An educational program for nurses can help address knowledge gaps related to advance health care directives (AHCDs), according to new research. This will help to ensure that patients’ wishes for care at the end of life are known and respected.

Maureen Kroning, EdD, RN, of Nyack College in New York and Good Samaritan Hospital presented her hospital’s experience with developing an inservice educational program to provide nurses with needed information on advance directives. In the Journal of Christian Nursing (2014; doi:10.1097/CNJ.0000000000000113), she wrote, “It is vital to recognize and address problems associated with AHCD so nurses can provide competent and compassionate care.”

Research has found that, while most adults want their wishes for end-of-life care response followed, only about one-third have completed AHCDs. Despite the growing need for advance care planning, many health care professionals lack the knowledge to teach patients about advance directives.

Continue Reading

At the study hospital, there was a recognized problem with AHCD education. On admission, patients were provided with an AHCD information packet and told to ask a nurse if they had any questions. “However,” Kroning wrote, “nurses expressed not fully understanding AHCDs, feeling incompetent to educate patients, nor did they believe AHCD education was an important part of their role.”

A subsequent survey of 49 nurses found significant deficits in knowledge regarding AHCDs, especially among less-experienced nurses. Nurses specifically and repeatedly addressed the need for more AHCD education.

In response, the hospital developed an AHCD inservice education program, specifically addressing the knowledge gaps uncovered by the survey and tailored to the needs of adult learners. The 2-hour program included information on AHCDs and living wills, and relevant federal and state laws. In addition to lecture and discussion, the program included role-playing opportunities and questions and answers. The online version of the article includes links to the author’s lecture slides and an AHCD patient booklet.

The educational program led to significant improvements in nurses’ knowledge of AHCDs. The hospital also saw vital changes in several areas related to AHCDs, including increased awareness of the problem by hospital leadership and the desire to obtain further AHCD education by nurses.

Other hospitals have been provided with and are implementing the educational intervention. Providing time for nurses to attend the program during regular work hours is a key factor in ensuring access to the inservice program.

The experience highlights the need to provide nurses with practical and relevant information about AHCDs and end-of-life care, Kroning stated. She wrote, “If nurses lack the education to effectively educate, how are patients going to make desired decisions about their wishes at the end of life?”

The article also highlights some key issues for further research related to AHCDs, including addressing patients’ distress around end-of-life care, issues surrounding health care team relationships, and the optimal timing of conversations with patients and families about completing an advance directive.