title: Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.
abstract: Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.
authors.affiliation: Senior Lecturer /Director International Programmes, School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
authors.forename: Alice
authors.initials: A
authors.lastname: Coffey
authors.affiliation: School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
authors.forename: Geraldine
authors.initials: G
authors.lastname: McCarthy
authors.affiliation: Research Assistant, Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weathers
authors.affiliation: Clinical Education Specialist, Center for Learning and Innovation, North Shore-LIJ Health System, Lake Success, New York, USA.
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Friedman
authors.affiliation: Senior Vice President, Chief Learning Officer, Center for Learning and Innovation, North Shore-LIJ Health System, Lake Success, New York, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Gallo
authors.affiliation: Associate Professor, Head of School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Mally
authors.initials: M
authors.lastname: Ehrenfeld
authors.affiliation: Professor in Nursing and Director of Research, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Sophia
authors.initials: S
authors.lastname: Chan
authors.affiliation: Assistant Professor, Director of Master of Nursing Programme, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: William H C
authors.initials: WH
authors.lastname: Li
authors.affiliation: Director, CEREF Centre for Research & Continuing Education, Padova, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Poletti
authors.affiliation: Associate Professor and Dean, Master in Nursing Sciences, Padua University, Padua, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Zanotti
authors.affiliation: Consultant in Geriatric Medicine, Centre of Gerontology and Rehabilitation, St. Finbarr's Hospital, Cork, Ireland.
authors.forename: D William
authors.initials: DW
authors.lastname: Molloy
authors.affiliation: Research Fellow and Consultant in Geriatric Medicine, Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland.
authors.forename: Ciara
authors.initials: C
authors.lastname: McGlade
authors.affiliation: Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Joyce J
authors.initials: JJ
authors.lastname: Fitzpatrick
authors.affiliation: Lecturer, Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Itzhaki
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D038622:Internationality; D009740:Nursing Staff; D013727:Terminal Care
keywords: advance directives; confidence; end-of-life; knowledge; nursing
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