The associations between work stress load, Advance care planning practice preferences and self-efficacy in Intensive care unit nurses

The associations between work stress load, Advance care planning practice preferences and self-efficacy in Intensive care unit nurses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The associations between work stress load, Advance care planning practice preferences and self-efficacy in Intensive care unit nurses HaoJie Wang, Weiqing Zhang, Kun Wang, Jielu Song, Yabing Cao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5332075/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Given that Intensive care unit (ICU) patients are mostly in critical condition, unable to participate in decision-making communication, family members are prone to make medical care decisions against the patient's wishes, to safeguard the patient's right to autonomous decision-making. ICU nurses serve as vital conduits for Advance Care Planning (ACP) communication due to their professional expertise and understanding of patient conditions. However, they carry out the incidence of ACP is relatively low, the present study to investigate the communication self-efficacy level of advanced care planning (ACP) among ICU nurses in a tertiary care hospital and the factors affecting it, and to provide a reference for developing an intervention program. Methods: From January 2024 to April 2024, 330 ICU nurses from six tertiary hospitals in *** Province were conveniently selected for the survey and analysis using the General Information Questionnaire, ACP Knowledge, Belief and Conduct Questionnaire, ACP Practice Preferences Scale, Work Stress Load Scale, and ACP Self-Efficacy Scale (Chinese version). Results: ICU nurses' ACP self-efficacy score (44.42±9.14), Pearson's analysis of the correlation between variables, and multiple linear regression to analyze the main influencing factors of ICU nurses' ACP communication self-efficacy showed that marital status, participation in hospice training, ACP knowledge-attitude-behavioral willingness, ACP practice preference, and work stress load P <0.05,explaining 79.1% of the total variance. Conclusion： ICU nurses' ACP communication self-efficacy is at a moderate level with many influencing factors, and it is recommended to implement interventions for the influencing factors to improve the level of ICU nurses' ACP communication self-efficacy. Intensive Care Unit Nurse Advanced Care Planning Self-Efficacy Influencing practice preferences Introduction Patients in the intensive care unit (ICU) are often critically ill and may be in a state of coma or unconsciousness. This condition renders them unable to communicate or make informed decisions about their treatment. Consequently, healthcare teams face significant challenges in making therapeutic choices 1 . In these situations, family members or designated surrogates assume the responsibility of providing informed consent for the patient's life-sustaining treatments. This can lead to difficult decisions that may conflict with the patient's preferences, presenting dilemmas between treatment options, associated risks and benefits, and balancing the patient's right to life with their right to die with dignity 2 , 3 . Advanced Care Planning (ACP) prioritizes the patient’s end-of-life wishes. It enables patients with decision-making capacity to communicate their preferences to family and healthcare professionals, thus guiding the healthcare services they wish to receive 4 .Through ACP, patients' wishes are documented in advance, offering guidance to family members during critical decisions. This process preserves the patient's autonomy and significantly enhances their quality of life and dignity. In the Intensive Care Unit (ICU), nurses frequently interact with patients and their families. They serve as vital conduits for Advance Care Planning (ACP) communication due to their professional expertise and understanding of patient conditions 5 , 6 . However, research indicates that ICU nurses often engage in ACP communication infrequently 7 . This situation likely correlates with numerous factors, including the high-stress nature of the ICU environment and nurses' limited cognitive understanding of ACP 8 . While prior studies have examined nurses' knowledge, beliefs, behaviors, and acceptance of ACP, there remains a significant gap in research focused on nurses' self-efficacy in ACP communication and the factors that may influence it 9 , 10 . Given the pressing necessity for Advance Care Planning (ACP) in Intensive Care Units (ICUs), this study seeks to investigate the current state of ACP communication self-efficacy among ICU nurses. It will delve into the factors that influence this self-efficacy in detail. This research will provide a critical framework for nursing administrators to devise targeted training programs and management strategies. By encouraging nurses to engage more proactively in ACP communication, they will better address the needs of patients and their families. This approach will safeguard patients' rights to life and dignity while enhancing the overall quality of healthcare in critical care environments. Methods Aims The aim of this study was to evaluate the current ACP communication self-efficacy among ICU nurses. It sought to identify the factors influencing their communication skills. Additionally, it aimed to offer a crucial foundation for nursing leaders to design targeted training programs and management strategies. This will enhance ICU nurses' self-efficacy and engagement in ACP communication. Study design We conducted a cross-sectional study involving ICU nurses from six tertiary care hospitals, each with over 2,000 beds. This study evaluated self-efficacy levels in ACP communication and examined pertinent factors. We employed a questionnaire that addressed general demographic traits, developed by our research team based on a literature review. Furthermore, we included the ACP knowledge-attitude-practice questionnaire, the ACP communication self-efficacy scale, the Advance Care Planning Practice Preference Scale, and the Stress Overload Scale. The preliminary study received approval from the Ethics Committee of *** (KY2024049), and all participants provided informed consent. Sample and setting A cross-sectional survey of ICU nurses in a convenience sample of six tertiary-level hospitals in ***Province was conducted from January 2024 to April 2024.Inclusion criteria: (1) obtaining the professional qualification certificate for nurses and completing the standardized nurse training; (2) ≥ 1 year of working hours in ICU nursing; and (3) providing informed consent and voluntary participation. Exclusion criteria: regulation training, internship, apprenticeship, and further training of nurses. According to the sample size calculation method of the current investigation, the sample size was estimated to be 10–20 times the independent variable 11 , fifteen potential influencing factors were included in this study, and the sample size was determined to be 188 ~ 375 cases by considering the 20% non-response rate. questionnaire of general characteristics Based on the literature review, the research team developed the questionnaire. We gathered the general characteristics of participants. There were nine entries, including age, gender, religion, ICU experience, education level, marital status, job title, specialty nursing status, and involvement in hospice training, which included caring for deceased patients. ACP communication self-efficacy scale The scale was developed by Baughman 12 et al and cross-culturally adapted by domestic scholars Yang Zhen 13 et al to assess nurses' confidence in ACP communication. According to nurse-led practices, the scale comprises three dimensions: preference discussion and assessment, information guidance and disclosure, and content assessment and determination, including 16 items in total. It employs a Likert scale, with scores ranging from 1 (very unconfident) to 5 (very confident). Notably, items 1, 6, and 14 are reverse scored. The overall score varies from 16 to 80, wherein higher scores signify greater confidence among nurses in engaging patients about ACP. The original scale underwent cross-cultural adaptation and was first utilized in Argentina and Spain, demonstrating strong internal consistency with Cronbach's α values of 0.89 and 0.95, respectively 14 , 15 . Advanced Care Planning Knowledge-Attitude-Practice questionnaire The scale, developed by Douzi Ding 16 , comprises three dimensions: ACP knowledge (12 items), attitude (13 items), and behavioral willingness (8 