Journal List > J Korean Acad Nurs Adm > v.25(4) > 1134995

Lee, Ha, and Yun: Nursing Students' Knowledge, Attitudes to Advance Medical Directives and Ethics Values



The purpose of this study was to identify the relationships among nursing students' knowledge, attitudes to advance medical directives and ethics values.


The study was a cross-sectional and descriptive survey, carried out with 232 students from two schools of nursing, one located in B and C city. Student nurses' knowledge, attitudes for advance medical directives and ethics values were measured using structured self-report questionnaires. Data were analyzed using t-test or one-way ANOVA, and Pearson correlation coefficients.


The scores for knowledge, attitudes for medical advance directives were 7.18 and 3.07, and for ethics values, 3.47. Nursing students' knowledge and attitude showed a significant difference depending on grade. Nursing students' ethics values showed significant differences depending on whether a study on ethics had been completed. A positive correlation was observed between nursing students' knowledge, attitudes for advance medical directives and ethics values.


The results of this study indicate that basic data for the development of an effective education program on ethics is important in establishing a positive attitude toward advance medical directives and the appropriate ethical values in student nurses.

Figures and Tables

Table 1

Level of Knowledge, Attitudes, and Ethical Values on Advance Medical Directives (N=232)

Table 2

Knowledge Level on Advance Medical Directives (N=232)

Table 3

Attitude Level on Advance Medical Directives (N=232)

Table 4

Knowledge, Attitude, and Ethical Values according to Demographic Characteristics (N=232)


*Scheffé test.

Table 5

Correlations between Ethical Values and Main Independent Variables (N=232)



