預立醫療照護計劃是一個關鍵過程，使個人及其家人能夠討論反映他們的價值觀、偏好和生活質量的未來醫療保健決策。儘管預立醫療照護計劃具有公認的好處，但其實施在個人、人際、提供者和系統層面上仍然存在著隔閡。鑑於護理師其獨特的職位以及與患者的密切關係，應是發起預立醫療照護計劃的理想人選。然而，他們在此過程中的參與是有限的。本研究應用延伸計劃行為理論（TPB）和結構方程模式（SEM）方法探討影響泰國護理師參與預立醫療照護計劃意願的因素。
此研究在 2022 年 10 月至 2023 年 4 月之間分兩個階段進行。第一階段係涉及泰國版護理師參與預立醫療照護計劃(NIPCP) 意願量表的文化適應和驗證。總共223 名註冊護理師(RN) 參與，證實了該量表的心理測量可靠性。泰國版認可的NIPCP包括了5個向度，20個項目組成，「意圖」、「態度」、「主觀規範」、「行為控制知覺」和「知識」。它顯示出適當的模型組合、複合信度和內部一致性。
在第二階段，使用 SEM 將驗證過的 NIPCP 量表應用於 515 名註冊護理師樣本中，以調查影響因素。2023年1月至4月透過醫院系統的線上調查，有效回覆率為82.31%。 研究結果顯示，雖然知識不能直接預測泰國護理師的 ACP 參與意願（β = 0.087，p = 0.292），但它顯著影響了態度（β = 0.448，p < .05）、主觀規範（β = 0.425，p <.05）和行為控制知覺（β = 0.682，p < .05）。 這些因素對護理師參與 ACP 的意圖產生了正面影響，並充分調解知識對意願的間接影響（β = 0.449，p < .05）。這些發現說明增強這些因素，可以提高護理師對 ACP 參與意願。
本研究結論顯示護理師的ACP參與需要教育介入和相關政策。建議包括具文化敏感性的ACP培訓計劃，以及創造支持性的環境，以促進醫療照護提供者、患者和家庭之間的開放溝通與合作。未來的研究應著重於測試模型在不同人群中的合適性，探討意願與實際行為之間的關係。此外，應以縱貫性研究來發展及評值教育計劃和促進ACP參與的政策。

Advance Care Planning (ACP) is a pivotal process that enables individuals and their families to engage in discussions regarding future healthcare decisions that reflect their values, preferences, and quality of life. Despite the well-established benefits of ACP, barriers to its implementation persist at individual, interpersonal, provider, and systemic levels. Given their distinctive positions and close rapport with patients, nurses are ideally positioned to initiate ACP. However, their involvement in the process is limited. This study explored the factors influencing Thai nurses’ intention to participate in ACP using an extended theory of planned behavior (TPB) and Structural Equation Modeling (SEM) approach.
To achieve the study’s purpose, two interconnected phases were conducted between October 2022 and April 2023. The first phase involved cultural adaptation and validation of the Thai version of the Nurses' Intention to Participate in Advance Care Planning (NIPACP) scale. A total of 223 Registered Nurses (RNs) with a 52% response rate confirmed the scale’s psychometric robustness. The Thai-validated NIPACP comprised 20 items across five dimensions: 'intention,’ ‘attitude,’ ‘subjective norm,’ ‘perceived behavioral control,’ and 'knowledge.’ It showed an adequate model fit, strong composite reliability, and robust internal consistency.
In the second phase, the validated NIPACP scale was applied to a separate sample of 515 RNs using SEM to investigate influencing factors. Data were collected from January to April 2023 through an online survey shared by the hospital's internal system, yielding a robust response rate of 82.31%. The findings revealed that, while knowledge did not directly predict Thai nurses' ACP engagement intention (β = 0.087, p = 0.292), it significantly influenced attitudes (β = 0.448, p < .05), subjective norm (β = 0.425, p < .05), and perceived behavioral control (β = 0.682, p < .05). These factors positively influenced nurses' intention to engage in ACP, and fully mediated the indirect effect of knowledge on intention (β = 0.449, p < .05). These findings underscore the importance of enhancing these factors to increase nurses’ ACP engagement intention.
The study concluded that ACP participation requires educational intervention and policies for nursing practice. Recommended approaches include culturally sensitive ACP training programs and the creation of supportive environments that foster open communication and collaboration among health care providers, patients, and families. Future research should focus on testing the model fit in diverse populations to explore the relationship between intention and actual behavior. Furthermore, longitudinal studies should be conducted to develop and evaluate the educational programs and policies that promote ACP involvement.

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