items), totaling 33 items. The cognitive dimension consists of judgmental questions, where a "correct" response earns 1 point, while "incorrect" and "unsure" yield 0 points. The attitude dimension utilizes a 5-point Likert scale (0 = strongly disagree, 4 = strongly agree), and the behavioral willingness dimension also follows this scale (0 = strongly unwilling, 4 = strongly willing). The maximum possible score is 96 points; higher scores indicate greater ACP knowledge and belief levels. The Cronbach's α coefficients for each dimension were 0.782, 0.907, and 0.896, respectively, while the overall Cronbach's α for the questionnaire was 0.922. Advance Care Planning Practice Preference scale Compiled by Yang Zhen 17 , this scale evaluates nurses' preferences regarding Advance Care Planning (ACP) practices. It encompasses three dimensions: behavioral attitudes (9 items), subjective norms (7 items), and perceived behavioral control (8 items), totaling 24 items. the 5-point Likert scale (Strongly Disagree, Disagree, Fairly Agree, Agree, and Strongly Agree) rates responses from 1 to 5, with a maximum score of 120. A higher score indicates a greater inclination to engage in ACP behavior. The Cronbach's α coefficient for this scale in the study was 0.746. Stress Overload Scale Developed by Amirkhan 18 , with Chinese translation by Suzy 19 et al., this instrument comprises two dimensions: event load and individual vulnerability, featuring a total of 22 items. It employs a 5-point Likert scale, with responses ranging from 1 to 5, signifying "never" to "always." A higher score indicates increased stress levels among nurses. The Cronbach's α coefficient stood at 0.940 and Ning Bin et al 20 study showed that the Cronbach's α coefficient is 0.936 of the scale . Data collection The tutor is tasked with reaching out to the nursing departments of various hospitals to aid in the survey. This research utilizes the online platform "Questionnaire Star." Respondents filled out the questionnaire anonymously. The homepage outlined the survey's purpose, significance, and instructions for completion. Each micro-signal could submit the questionnaire only once. In total, 345 questionnaires were collected. After excluding invalid samples with response times under three minutes or inconsistent answers, the study yielded 330 valid samples, resulting in an effective rate of 95.65%. Statistical analysis SPSS 26.0 software facilitated data analysis. For count data, researchers presented statistical descriptions using frequency and composition ratios. They described measurement data through mean ± standard deviation. To compare groups, they employed independent samples t-tests or one-way ANOVA. Pearson correlation analysis examined variable correlations. Additionally, multivariate stepwise regression analysis identified factors influencing ACP communication self-efficacy. The significance level was set at α = 0.05, considering P < 0.05 as statistically significant. Results Participant characteristics This study included 330 ICU nurses, of which 30 (9.1%) were male and 300 (90.9%) were female, with an average age (30.38 ± 4.86). General data information and univariate analysis are shown in Table 1 . Table 1 Participant characteristics and univariate analysis results(N = 330) Item Score n(%) statistical ( t/F ) P Age 1.593 0.191 40 45.77 ± 6.32 18(5.4%) Sex 7.425 0.157 Male 46.93 ± 12.38 30(9.1%) Fem al e 43.59 ± 7.70 300(90.9%) Religious beliefs 0.155 0.283 No 43.82 ± 8.30 322(97.6%) Yes 47.00 ± 6.23 8(2.4%) Years of ICU experience 4.564 0.004 1 ~ 5 42.27 ± 7.48 182(55.2%) 6 ~ 10 46.47 ± 7.97 68(20.6%) > 10 44.825 ± 7.17 80(24.2%) Education level 43.434 < 0.001 Specialized and below 38.87 ± 8.66 76(23.0%) undergraduate 44.40 ± 6.50 228(69.1%) Postgraduate and above 54.15 ± 10.08 26(7.9%) Marrital status 0.424 0.037 Single 43.05 ± 8.10 146(44.2%) Married 44.96 ± 8.37 184(55.8%) Position 1.339 0.262 Nurse 43.04 ± 5.91 114(34.5%) Nurse Practitioner 44.24 ± 9.49 84(25.5%) Nurse Practitioner in Charge 44.65 ± 9.26 126(38.2%) Associate Nurse Practitioner and above 39.67 ± 3.62 6(1.8%) Nurse specialist 2.096 0.148 Yes 45.24 ± 8.33 168(50.9%) NO 42.51 ± 7.98 162(49.1%) Attended hospice training 18.856 < 0.001 Yes 47.52 ± 9.86 214(64.8%) No 41.93 ± 6.48 116(35.2%) Scale and dimension scores The total ACP communication self-efficacy score for ICU nurses in this study was (43.90 ± 8.264), and the rest of the scale dimensions scores, along with the average scores of the items are shown in Table 2 . Table 2 Scale and dimension scores Dimension Items Score range Score Item score average Knowledge 12 0 ~ 12 7.33 ± 2.38 0.61 ± 0.20 Attitude 13 0 ~ 52 33.77 ± 7.93 2.59 ± 0.61 Behavioral intention 8 0 ~ 32 24.45 ± 4.33 3.05 ± 0.54 ACP knowledge,attitude and practice 33 0 ~ 96 63.64 ± 10.48 1.93 ± 0.32 Preference discussion 5 5 ~ 25 14.68 ± 3.45 2.94 ± 0.69 Information guidance 5 5 ~ 25 14.93 ± 2.83 2.99 ± 0.57 Content assessment 5 5 ~ 25 14.29 ± 2.97 2.86 ± 0.59 ACP self-efficacy 15 15 ~ 75 43.90 ± 8.26 2.93 ± 0.55 ACP practice preferences 24 24 ~ 110 91.72 ± 12.23 3.82 ± 0.51 Stress overload 22 22 ~ 110 73.68 ± 6.22 3.35 ± 0.83 Correlation analysis The results of the Pearson correlation analysis between ACP communication self-efficacy, the ACP knowledge-attitude-practice questionnaire, practice preferences, and work stress overload are presented in Table 3 . Table 3 The results of pearson correlation of ACP self-efficacy Dimension Knowledge Attitude Behavioral intention ACP knowledge- attitude-practice Stress overload Stress overload Preference discussion 0.446** 0.487** 0.377** 0.654** -0.547** 0.724** Information guidance 0.455** 0.542** 0.467** 0.679** -0.602** 0.793** Content assessment 0.440** 0.495** 0.488** 0.643** -0.600** 0.753** ACP self-efficacy 0.491** 0.558** 0.487** 0.724** -0.640** 0.831** Multiple regression analysis of ACP communication self-efficacy Using ACP communication self-efficacy as the dependent variable, the analysis identified nine significant factors: years of work experience, education level, marital status, participation in ACP training, ACP knowledge, ACP attitude, willingness to engage in ACP behaviors, preference for ACP practices, and work stress load. The multicollinearity diagnosis indicated that each model maintained a tolerance level between 0.496 and 0.880, with a variance inflation factor ranging from 1.137 to 2.018, confirming the absence of multicollinearity. The findings revealed that marital status, participation in relevant training, ACP knowledge, ACP attitude, intention to engage in ACP, preference for ACP practices, and stress overload significantly influenced ACP communication self-efficacy among ICU nurses, collectively explaining 79.1% of the total variance, as outlined in Table 4 .. Table 4 Multiple linear regression analysis of factors influencing ACP communication self-efficacy Model B SE β t P 95%CI Constant 8.293 2.424 3.422 < 0.001 3.536 ~ 13.050 Marital status -1.047 0.354 -0.057 -2.957 0.003 -1.741~-0.352 Attended hospice training 2.542 0.310 0.135 8.210 < 0.001 1.934 ~ 3.150 knowledge 0.222 0.072 0.061 3.099 0.002 0.081 ~ 3.363 Attitude 0.169 0.023 0.151 7.402 < 0.001 0.124 ~ 0.214 Behavioral Intentions 0.079 0.039 0.039 2.056 0.040 0.004 ~ 0.155 Practice Preferences 0.419 0.016 0.575 26.219 < 0.001 0.388 ~ 0.451 Stress overload -0.187 0.018 -0.206 -10.556 < 0.001 -0.222~-0.152 Discussion The effect of general demographic information The results indicate that marital status and completion of palliative care training influence ICU nurses' self-efficacy in advance care planning communication ( P < 0.05). Unmarried nurses tend to have higher self-efficacy in this regard, likely due to their focus on personal development and enhancement of professional skills, alongside fewer responsibilities at home, allowing them more time and enthusiasm to participate in advance care planning training and practice communication skills. Conversely, married nurses benefit from emotional support within their families. They may prioritize familial bonds, which, coupled with empathetic considerations, leads them to avoid end-of-life conversations with patients or families to alleviate emotional stress or burden 21 . In this study, 64.8% of ICU nurses had participated in palliative care training. Such training can enhance healthcare providers' capabilities to alleviate patient suffering by providing comfort-focused care, bolstering communication with patients and their families, and meeting patient needs to offer more human-centered care. Scholar Parekh 22 developed a simulated ACP training dialogue, which improved self-efficacy