1. Lee YG. Advanced directive. Legal Studies (Hanyang University, Institute for Legal Studies). 2017; 34(4):293–318. DOI: 10.18018/HYLR.2017.34.4.293.
2. Hong YS, Lee DI. Moral reflexion in hospice-centring on advance medical directive. The Korean Journal of Hospice and Palliative Care. 2008; 11(2):73–77.
3. Ministry of Education (KR). Act on decisions on life-sustaining treatment for patients in hospice and palliative care or at the end of life. Act No. 14013. 2016. 02. 03. Retrieved October 19, 2018. from:
4. Jezewski MA, Brown JK, Yow-Wu BW, Meeker MA. Oncology nurses' knowledge, attitudes, and experiences regarding advance directives. Oncology Nursing Forum. 2005; 32(2):319–327. DOI: 10.1188/04.Onf.319-327.
5. Moon SJ. Potential conflicts between death with dignity and patients' self-determination right. Lawyers Association Journal. 2009; 58(6):5–44. DOI: 10.17007/klaj.2009.58.6.001001001.
6. Kim MH, Kang EH, Kim MY. Family decision-making to withdraw life-sustaining treatment for terminally-ill patients in an unconscious state. Korean Journal of Hospice and Palliative Care. 2012; 15(3):147–154.
7. Yeun EJ, Hong YP, An JH. Attitudes toward life sustaining treatment (LST) of health professionals and general public: a co-orientational look. Journal of Korea Society for Wellness. 2016; 11(1):1–14. DOI: 10.21097/ksw.2016.
8. Kim HJ. Nurses' knowledge, attitudes, experiences, and confidence toward advance directives [master's thesis]. Busan: Pusan National University;2015.
9. Park JA, Jung DY. The comparing perception of advance directives in one general hospital doctors and nurses. Health & Nursing. 2013; 25(2):25–33.
10. Flannery L, Ramjan LM, Peters K. End-of-life decisions in the Intensive Care Unit (ICU) - Exploring the experiences of ICU nurses and doctors - a critical literature review. Australian Critical Care. 2016; 29(2):97–103. DOI: 10.1016/j.aucc.2015.07.004.
11. George TP, DeCristofaro C, Murphy PF, Remle CR. Knowledge, attitudes, and experience with advance directives among prelicensure nursing students. Journal of Nursing Education. 2018; 57(1):35–39. DOI: 10.3928/01484834-20180102-07.
12. Scherer Y, Jezewski MA, Graves B, Wu YW, Bu X. Advance directives and end-of-life decision making: survey of critical care nurses' knowledge, attitude, and experience. Critical Care Nurse. 2006; 26(4):30–40.
13. Jo KH, Kim YJ, Sohn KC. Types of perception toward endof-life medical decision-making of clinical nurses: Q-methodological approach. Korean Journal of Hospice and Palliative Care. 2012; 15(1):18–29.
14. Kim MY, Kim KS. Korean nurses' attitude towards advance directives and end of life decision making. Journal of Korean Critical Care Nursing. 2010; 3(2):77–90.
15. Jung SY, Lee HJ, Lee SH. Characteristics of end of life sustaining treatment and attitudes towards advance directives among geriatric patients. Journal of East-West Nursing Research. 2014; 20(2):103–111. DOI: 10.14370/jewnr.2014.20.2.103.
16. Kim HK, Nam E, Lee KE, Lee SN. Awareness and attitude change after end-of-life care education for medical students. Korean Journal of Hospice and Palliative care. 2012; 15(1):30–35.
17. Kim JG, Yoo JH, Cheon EY. Relationship among Incivility, burnout, coping and satisfaction to clinical practice experienced by nursing college students in clinical practice. Journal of the Korea Academia-Industrial cooperation Society. 2017; 18(1):316–324.
18. Kwon KE, Yoo MS. Biomedical ethics awareness and attitudes toward dignified death and advance directives among nursing students. Journal of Korean Academic Society of Home Health Care Nursing. 2018; 25(3):204–214. DOI: 10.22705/jkashcn.2018.25.3.204.
19. Kwon Ih. Comparison on awareness of good death and knowledge and attitude of advance directives of nursing students and non-nursing students in universities [master's thesis]. Busan: Kosin University;2018.
20. Kim YJ, Lee MN. Attitude on nursing ethical values and on brain death organ donation of hospital nurses. Journal of the Korea Contents Association. 2011; 11(10):312–323. DOI: 10.5392/JKCA.2011.11.10.312.
21. Lee YS. A study of the ethical values of Korean nurses. Journal of Nurses Academic Society. 1990; 20(2):249–270. DOI: 10.4040/jnas.1990.20.2.249.
22. Koo OH, Ryu YM. The Influence of Ethical Values and Ethical Sensitivity on Character of Nursing Students. Journal of Digital Convergence. 2018; 16(9):219–228. DOI: 10.14400/JDC.2018.16.9.219.
23. Oh Y, Gastmans C. Moral distress experienced by nurses: a quantitative literature review. Nursing Ethics. 2015; 22(1):15–31. DOI: 10.1177/0969733013502803.
24. Hong SW, Kim SM. Knowledge regarding advance directives among community-dwelling elderly. Journal of Korean Academic Society of Nursing Education. 2013; 19(3):330–340. DOI: 10.5977/jkasne.2013.19.3.330.
25. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, N.J.: L. Erlbaum Associates;1988. p. 1–18.
26. Eom IH. Affecting factors on nursing performance of clinical nurses: with focus on ethical values and organization culture [master's thesis]. Seoul: Korea University;2014.
27. Kwon YM. A study on moral judgement and ethical values of nursing students. Journal of Korean Academic Society of Nursing Education. 2002; 8(1):17–28.
28. Skela-Savič B, Kiger A. Self-assessment of clinical nurse mentors as dimensions of professional development and the capability of developing ethical values at nursing students: A correlational research study. Nurse Education Today. 2015; 35(10):1044–1051. DOI: 10.1016/j.nedt.2015.04.003.
29. Um YR, Kang SY, Noh WJ. Changing to positive ethics in hospital nurses through ‘theatre of situations’. Journal of Korean Clinical Nursing Research. 2012; 18(1):1–12.
30. Lee SH, Kim SY, Kim JA. Ethical value of nursing students. Journal of Korean Academy of Nursing Administration. 2007; 13(2):145–155.

Hyun-Ju Lee

Jungmi Yun

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