Knowledge, attitude and practice of advance care planning among nursing interns: A mixed-methods approach

Aim: To investigate the knowledge, attitudes and practice of advance care planning and confirm their influencing factors among nursing interns in China. Background: Due to a lack of standardized courses on advance care planning (ACP) in China, nursing interns do not possess the knowledge of ACP and cannot apply it to clinical practice. Design: A convergent parallel mixed-methods design. Methods: 382 nursing interns aged > 18 years were recruited using convenience sampling. Quantitative data were collected using the General Demographic Characteristics Questionnaire and the Advance Care Planning Knowledge, Attitude and Practice Questionnaire. Thirteen nursing interns were drawn from the quantitative phase and their interviews were thematically analyzed. Results: The ACP attitudes and practice scores of nursing students were 48.85 +/- 6.39 and 32.23 +/- 4.58, respectively, with a high level, while their ACP knowledge score was 6.89 +/- 2.70, with a medium level. The significant promotive factors included positive attitude toward death and the nursing major and experience in clinical rescues and palliative care training; The key hindrance factors included the lack of ACP education and the limitations of the working environment. Conclusions: The study highlighted the importance of delivering systematic palliative care training and integrating the practice of ACP into routine nursing practice. Doing this can help expand advance care planning knowledge, establish positive attitudes and meet the practical needs of nursing interns for their ACP clinical practice.