Organizational and Personal Factors Influencing ICU Nurses’ Engagement in Advance Care Planning: A Mixed-methods Study

This study examined factors influencing intensive care unit nurses' engagement in advance care planning. A concurrent mixed-methods design integrated a survey from 158 nurses across 3 university-affiliated hospitals with narrative responses. Nurse-physician collaboration emerged as the strongest predictor of engagement, followed by working in medical intensive care units. Qualitative findings identified barriers such as limited education, administrative workload, and hierarchical decision-making, while nurses emphasized roles in emotional support, patient advocacy, and communication. These findings suggest that engagement is shaped by team dynamics and institutional context. Strengthening collaboration and providing targeted education may enhance nurses' contributions to end-of-life care.