Knowledge and attitudes toward advance directives among ICU nurses

End-of-life decision-making in Intensive Care Units (ICUs) may be hindered not only by the absence of advance directives (ADs), but also by limited knowledge among ICU nurses. The aim of this study was to analyse knowledge and attitudes regarding advance directives among ICU nurses.

An observational, descriptive, cross-sectional and multicentre study was conducted among ICU nurses working in public hospitals in Las Palmas (Spain). An anonymous electronic questionnaire was used. Statistical analysis was performed using R Core Team 2024.

A total of 229 responses were obtained from a population of 260 professionals, yielding a response rate of 88.1%. Most participants were women (75.6%) and had a median of 6 years of ICU experience (interquartile range: 3-14). Overall, 87.7% reported not having received specific training on advance directives (ADs). Although attitudes toward ADs were highly favorable (scores above 9/10), the level of knowledge was limited, particularly regarding legal aspects, procedures, documentation, and content.

A discrepancy exists between nurses' favorable attitudes toward ADs and their limited practical knowledge. The implementation of targeted training programs, along with the development of institutional protocols, could enhance the integration of ADs into ICU clinical practice.