背　景 提昇末期照護品質是國際潮流所關切之議題，預立醫囑即以尊重病人自主及重視末期生活品質為主要考量，而在推動預立醫囑的過程，護理人員扮演著獨特且重要的角色。
目　的 探討護理人員預立醫囑知識、態度、經驗與自信及其影響因素。
方　法 採描述相關性研究設計，選取南部某區域醫院護理人員為研究對象，共收案545位。研究工具包含基本屬性及預立醫囑知識、態度、經驗與自信之問卷。所得資料以SPSS13.0軟體建檔，並以描述性及推論性統計如t檢定、單因子變異數分析及皮爾森積差相關進行。
結　果 預立醫囑知識以簽署文件形式最為缺乏；態度偏向正向；實務經驗偏低；對熟悉預立醫囑法律最無自信。年紀大、年資深、曾與他人討論臨終決策者之預立醫囑知識得分較高，教育程度為大學以上及曾與他人討論臨終決策者之態度較正向，內科與加護單位護理人員、自身已簽署預立醫囑及曾與他人討論臨終決策者有較多的預立醫囑推行經驗與自信，且男性護理人員推行預立醫囑自信高於女性護理人員。而知識與態度、經驗及自信皆呈正相關，態度、經驗與自信亦呈正相關。
結　論 研究結果顯示護理人員預立醫囑知識及經驗仍相當不足，對預立醫囑法律最不熟悉而缺乏信心，建議能依不足處規劃在職教育內容，除提升護理人員正確認知，引領其重視末期照護議題，進而能有效落實預立醫囑的推動。

Background: Improving patient end of life quality is a high profle issue worldwide. Advance directives (ADs) are one way to respect patient autonomy and help ensure end of life quality. In the process of decision making, nurses play a unique and vital role in encouraging patients to complete ADs.
Purpose: The purpose of this study was to explore the knowledge, attitudes, practices, and confdence of nurses in discussing ADs with patients and to identify key factors infuencing the effectiveness of such.
Methods: This was a descriptive-correlational research that targeted 545 nurses working in a regional hospital in southern Taiwan. Structured questionnaires gathered basic demographic data and surveyed knowledge, attitudes, prac-tices, and confdence with regard to advance directives. Data were managed using SPSS 13.0 software and analysed
with descriptive and deductive statistics such as the independent t test, one-way ANOVA and Pearson correlation.
Results: Nurses were relatively less knowledgeable about the various types of ADs, held positive attitudes toward ADs, had less AD practices, and lacked confdence with regard to current regulations related to ADs. Older and se-nior nursing staff, as well as those who had previously discussed end of life care decisions with others, had relatively greater knowledge. Higher education level (college degree or above) and previous experience discussing end of life
care decisions with others were found to be factors positively infuencing attitudes toward ADs. Medical and intensive care unit nurses, nurses who had completed their own ADs, and nurses who had previously discussed end of life care decisions with others had relatively more practices and greater confdence. Confdence was also highly infuenced by gender. Knowledge and attitudes were found to correlate positively with both practices and confdence. Attitudes, prac-tices and confdence were also positively correlated.
Conclusions: Findings showed that nurses had insuffcient knowledge, inadequate practices and lacked confdence regarding AD regulations. Such indicates the need for institutions to plan and provide relevant educational program-ming to provide appropriate knowledge, encourage nurses to value end of life issues and enhance AD facilitation ef-fectiveness.