacy.…”

“…Both these proactive and reactive perspectives on advocacy (Snowball 1996) stem from nursing ethics: advocacy is understood and approached as a professional nursing duty (Blondeau et al 2000) and as a necessary condition for good care (Leino-Kilpi 1990, Yonge & Molzahn 2002, reflecting respect for patients (Gadow 1980, Hem & Heggen 2004. On the other hand, advocacy has been described as part of outcome management (Soderhamn & Idvall 2003), an impossible task for nurses (Gates 1995, Welchman & Griener 2005, and a professionalization strategy (Long 2005).…”

Perceptions of Preparedness to Assist Elders with End-of-Life Care Preferences

“…The literature also suggests that some health and allied health practitioners may use their professional authority and power to coercively change clients' decisions in spite of a client's previously articulated value history (Blondeau, Lavoie, Valois, Keyserlingk, Herbert, & Martineau, 2000;Gordon & Shade, 1999;Kapp, 1999;Peppin, 1995;Richter et al, 2002;Thompson, Barbour, & Schwartz, 2003). The motivation for over-ruling or suppressing a client's articulated value history may be based on practitioner-beneficence, i.e., the belief that because of his or her specialized knowledge and expertise, a practitioner's decision is preferred to that of a client (Kane, 1998;Kapp, 1999).…”

“…From the perspective of the elder client, advance directives are executed as a preparation for death (Blondeau et al, 2000;Kapp, 1999;Singer et al, 1998;Thompson et al, 2003). More importantly, elders may believe that advance directives will relieve their family of difficult decision-making during an emotionally vulnerable time (Singer et al, 1998).…”

End‐of‐Life Decision‐Making in Canada: The Report by the Royal Society of Canada Expert Panel on End‐of‐Life Decision‐Making

“…Blondeau and colleagues assessed the beliefs that influence nurses' intention to respect or not respect an advance directive document. 63 306 nurses who work either in a long-term care centre or in a hospital centre offering general and specialized care completed a multistatement questionnaire. The results show that nurses have a strong intention to comply with advance directives written by patients.…”