Journal of Professional Nursing

Primary healthcare NZ nurses’ experiences of advance directives: Understanding their potential role

Raewyn Davidson, MN. Contractor, Hawkes Bay DHB, Napier, New Zealand
Elizabeth Banister, PhD, RN. Adjunct Professor, Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, New Zealand
Kay de Vries, PhD, MSc, RN. Senior Lecturer, Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, New Zealand

Reference:  Davidson, R., Banister, E., & de Vries, K. (2013). Primary healthcare NZ nurses’ experiences of advance directives: Understanding their potential role. Nursing Praxis in New Zealand, 29(2), 26-33.



Advance directives are one aspect of advance care planning designed to improve end of life care. The New Zealand Nurses Organisation released their first mission statement in 2010 concerning advance directives suggesting an increase in the use of these. A burgeoning older population, expected to rise over the next few years, places the primary healthcare nurse in a pivotal role to address the challenges in constructing advance directives. While literature supports the role for primary healthcare nurses in promoting advance directives, no research was found on this role in the New Zealand context. This paper presents results of a qualitative study conducted in New Zealand with 13 senior primary healthcare nurses with respect to their knowledge, attitudes, and experiences of advance directives. Results of the analysis revealed a dynamic process involving participants coming to understand their potential role in this area. This process included reflection on personal experience with advance directives; values and ethics related to end of life issues; and professional actions.

advance directives; advance care planning; primary healthcare nurses’ experience, professional action.

Most nurses can expect to care for dying patients at some stage of their career (New Zealand Nurses Organisation (NZNO) 2010a). A burgeoning older population in New Zealand, expected to rise in the next 15 years (Ministry of Health (MOH), 2002), will impact on healthcare services (MOH, 2006). The vision for primary health services emphasises population health care and a wider range of services such as health promotion, preventative care and co-ordination across services (MOH, 2001a). Within this context, primary healthcare nurses have an important role in providing patient-centred end of life care (MOH, 2001b). In particular, primary health care nurses need to be familiar with patient and whânau/ family wishes including those concerning advance care planning. Advance care planning is recognised internationally as pivotal to providing quality end of life care (Phillips et al., 2011). It offers opportunities for individuals to co-create with significant others and health professionals, their healthcare wishes should they lose their decision making ability (Blackford & Street, 2011).

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