in ACP communication. The essence of ACP comprises the communication process with patients and families. Training allows for in-depth learning of related theoretical knowledge, methods, and techniques, and mastering effective communication strategies 23 . Therefore, it is essential to develop a systematic ACP training program and implement comprehensive, multi-faceted, and specific training measures to enhance ICU nurses' ability to apply ACP in their departments. Influence of ACP knowledge-attitude-practice The findings of this study indicated that ICU nurses' knowledge, attitudes, and behaviors regarding Advanced Care Planning (ACP) significantly impacted their self-efficacy in ACP communication, showing a strong positive correlation ( P < 0.001). This study aligns with Hsieh's 24 , in which ACP knowledge, attitudes, and behavioral willingness were all influential factors of ACP communication self-efficacy. At the knowledge level, a comprehensive understanding of ACP concepts, processes, purposes, and significances underpins effective ACP 25 . Regarding attitudes, a proactive outlook boosts ICU nurses’ initiative in ACP discussions. Nurses with a favorable attitude toward ACP tend to actively engage in opening dialogues, maintain positivity during challenging discussions, and continually refine their communication strategies. Behavioral willingness reflects nurses' propensity to transform their knowledge and attitudes into actionable steps. ICU nurses demonstrating higher behavioral readiness often recognize patients' needs during clinical care, facilitate ACP conversations, and regularly practice their communication skills, thereby enhancing their self-efficacy in ACP-related dialogues. Liuliu Chen 26 advocated for enhancing nurses' ACP communication abilities through training in ACP knowledge, attitudes, and practical skills. Given the critical illnesses and fluctuating conditions of ICU patients, nursing leaders and educational experts should create comprehensive training programs that provide systematic instruction on the unique needs of ICU patients 27 . Such training should encompass essential critical care competencies, clinical decision support, patient and family communication strategies, and psychosocial support. This approach ensures ICU nurses acquire vital ACP-related knowledge and skills, and encourages their involvement in guiding patients and families through the ACP process, thereby improving the quality of care at the end of life. The effect of ACP practice preferences The findings from this research indicated a significant positive relationship between ACP practice preference and ACP communication self-efficacy ( P < 0.05), which is similar to the study by Jialu Zhu 28 . ACP practice preference encompasses three dimensions: behavioral attitudes, subjective norms, and perceived behavioral control. It specifically highlights the behaviors of nurses during ACP implementation. The study revealed that clinical nurses who exhibited a strong practice preference were more likely to actively engage in ACP within clinical settings. Furthermore, enhanced normative beliefs and commitment to ACP emerged as critical factors influencing practice preference. Notably, when nurses recognized fewer facilitators or barriers to ACP implementation, their practice preference likewise increased 13 . Merely developing training programs to boost nurses' knowledge, beliefs, and behaviors is inadequate. It is crucial to deepen ICU nurses' comprehension of ACP's importance and to align their behavioral attitudes with real clinical situations. Nursing leaders should employ incentives to motivate nurses to engage in ongoing education and practical application of ACP. They should also encourage active participation in the clinical decision-making process to fortify nursing behaviors. Simultaneously, fostering interdisciplinary collaboration will help integrate ACP principles into clinical practice, allowing nurses to fully understand the significance of ACP. This approach not only enhances adherence to ACP protocols but also improves nurses' ACP communication self-efficacy, ultimately elevating the care quality and patient experience. The effect of work stress load This study identifies work stress load as a significant factor affecting ACP communication self-efficacy ( P < 0.05) among ICU nurses. Increased work stress correlates with decreased self-efficacy in ACP communication. This finding aligns with Cheng's research, as ICU environments are often confined and handle critically ill patients with complex, fluctuating conditions. Nurses in these units frequently face lengthy shifts, demanding higher work quality, efficiency, and enthusiasm compared to other healthcare settings. The high-intensity nature of their roles can lead to oversight of patient needs. Moreover, the pressures faced by ICU nurses can impair their physiological and psychological well-being, contributing to occupational fatigue. This fatigue diminishes their motivation to engage with ACP training alongside clinical responsibilities 29 . In light of the challenging work environment, healthcare managers should establish clear and tailored career objectives for ICU nurses. They should simplify excessive workflows, strategically design training materials, and allocate adequate time for nurses to acquire ACP knowledge. Doing so will enhance learning outcomes and integrate training with clinical duties, ultimately fostering the professional development and communication confidence of nurses. Conclusion This study investigated the current status of ICU nurses' ACP communication self-efficacy level and its influencing factors, and the findings showed that whether or not they had participated in hospice training, ACP knowledge, attitudes, behavioral willingness, ACP practice preference, and work stress load were the influencing factors affecting ICU nurses' ACP communication self-efficacy. Nursing administrators were prompted to develop an educational training program to improve ICU nurses' ACP communication willingness and behavioral competence. Limitation This study used convenience sampling to obtain a sample of ICU nurses in *** hospitals It is recommended that future multicenter studies may be used to expand the study geographic area and sample size to incorporate factors influencing ICU nurses' ACP communication self-efficacy from different aspects. In addition, the results of multiple linear regression were not sufficient to detect all influencing factors due to the heterogeneous distribution of participant characteristics in the sample. Declarations Ethics statements and consent for public ： According to the Declaration of Helsinki, this study was approved by the Ethics Committee of The Second affiliate hospital of Zhengzhou University(KY2024219) and the methods were carried out in accordance with the approved guidelines. All the patients have been informed and siqned informed consent before the experiments. Availability of data and materials ： this manuscript does not report data generation or analysis. Funding declaration ： This study received funding from the National Continuing Education Program (2023-14-01-090) and the Continuing Medicine Project in Henan Province(WJLX2023069). Conflict if interest statement: I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Authorship statement: Authorship statement confirming that all listed authors meet the authorship criteria and that all authors are in agreement with the content of the manuscript. Acknowledge ： I would like to thank my supervisor who helped me with research design and financial support, my research group who is responsible for literature title retrieval, data collection and entry, and the ethics committee of the Second Affiliated Hospital of Zhengzhou University for their ethical support Author Contribution HaoJie Wang : Responsible for the planning and development of the overall research program, with clear direction and focus of the research;Weiqing Zhang : Responsible for quality control. Establish strict quality control standards and processes, and supervise and inspect all aspects of the study;Kun Wang : Focus on literature review. Extensively collect literature in related fields and systematically sort out existing research results to provide a solid theoretical foundation and background information for this study;Jielu Song and Yabing Cao : Mainly responsible for data collection. 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Ann Palliat Med . 2022;11(2):412-422. doi:10.21037/apm-21-2161 Chen Liu-Liu, Yang Liu, Zhao Jun-Yan, et al. Communication training for nursing staff on pre-established health care plans. Journal of Nursing. 