关键词: 预立医疗照护计划；晚期照顾；护士角色；治疗决定

Abstract: This paper reports the findings of focus study interviews that explores the experiences of trained nurses in the implementation of ACP. It was a process evaluation of a study that promotes ACP in hospital setting. The ACP programme in this study was developed with reference to the relevant cultural issues in the Chinese community and the format of the Serious Illness Conversation Guide. The nurses as study informants identified the exceptional roles of nurses in advocacy and communication throughout the ACP process, yet the promotion of ACP requires support at the level of macro-environment. Three themes in relation to the support needed emerged from their sharing, namely life and death education in the community, fundamental training for health care providers, as well as support and recognition from organization and management.

Key words: Advance Care Planning; end-of-life care; nurses' role; treatment decision