Metas de Enfermería

Metas de Enfermería

SEPTIEMBRE 2013 N° 7 Volumen 16

The right to the Advance Directive Statement and Prior Instructions. Knowledge and professional competence

Section: Ethics and Society

How to quote

Arbe Ochandiano MM, Calvo Sánchez MD. El derecho a la Declaración Anticipada de Voluntades e Instrucciones Previas. Conocimiento y competencia profesional. Metas Enferm 2013; (7):56-62.


1Mª Milagros Arbe Ochandiano, 1Mª Dolores Calvo Sánchez


1Enfermera, doctora y profesora de la Universidad de Salamanca.

Contact address

María Dolores Calvo Sánchez. Universidad de Salamanca. Escuela Universitaria de Enfermería y Fisioterapia. C/ Donantes de Sangre, s/n. 37007 Salamanca

Contact email: mdcalvo@usal.es


Objective: to determine the knowledge by nursing professionals about the Prior Instructions (PI) document; to identify the access to documents in the formal PI registry existing in the Comunidad Autónoma de Castilla y León (CyL), Spain; to understand the perception by professionals about nursing competence regarding said document, and whether they are acting with complete technical and scientific autonomy according to current legislation.

Method: transversal descriptive study, during the first trimester of 2010; the study population was nurses from Castilla y León. From a total population of 16,002 professionals registered in the nine official Associations of Nurses in the province, 850 nurses were selected by gender and age quotas. A questionnaire prepared ad hoc for the study (10 items) was used for data collection. Results: 816 valid surveys were completed. A 79% of professionals claim to know the PI document. A 29% does not know which their competence is, as determined by current legislation. An 80% considers that those cares stated in the PI document fall within their competence. A 98% acknowledges that feeding and hydrating a terminal patient are nursing competences. Regarding the disconnection of the ventilator or the interruption of feeding and hydration, 52% would do it if there was a medical order, 16% would allege conscientious objection, and 32% would do it without any condition. Only 9% state that they have access to the formal registry, and claim it is necessary to increase the level of training about this matter. Conclusions: the majority of nursing professionals is aware of the current legislation about PIs, and considers them as a right of the patient, even though there are reasonable doubts about whether this competence can be conducted in an autonomous way, confirming there is no access to the formal registry. They have no problems in being actively involved in disconnection or discontinuation of feeding or nutrition by patient order, and they acknowledge the need for higher training and research.


Advance Directive Statement; ethics; legislation; nursing competencies; Previous instructions

Versión en Español


El derecho a la Declaración Anticipada de Voluntades e Instrucciones Previas. Conocimiento y competencia profesional