2020;35(10):47-50. Van Scoy LJ, Day AG, Howard M, Sudore R, Heyland DK. Adaptation and Preliminary Validation of the Advance Care Planning Engagement Survey for Surrogate Decision Makers. J Pain Symptom Manage . 2019;57(5):980-988.e9. doi:10.1016/j.jpainsymman.2019.01.008 Zhu Jialu, He Haiyan, Mou Shaoyu, Huang Yuxuan, Tang Qing, Yu Xiuli. Evaluation of the Effectiveness of Pre-established Health Care Program Training for Nursing Facility Volunteers. Journal of Nursing. 2022;37(7):76-78, 104. Ry L, Lc B, S S, et al. Association of Physician Orders for Life-Sustaining Treatment With ICU Admission Among Patients Hospitalized Near the End of Life. JAMA . 2020;323(10). doi:10.1001/jama.2019.22523 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5332075","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":372951423,"identity":"ef0199aa-a1ff-4bd0-9f0f-623bb7fc2f13","order_by":0,"name":"HaoJie Wang","email":"","orcid":"","institution":"The Second Clinical Medical School of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"HaoJie","middleName":"","lastName":"Wang","suffix":""},{"id":372951424,"identity":"c3410db7-615d-43c0-ac6f-f6db86f77035","order_by":1,"name":"Weiqing Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYDACCQjFw8AMJBMMbOTY2JsPkKDlQUGaMR/PsQSitIAB44MPhxPnSeQo4NUhP7v52cOvbTYyfMd5D79IMEhLb2PIYWD4UbENpxbGOcfMjWXb0ngkD/OlWQD9ktvGcPYAY8+Z2zi1MEskmElLbjvMY3CYx8wAaEtuG2NfAjNjG24tbBLp34Ba/sO0HE5nY+YxwKuFRyLHTPLjtgMgLcYPgFoS2NgIaJGQyCmTZvyXDPQLjxkwXtIM23jYEg7i84v8jPRtkj/O2NnznT9j/PHHHxt5+fmPDz74UYFbCzgIeEDkAaC/YCIH8KoHAsYfEGXMHwipHAWjYBSMgpEJALT2VMlCb9QmAAAAAElFTkSuQmCC","orcid":"","institution":"The Second Clinical Medical School of Zhengzhou University","correspondingAuthor":true,"prefix":"","firstName":"Weiqing","middleName":"","lastName":"Zhang","suffix":""},{"id":372951425,"identity":"043ba0ff-3593-4a27-a2e6-90c242e8c271","order_by":2,"name":"Kun Wang","email":"","orcid":"","institution":"Nanjing Drum Tower Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kun","middleName":"","lastName":"Wang","suffix":""},{"id":372951426,"identity":"973c6854-e47b-4688-8249-ae6bdb2e51a0","order_by":3,"name":"Jielu Song","email":"","orcid":"","institution":"College of Nursing and Health, Zhengzhou University;","correspondingAuthor":false,"prefix":"","firstName":"Jielu","middleName":"","lastName":"Song","suffix":""},{"id":372951427,"identity":"1aabd138-38ed-4a2c-9e2f-593d73492d46","order_by":4,"name":"Yabing Cao","email":"","orcid":"","institution":"The Second Clinical Medical School of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"Yabing","middleName":"","lastName":"Cao","suffix":""},{"id":372951429,"identity":"3f3a7c65-6662-4977-86a5-00666446ac8a","order_by":5,"name":"ZhiHua Wei","email":"","orcid":"","institution":"The Second Clinical Medical School of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"ZhiHua","middleName":"","lastName":"Wei","suffix":""}],"badges":[],"createdAt":"2024-10-25 11:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5332075/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5332075/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101370894,"identity":"75f5b665-77b4-4afd-b762-603f36ce661c","added_by":"auto","created_at":"2026-01-29 02:54:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1065318,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5332075/v1/2a96f391-0d20-47c3-bc75-c10889314565.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The associations between work stress load, Advance care planning practice preferences and self-efficacy in Intensive care unit nurses","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePatients in the intensive care unit (ICU) are often critically ill and may be in a state of coma or unconsciousness. This condition renders them unable to communicate or make informed decisions about their treatment. Consequently, healthcare teams face significant challenges in making therapeutic choices\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In these situations, family members or designated surrogates assume the responsibility of providing informed consent for the patient's life-sustaining treatments. This can lead to difficult decisions that may conflict with the patient's preferences, presenting dilemmas between treatment options, associated risks and benefits, and balancing the patient's right to life with their right to die with dignity\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Advanced Care Planning (ACP) prioritizes the patient\u0026rsquo;s end-of-life wishes. It enables patients with decision-making capacity to communicate their preferences to family and healthcare professionals, thus guiding the healthcare services they wish to receive\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.Through ACP, patients' wishes are documented in advance, offering guidance to family members during critical decisions. This process preserves the patient's autonomy and significantly enhances their quality of life and dignity.\u003c/p\u003e \u003cp\u003eIn the Intensive Care Unit (ICU), nurses frequently interact with patients and their families. They serve as vital conduits for Advance Care Planning (ACP) communication due to their professional expertise and understanding of patient conditions\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. However, research indicates that ICU nurses often engage in ACP communication infrequently\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. This situation likely correlates with numerous factors, including the high-stress nature of the ICU environment and nurses' limited cognitive understanding of ACP\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. While prior studies have examined nurses' knowledge, beliefs, behaviors, and acceptance of ACP, there remains a significant gap in research focused on nurses' self-efficacy in ACP communication and the factors that may influence it\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGiven the pressing necessity for Advance Care Planning (ACP) in Intensive Care Units (ICUs), this study seeks to investigate the current state of ACP communication self-efficacy among ICU nurses. It will delve into the factors that influence this self-efficacy in detail. This research will provide a critical framework for nursing administrators to devise targeted training programs and management strategies. By encouraging nurses to engage more proactively in ACP communication, they will better address the needs of patients and their families. This approach will safeguard patients' rights to life and dignity while enhancing the overall quality of healthcare in critical care environments.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eThe aim of this study was to evaluate the current ACP communication self-efficacy among ICU nurses. It sought to identify the factors influencing their communication skills. Additionally, it aimed to offer a crucial foundation for nursing leaders to design targeted training programs and management strategies. This will enhance ICU nurses' self-efficacy and engagement in ACP communication.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003e We conducted a cross-sectional study involving ICU nurses from six tertiary care hospitals, each with over 2,000 beds. This study evaluated self-efficacy levels in ACP communication and examined pertinent factors. We employed a questionnaire that addressed general demographic traits, developed by our research team based on a literature review. Furthermore, we included the ACP knowledge-attitude-practice questionnaire, the ACP communication self-efficacy scale, the Advance Care Planning Practice Preference Scale, and the Stress Overload Scale. The preliminary study received approval from the Ethics Committee of *** (KY2024049), and all participants provided informed consent.\u003c/p\u003e\n\u003ch3\u003eSample and setting\u003c/h3\u003e\n\u003cp\u003eA cross-sectional survey of ICU nurses in a convenience sample of six tertiary-level hospitals in ***Province was conducted from January 2024 to April 2024.Inclusion criteria: (1) obtaining the professional qualification certificate for nurses and completing the standardized nurse training; (2)\u0026thinsp;\u0026ge;\u0026thinsp;1 year of working hours in ICU nursing; and (3) providing informed consent and voluntary participation. Exclusion criteria: regulation training, internship, apprenticeship, and further training of nurses. According to the sample size calculation method of the current investigation, the sample size was estimated to be 10\u0026ndash;20 times the independent variable\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, fifteen potential influencing factors were included in this study, and the sample size was determined to be 188\u0026thinsp;~\u0026thinsp;375 cases by considering the 20% non-response rate.