To assess the attitudes of nurses and consultants on the implementation of advance directives in the Maltese health system

Abstract

Background: An Advance Directive is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. Knowledge of and the attitude towards Advance Directives, can contribute to nurses' and physicians’ confidence in discussing EOL issues with patients and families. In Malta, the option of Advance Directives is still not available. The implementation and effect of Advance Directives in a health system still needs to be investigated. Aim: The aim of this study is to investigate nurses’ and consultants’ attitudes toward the implementation of advance directives for patients in an acute care setting. Method: Several databases were used to search for relevant studies for the literature review related to the chosen topic. For the local research investigation, a descriptive, exploratory nonexperimental design has been considered to be the most suited type of research design for this study. A mixed methods design using both quantitative and qualitative research were used to conduct this study. For the Quantitative research, a questionnaire was provided to 348 nurses working in Medical Wards at Mater Dei Hospital and in Sir Anthony Mamo Oncology Hospital. A total of 214 questionnaires were collected. For the Qualitative aspect of this study, a semi structured audio-taped interview, was done with 6 Consultants, 5 individuals in a managerial position and 1 key expert. The data was conducted in the same period hence this will result in cross-sectional research study design. Results: Nurses and Consultants tend to have a general positive attitude toward the implementation of Advance Directives in the Maltese Health System. From a managerial perspective, ethics and legal issues were identified as being the two main challenges for the implementation of Advance Directives. Barriers in communication and the Maltese culture and religion may also hinder the implementation of Advance Directive in the Maltese Health System. Conclusion: It is recommended that education and training about Advance Directives is given to all healthcare professionals and to the general public. The creation of proper guidelines, protocols and policies could also help all parties involved so as to handle any challenges and dilemmas related to the implementation and practice of advance directives. More in-depth studies need to be carried out in order to strengthen the evidence and explore any emerging issues on Advance Directives.