BACKGROUND: The Patient Self-Determination Act offers persons the opportunity to make their end-of-life choices known by the use of advance directives. Although nurses are designated advocates for patients and are available to communicate patients' concerns and wishes to other healthcare providers, few data on nurses' knowledge of advance directives have been reported. OBJECTIVE: To describe nurses' knowledge of advanced directives. SAMPLE: A volunteer sample of 339 RNs in a 600-bed acute care teaching hospital was surveyed. The sample represents 38% of the approximately 900 nurses employed at this hospital. METHODS: Data obtained from a 44-item questionnaire that tested nurses' knowledge of advance directives were analyzed. In addition, the relationship between nurses' knowledge of advance directives and certain demographic factors was analyzed. RESULTS: The mean score for knowledge of advance directives was 78% correct answers. Fifty-five percent of the respondents indicated that they did not have a good understanding of advance directives. Only 14% had completed these end-of-life documents for themselves, and 92% indicated that further education would increase their understanding of advance directives. An analysis of variance produced only one significant finding: the relationship between ethnicity and knowledge about advance directives. CONCLUSIONS: Nurses must increase their knowledge of advance directives. Results of this survey should stimulate caregivers and hospital policy makers to take a long-range view of their responsibilities to patients regarding advance directives and their responsibilities for educating the persons who convey information about advance directives to patients.

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