\u003c/p\u003e\n\u003ch3\u003equestionnaire of general characteristics\u003c/h3\u003e\n\u003cp\u003eBased on the literature review, the research team developed the questionnaire. We gathered the general characteristics of participants. There were nine entries, including age, gender, religion, ICU experience, education level, marital status, job title, specialty nursing status, and involvement in hospice training, which included caring for deceased patients.\u003c/p\u003e\n\u003ch3\u003eACP communication self-efficacy scale\u003c/h3\u003e\n\u003cp\u003eThe scale was developed by Baughman\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e et al and cross-culturally adapted by domestic scholars Yang Zhen\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003eet al to assess nurses' confidence in ACP communication. According to nurse-led practices, the scale comprises three dimensions: preference discussion and assessment, information guidance and disclosure, and content assessment and determination, including 16 items in total. It employs a Likert scale, with scores ranging from 1 (very unconfident) to 5 (very confident). Notably, items 1, 6, and 14 are reverse scored. The overall score varies from 16 to 80, wherein higher scores signify greater confidence among nurses in engaging patients about ACP. The original scale underwent cross-cultural adaptation and was first utilized in Argentina and Spain, demonstrating strong internal consistency with Cronbach's α values of 0.89 and 0.95, respectively\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAdvanced Care Planning Knowledge-Attitude-Practice questionnaire\u003c/h2\u003e \u003cp\u003eThe scale, developed by Douzi Ding\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, comprises three dimensions: ACP knowledge (12 items), attitude (13 items), and behavioral willingness (8 items), totaling 33 items. The cognitive dimension consists of judgmental questions, where a \"correct\" response earns 1 point, while \"incorrect\" and \"unsure\" yield 0 points. The attitude dimension utilizes a 5-point Likert scale (0\u0026thinsp;=\u0026thinsp;strongly disagree, 4\u0026thinsp;=\u0026thinsp;strongly agree), and the behavioral willingness dimension also follows this scale (0\u0026thinsp;=\u0026thinsp;strongly unwilling, 4\u0026thinsp;=\u0026thinsp;strongly willing). The maximum possible score is 96 points; higher scores indicate greater ACP knowledge and belief levels. The Cronbach's α coefficients for each dimension were 0.782, 0.907, and 0.896, respectively, while the overall Cronbach's α for the questionnaire was 0.922.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAdvance Care Planning Practice Preference scale\u003c/h3\u003e\n\u003cp\u003eCompiled by Yang Zhen\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, this scale evaluates nurses' preferences regarding Advance Care Planning (ACP) practices. It encompasses three dimensions: behavioral attitudes (9 items), subjective norms (7 items), and perceived behavioral control (8 items), totaling 24 items. the 5-point Likert scale (Strongly Disagree, Disagree, Fairly Agree, Agree, and Strongly Agree) rates responses from 1 to 5, with a maximum score of 120. A higher score indicates a greater inclination to engage in ACP behavior. The Cronbach's α coefficient for this scale in the study was 0.746.\u003c/p\u003e\n\u003ch3\u003eStress Overload Scale\u003c/h3\u003e\n\u003cp\u003eDeveloped by Amirkhan\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, with Chinese translation by Suzy\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003eet al., this instrument comprises two dimensions: event load and individual vulnerability, featuring a total of 22 items. It employs a 5-point Likert scale, with responses ranging from 1 to 5, signifying \"never\" to \"always.\" A higher score indicates increased stress levels among nurses. The Cronbach's α coefficient stood at 0.940 and Ning Bin et al\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e study showed that the Cronbach's α coefficient is 0.936 of the scale .\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe tutor is tasked with reaching out to the nursing departments of various hospitals to aid in the survey. This research utilizes the online platform \"Questionnaire Star.\" Respondents filled out the questionnaire anonymously. The homepage outlined the survey's purpose, significance, and instructions for completion. Each micro-signal could submit the questionnaire only once. In total, 345 questionnaires were collected. After excluding invalid samples with response times under three minutes or inconsistent answers, the study yielded 330 valid samples, resulting in an effective rate of 95.65%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSPSS 26.0 software facilitated data analysis. For count data, researchers presented statistical descriptions using frequency and composition ratios. They described measurement data through mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. To compare groups, they employed independent samples t-tests or one-way ANOVA. Pearson correlation analysis examined variable correlations. Additionally, multivariate stepwise regression analysis identified factors influencing ACP communication self-efficacy. The significance level was set at \u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05, considering \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eThis study included 330 ICU nurses, of which 30 (9.1%) were male and 300 (90.9%) were female, with an average age (30.38\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86). General data information and univariate analysis are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant characteristics and univariate analysis results(N\u0026thinsp;=\u0026thinsp;330)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003estatistical\u003c/p\u003e \u003cp\u003e(\u003cem\u003et/F\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64(19.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026thinsp;~\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e43.71\u0026thinsp;\u0026plusmn;\u0026thinsp;8.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126(38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026thinsp;~\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e44.69\u0026thinsp;\u0026plusmn;\u0026thinsp;9.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122(36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e45.77\u0026thinsp;\u0026plusmn;\u0026thinsp;6.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e46.93\u0026thinsp;\u0026plusmn;\u0026thinsp;12.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30(9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFem\u003cb\u003eal\u003c/b\u003ee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e43.59\u0026thinsp;\u0026plusmn;\u0026thinsp;7.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e300(90.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligious beliefs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e43.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e322(97.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e47.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of ICU experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026thinsp;~\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182(55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026thinsp;~\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e46.47\u0026thinsp;\u0026plusmn;\u0026thinsp;7.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68(20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e44.825\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80(24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialized and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e38.87\u0026thinsp;\u0026plusmn;\u0026thinsp;8.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76(23.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eundergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e44.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228(69.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e54.15\u0026thinsp;\u0026plusmn;\u0026thinsp;10.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarrital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e43.05\u0026thinsp;\u0026plusmn;\u0026thinsp;8.