Knowledge, attitudes and experiences of nurses and nursing students regarding Advance Directives: a scoping review

Objective: To map the literature on the knowledge, attitudes and experiences of nurses and nursing students regarding Advance Directives (ADs). Self-determination is acknowledged as a fundamental principle of international law and human rights. The International Council of Nurses (ICN) Code of Ethics (2021) underscores the nurse’s role as an advocate for the individual receiving care, fostering self-determination and ensuring continuity of care. ADs constitute a legal instrument that enables adults to articulate their preferences regarding healthcare treatments in advance and to designate a proxy in the event of future decision-making incapacity. Despite legislative advancements, significant gaps persist within clinical practice and professional education concerning the implementation and comprehension of ADs. The aim of this scoping review is to map the existing knowledge, attitudes, and experiences of nurses and nursing students in relation to ADs, a legal and clinical tool designed to safeguard the principle of self-determination. Nevertheless, there is currently no systematic framework at the international level describing nurses’ knowledge, attitudes, and experiences regarding ADs. Existing literature highlights generally low levels of knowledge and competence on this topic, both among healthcare professionals and nursing students. Although some continuing education programs have attempted to address these gaps, the inclusion of ADs in university curricula and professional development initiatives remains inconsistent and insufficient. This situation contributes to the persistent underutilization of ADs in clinical practice and to nurses’ difficulties in managing situations that require their application. A systematic mapping of the literature is therefore necessary to understand the current state of knowledge, identify educational and organizational gaps, and guide targeted training interventions as well as more effective health policies. The aim of this scoping review is therefore to systematically map nurses’ and nursing students’ knowledge, attitudes, and experiences regarding ADs, an instrument that embodies the ethical and legal principle of self-determination. Secondly, the review seeks to analyses, according to COSMIN criteria, the instruments used in studies to measure these dimensions, to assess their methodological quality and psychometric properties. This approach will enable the identification of valid and reliable tools and guide the development or improvement of future measurement instruments.