背景︰病人自主權利法於2019年1月6日正式實施，國內已發表之預立醫療決
定相關研究，都是探討安寧緩和醫療條例的知識，尚未探討針對護理人員
對於病人自主權利法之預立醫療決定的相關研究。
目的︰了解臨床護理人員對於預立醫療決定的知識現況，並探討預立醫療決定知識之相關影響因素。
方法︰採橫斷式相關性研究設計，以南部某區域教學醫院為收案場所，方便取樣選取144名通過試用期之護理人員，並運用結構式問卷收集資料，問卷內容為評估護理人員對預立醫療決定的知識，共20題，總分20分，計分方式採答對得l分，答錯0分計算，得分越高代表預立醫療決定知識越正確。所得資料以描述性統計含次數分配、百分比、平均差及標準差等分析；推論性統計則以獨立樣本t檢定（t - test）、單因子變異數分析（one-way ANOVA）及多元迴歸分析（multiple regression）等統計資料分析。
結果：研究結果顯示本研究對象以內科系、年齡21-30歲、工作年資10年以內、未婚、大學學歷、佛教/道教之女性護理師、沒有上過相關課程、有照顧過末期病人的經驗、沒有跟他人討論過臨終、無簽署意願為多數。護理人員預立醫療決定知識平均得分為15.8（SD=1.75），題項以「依據病人自主權利法，當末期病人，意識昏迷且已簽屬預立醫療決定時，醫護人員執行預立醫療決定的程序為何」最不清楚，答對率僅14%，其次為「預立醫療決定可選擇接受或拒絕的醫療照護選項」及「五種臨床條件確診的程序」此二題答對率亦不高，為59%；小組長以上（p < .001）、護理工作總年資10年以上（p = .019）及教育程度研究所以上（p = .031）之護理人員知識得分顯著較高，經多元迴歸分析後職稱（p = .020）為護理人員預立醫療決定知識之預測因素。
結論：透過上述得知護理人員於執行預立醫療決定程序、可接受或拒絕的照護
選項及五種臨床條件確診的程序之認知最為不足，小組長以上的護理人員知識
得分較高，建議加強臨床基層護理人員臨床案例討論或工作坊此層面的教育，
進而落實預立醫療決定之推展。

An advance decision can enhance end-of-life care by allowing patients to discuss and record their future health and care wishes. The value of this process is for providing the opportunity for people to discuss and reflect on what matters to them and let that person to consider the personal preference or other issues under those circumstances. The Patient Right to Autonomy Act was officially implemented on 6 January 2019 in Taiwan. However, the process of advance decision is still inadequately implemented in the context of participation and practice. There is no prior study exploring the current status and factor associated with knowledge of advance decision among nursing staff. The purpose of this study was to identify the relationship between clinical nursing staff and knowledge of Advance Decision, and explore factors influencing knowledge of Advance Decision. A cross-sectional study was conducted. A convenience sample of 144 nursing staffs was recruited from Southern regional teaching hospital. Self-developed questionnaire were used to examine demographic and nursing staff’s knowledge of Advance Decision (CVI = .92; Cronbach’s alpha = .83). Total of 20 questions were distributed, giving a total mark of 20 points. One point was assigned per correct question and zero point was allocated per wrong answer. Higher score revealed greater accuracy in knowledge of Advance Decision. The study results indicated that the majority of the subjects were from internal medicine units, age 21- 30 years, job tenure less than 10 years, unmarried, university degree, female nursing staff with Buddhism/Taoism belief, no experience in caring for terminal patients, had not discussed terminal life with others and not willing to sign an Advance Decision. The average score for nursing staff in Advance Decision was 15.8 (SD=1.75). Statistically significantly higher scores were found in respondents with position greater than team chief leader (p < .001), total work seniority over 10 years (p = .019) and educational status higher than research institute (p = .031). Multiple linear regression indicated that job title was a predictor of Advance Decision among nursing staff (B = 1.34, p < .020). Respondents with a position greater than team chief leader scored better. It is recommended that clinical case discussions or workshops for clinical nursing staff training should be provided in order to further promote the implementation of Advance Decision.

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