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e146(44.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e44.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e184(55.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePosition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e43.04\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114(34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse Practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e44.24\u0026thinsp;\u0026plusmn;\u0026thinsp;9.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84(25.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse Practitioner in Charge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e44.65\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126(38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate Nurse Practitioner and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e39.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNurse specialist\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e45.24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e168(50.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162(49.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttended hospice training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e47.52\u0026thinsp;\u0026plusmn;\u0026thinsp;9.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214(64.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e41.93\u0026thinsp;\u0026plusmn;\u0026thinsp;6.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116(35.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eScale and dimension scores\u003c/h2\u003e \u003cp\u003eThe total ACP communication self-efficacy score for ICU nurses in this study was (43.90\u0026thinsp;\u0026plusmn;\u0026thinsp;8.264), and the rest of the scale dimensions scores, along with the average scores of the items are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScale and dimension scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eItem score average\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;~\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e7.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;~\u0026thinsp;52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e33.77\u0026thinsp;\u0026plusmn;\u0026thinsp;7.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehavioral intention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;~\u0026thinsp;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACP knowledge,attitude and practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026thinsp;~\u0026thinsp;96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e63.64\u0026thinsp;\u0026plusmn;\u0026thinsp;10.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreference discussion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026thinsp;~\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026thinsp;~\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContent assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026thinsp;~\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACP self-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u0026thinsp;~\u0026thinsp;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e43.90\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACP practice preferences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u0026thinsp;~\u0026thinsp;110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e91.72\u0026thinsp;\u0026plusmn;\u0026thinsp;12.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress overload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u0026thinsp;~\u0026thinsp;110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e73.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation analysis\u003c/h2\u003e \u003cp\u003eThe results of the Pearson correlation analysis between ACP communication self-efficacy, the ACP knowledge-attitude-practice questionnaire, practice preferences, and work stress overload are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe results of pearson correlation of ACP self-efficacy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBehavioral intention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eACP knowledge-\u003c/p\u003e \u003cp\u003eattitude-practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStress overload\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStress overload\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreference discussion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.446**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.487**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.377**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.654**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.547**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.724**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.455**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.542**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.467**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.679**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.602**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.793**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContent assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.440**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.495**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.488**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.643**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.600**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.753**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACP self-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.491**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.558**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.487**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.724**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.640**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.831**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eMultiple regression analysis of ACP communication self-efficacy\u003c/h2\u003e \u003cp\u003eUsing ACP communication self-efficacy as the dependent variable, the analysis identified nine significant factors: years of work experience, education level, marital status, participation in ACP training, ACP knowledge, ACP attitude, willingness to engage in ACP behaviors, preference for ACP practices, and work stress load. The multicollinearity diagnosis indicated that each model maintained a tolerance level between 0.496 and 0.880, with a variance inflation factor ranging from 1.137 to 2.018, confirming the absence of multicollinearity. The findings revealed that marital status, participation in relevant training, ACP knowledge, ACP attitude, intention to engage in ACP, preference for ACP practices, and stress overload significantly influenced ACP communication self-efficacy among ICU nurses, collectively explaining 79.1% of the total variance, as outlined in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e..\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression analysis of factors influencing ACP communication self-efficacy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.536\u0026thinsp;~\u0026thinsp;13.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-1.741~-0.352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttended hospice training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.934\u0026thinsp;~\u0026thinsp;3.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eknowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.081\u0026thinsp;~\u0026thinsp;3.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.124\u0026thinsp;~\u0026thinsp;0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehavioral Intentions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.004\u0026thinsp;~\u0026thinsp;0.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice Preferences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.388\u0026thinsp;~\u0026thinsp;0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress overload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-10.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-0.222~-0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eThe effect of general demographic information\u003c/h2\u003e \u003cp\u003eThe results indicate that marital status and completion of palliative care training influence ICU nurses' self-efficacy in advance care planning communication (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Unmarried nurses tend to have higher self-efficacy in this regard, likely due to their focus on personal development and enhancement of professional skills, alongside fewer responsibilities at home, allowing them more time and enthusiasm to participate in advance care planning training and practice communication skills. Conversely, married nurses benefit from emotional support within their families. They may prioritize familial bonds, which, coupled with empathetic considerations, leads them to avoid end-of-life conversations with patients or families to alleviate emotional stress or burden\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. In this study, 64.8% of ICU nurses had participated in palliative care training. Such training can enhance healthcare providers' capabilities to alleviate patient suffering by providing comfort-focused care, bolstering communication with patients and their families, and meeting patient needs to offer more human-centered care. Scholar Parekh\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e developed a simulated ACP training dialogue, which improved self-efficacy in ACP communication. The essence of ACP comprises the communication process with patients and families. Training allows for in-depth learning of related theoretical knowledge, methods, and techniques, and mastering effective communication strategies\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Therefore, it is essential to develop a systematic ACP training program and implement comprehensive, multi-faceted, and specific training measures to enhance ICU nurses' ability to apply ACP in their departments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eInfluence of ACP knowledge-attitude-practice\u003c/h2\u003e \u003cp\u003eThe findings of this study indicated that ICU nurses' knowledge, attitudes, and behaviors regarding Advanced Care Planning (ACP) significantly impacted their self-efficacy in ACP communication, showing a strong positive correlation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This study aligns with Hsieh's\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, in which ACP knowledge, attitudes, and behavioral willingness were all influential factors of ACP communication self-efficacy. At the knowledge level, a comprehensive understanding of ACP concepts, processes, purposes, and significances underpins effective ACP\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Regarding attitudes, a proactive outlook boosts ICU nurses\u0026rsquo; initiative in ACP discussions. Nurses with a favorable attitude toward ACP tend to actively engage in opening dialogues, maintain positivity during challenging discussions, and continually refine their communication strategies. Behavioral willingness reflects nurses' propensity to transform their knowledge and attitudes into actionable steps. ICU nurses demonstrating higher behavioral readiness often recognize patients' needs during clinical care, facilitate ACP conversations, and regularly practice their communication skills, thereby enhancing their self-efficacy in ACP-related dialogues. Liuliu Chen\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e advocated for enhancing nurses' ACP communication abilities through training in ACP knowledge, attitudes, and practical skills. Given the critical illnesses and fluctuating conditions of ICU patients, nursing leaders and educational experts should create comprehensive training programs that provide systematic instruction on the unique needs of ICU patients\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Such training should encompass essential critical care competencies, clinical decision support, patient and family communication strategies, and psychosocial support. This approach ensures ICU nurses acquire vital ACP-related knowledge and skills, and encourages their involvement in guiding patients and families through the ACP process, thereby improving the quality of care at the end of life.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eThe effect of ACP practice preferences\u003c/h2\u003e \u003cp\u003eThe findings from this research indicated a significant positive relationship between ACP practice preference and ACP communication self-efficacy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), which is similar to the study by Jialu Zhu\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. ACP practice preference encompasses three dimensions: behavioral attitudes, subjective norms, and perceived behavioral control. It specifically highlights the behaviors of nurses during ACP implementation. The study revealed that clinical nurses who exhibited a strong practice preference were more likely to actively engage in ACP within clinical settings. Furthermore, enhanced normative beliefs and commitment to ACP emerged as critical factors influencing practice preference. Notably, when nurses recognized fewer facilitators or barriers to ACP implementation, their practice preference likewise increased\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Merely developing training programs to boost nurses' knowledge, beliefs, and behaviors is inadequate. It is crucial to deepen ICU nurses' comprehension of ACP's importance and to align their behavioral attitudes with real clinical situations. Nursing leaders should employ incentives to motivate nurses to engage in ongoing education and practical application of ACP. They should also encourage active participation in the clinical decision-making process to fortify nursing behaviors. Simultaneously, fostering interdisciplinary collaboration will help integrate ACP principles into clinical practice, allowing nurses to fully understand the significance of ACP. This approach not only enhances adherence to ACP protocols but also improves nurses' ACP communication self-efficacy, ultimately elevating the care quality and patient experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eThe effect of work stress load\u003c/h2\u003e \u003cp\u003eThis study identifies work stress load as a significant factor affecting ACP communication self-efficacy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) among ICU nurses. Increased work stress correlates with decreased self-efficacy in ACP communication. This finding aligns with Cheng's research, as ICU environments are often confined and handle critically ill patients with complex, fluctuating conditions. Nurses in these units frequently face lengthy shifts, demanding higher work quality, efficiency, and enthusiasm compared to other healthcare settings. The high-intensity nature of their roles can lead to oversight of patient needs. Moreover, the pressures faced by ICU nurses can impair their physiological and psychological well-being, contributing to occupational fatigue. This fatigue diminishes their motivation to engage with ACP training alongside clinical responsibilities\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. In light of the challenging work environment, healthcare managers should establish clear and tailored career objectives for ICU nurses. They should simplify excessive workflows, strategically design training materials, and allocate adequate time for nurses to acquire ACP knowledge. Doing so will enhance learning outcomes and integrate training with clinical duties, ultimately fostering the professional development and communication confidence of nurses.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study investigated the current status of ICU nurses' ACP communication self-efficacy level and its influencing factors, and the findings showed that whether or not they had participated in hospice training, ACP knowledge, attitudes, behavioral willingness, ACP practice preference, and work stress load were the influencing factors affecting ICU nurses' ACP communication self-efficacy. Nursing administrators were prompted to develop an educational training program to improve ICU nurses' ACP communication willingness and behavioral competence.\u003c/p\u003e\n\u003ch1\u003eLimitation\u003c/h1\u003e\n\u003cp\u003eThis study used convenience sampling to obtain a sample of ICU nurses in *** hospitals It is recommended that future multicenter studies may be used to expand the study geographic area and sample size to incorporate factors influencing ICU nurses' ACP communication self-efficacy from different aspects. In addition, the results of multiple linear regression were not sufficient to detect all influencing factors due to the heterogeneous distribution of participant characteristics in the sample.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics statements and consent for public\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the Declaration of Helsinki, this study was approved by the Ethics Committee of The Second affiliate hospital of Zhengzhou University(KY2024219) and the methods were carried out in accordance with the approved guidelines. All the patients have been informed and siqned informed consent before the experiments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ethis manuscript does not report data generation or analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received funding from the National Continuing Education Program (2023-14-01-090) and the Continuing Medicine Project in Henan Province(WJLX2023069).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict if interest statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthorship statement confirming that all listed authors meet the authorship criteria and that all authors are in agreement with the content of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledge\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to thank my supervisor who helped me with research design and financial support, my research group who is responsible for literature title retrieval, data collection and entry, and the ethics committee of the Second Affiliated Hospital of Zhengzhou University for their ethical support\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHaoJie Wang : Responsible for the planning and development of the overall research program, with clear direction and focus of the research;Weiqing Zhang : Responsible for quality control. Establish strict quality control standards and processes, and supervise and inspect all aspects of the study;Kun Wang : Focus on literature review. Extensively collect literature in related fields and systematically sort out existing research results to provide a solid theoretical foundation and background information for this study;Jielu Song and Yabing Cao : Mainly responsible for data collection. Design scientific and reasonable data collection toolsZhihua Wei : Communicate and coordinate positively and effectively with all parties involved in the study, including research subjects, cooperative units, etc.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCruz Carreras MT, Nortj\u0026eacute; N, Thompson E, et al. 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Spanish Cross-Cultural Adaptation and Psychometric Properties of the Advance Care Planning Self-Efficacy: A Cross-Sectional Study. \u003cem\u003eJ Palliat Med\u003c/em\u003e. 2021;24(12):1807-1815. doi:10.1089/jpm.2020.0653\u003c/li\u003e\n\u003cli\u003eDi Gennaro S, Fila J, Veloso V, Lasmar\u0026iacute;as C, Tripodoro VA, GRUPO PCA-ARGENTINA Y RED-IN-PAL (PALLIUM LATINOAM\u0026Eacute;RICA). [Perceived self-efficacy scale on shared care planning (ACP-SEs) Argentina]. \u003cem\u003eMedicina (B Aires)\u003c/em\u003e. 2024;84(4):619-628.\u003c/li\u003e\n\u003cli\u003eDodzi Ding. Research on the Effectiveness of Medical Students\u0026apos; Training in Pre-established Health Care Programs. Master\u0026apos;s thesis. Zunyi Medical University; 2020. doi:10.27680/d.cnki.gzyyc.2020.000373.\u003c/li\u003e\n\u003cli\u003eYang Z, Wang H, Wang A. 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Contemporary Nurses (in Chinese). 2024;31(8):148-151. doi:10.19792/j.cnki.1006-6411.2024.23.036.\u003c/li\u003e\n\u003cli\u003eWang F, Zhang JL, Liang Y, et al. A study of the impact of nurses\u0026apos; empathy on their sense of professional respect. Journal of Nursing Management. 2023;23(9):722-726.\u003c/li\u003e\n\u003cli\u003eParekh de Campos A, Polifroni EC. Development of a Standardized Simulation: Advance Care Planning Conversations for Nurses. \u003cem\u003eNurs Res\u003c/em\u003e. 2023;72(1):74-80. doi:10.1097/NNR.0000000000000625\u003c/li\u003e\n\u003cli\u003eA H, M H, D G, et al. Advance care planning conversations in primary care: a quality improvement project using the Serious Illness Care Program. \u003cem\u003eBMC palliative care\u003c/em\u003e. 2021;20(1). doi:10.1186/s12904-021-00817-z\u003c/li\u003e\n\u003cli\u003eCc H, Hp H, Th T, Ic C, Rd B, Sw J. The exploration of the knowledge, attitudes and practice behaviors of advanced care planning and its related predictors among Taiwanese nurses. \u003cem\u003eBMC palliative care\u003c/em\u003e. 2019;18(1). doi:10.1186/s12904-019-0483-9\u003c/li\u003e\n\u003cli\u003eOkada H, Kiuchi T, Okuhara T, Kizawa Y. Effect of advance care planning discussions with trained nurses in older adults with chronic diseases in Japan. \u003cem\u003eAnn Palliat Med\u003c/em\u003e. 2022;11(2):412-422. doi:10.21037/apm-21-2161\u003c/li\u003e\n\u003cli\u003eChen Liu-Liu, Yang Liu, Zhao Jun-Yan, et al. Communication training for nursing staff on pre-established health care plans. Journal of Nursing. 2020;35(10):47-50.\u003c/li\u003e\n\u003cli\u003eVan Scoy LJ, Day AG, Howard M, Sudore R, Heyland DK. Adaptation and Preliminary Validation of the Advance Care Planning Engagement Survey for Surrogate Decision Makers. \u003cem\u003eJ Pain Symptom Manage\u003c/em\u003e. 2019;57(5):980-988.e9. doi:10.1016/j.jpainsymman.2019.01.008\u003c/li\u003e\n\u003cli\u003eZhu Jialu, He Haiyan, Mou Shaoyu, Huang Yuxuan, Tang Qing, Yu Xiuli. Evaluation of the Effectiveness of Pre-established Health Care Program Training for Nursing Facility Volunteers. Journal of Nursing. 2022;37(7):76-78, 104.\u003c/li\u003e\n\u003cli\u003eRy L, Lc B, S S, et al. Association of Physician Orders for Life-Sustaining Treatment With ICU Admission Among Patients Hospitalized Near the End of Life. \u003cem\u003eJAMA\u003c/em\u003e. 2020;323(10). doi:10.1001/jama.2019.22523\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intensive Care Unit, Nurse, Advanced Care Planning, Self-Efficacy, Influencing, practice preferences","lastPublishedDoi":"10.21203/rs.3.rs-5332075/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5332075/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eGiven that Intensive care unit (ICU) patients are mostly in critical condition, unable to participate in decision-making communication, family members are prone to make medical care decisions against the patient's wishes, to safeguard the patient's right to autonomous decision-making. ICU nurses serve as vital conduits for Advance Care Planning (ACP) communication due to their professional expertise and understanding of patient conditions. However, they carry out the incidence of ACP is relatively low, the present study to investigate the communication self-efficacy level of advanced care planning (ACP) among ICU nurses in a tertiary care hospital and the factors affecting it, and to provide a reference for developing an intervention program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eFrom January 2024 to April 2024, 330 ICU nurses from six tertiary hospitals in *** Province were conveniently selected for the survey and analysis using the General Information Questionnaire, ACP Knowledge, Belief and Conduct Questionnaire, ACP Practice Preferences Scale, Work Stress Load Scale, and ACP Self-Efficacy Scale (Chinese version).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eICU nurses' ACP self-efficacy score (44.42±9.14), Pearson's analysis of the correlation between variables, and multiple linear regression to analyze the main influencing factors of ICU nurses' ACP communication self-efficacy showed that marital status, participation in hospice training, ACP knowledge-attitude-behavioral willingness, ACP practice preference, and work stress load \u003cem\u003eP\u003c/em\u003e \u0026lt;0.05,explaining 79.1% of the total variance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion：\u003c/strong\u003eICU nurses' ACP communication self-efficacy is at a moderate level with many influencing factors, and it is recommended to implement interventions for the influencing factors to improve the level of ICU nurses' ACP communication self-efficacy.\u003c/p\u003e","manuscriptTitle":"The associations between work stress load, Advance care planning practice preferences and self-efficacy in Intensive care unit nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-06 13:22:06","doi":"10.21203/rs.3.rs-5332075/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3bd749a1-6832-44f3-965d-389a9b331f1e","owner":[],"postedDate":"November 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-29T02:54:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-06 13:22:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5332075","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5332075","identity":"rs-5332075","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}