‘Getting Everyone on the Same Page’: Long-Term-Care Nurses' Experiences With Advance Care Planning

IF 1.6 4区 医学 Q4 GERIATRICS & GERONTOLOGY
Preetha Krishnan, Susan McClement, Genevieve Thompson, Marie Edwards, Philip St. John
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引用次数: 0

Abstract

Introduction

Much of the literature examining the experiences of advance care planning (ACP) in long-term care (LTC) has been from the perspectives of residents and their families. Largely absent from the literature are the perspectives of LTC nurses, who are key members of the healthcare team most involved with LTC residents/families and well positioned to facilitate the ACP process. The purpose of this study was to develop an inductively derived empirical model to address this gap in empirical knowledge.

Methods

A constructivist grounded theory (CGT) methodology was used in this study of 25 nurses working in 18 different LTC facilities in central Canada. Data were collected using a demographic questionnaire; in-depth, semi-structured, audio-recorded and face-to-face/telephone interviews; field notes; and memos. Descriptive statistics and specific CGT coding procedures were used to analyse the data.

Results

The basic social process that emerged from the data was that of nurses trying to identify an ACP level and craft a corresponding care plan that they believed would optimise residents' comfort in LTC during both acute medical events and at the end-of-life (EOL). The empirically derived theoretical model that captured the experiences, processes and strategies of nurses to address the identified social process was orchestrating comfort: getting everyone on the same page. This model encompassed two main processes, downgrading and upgrading ACP levels, and two preconditions, piecing together the big picture and selling the big picture.

Conclusions

Ensuring comfort for LTC residents at the end-of-life or during acute events by getting everyone on the same page is a complex process. The ability of nurses to downgrade or upgrade the ACP level to orchestrate comfort for LTC residents involves many factors related to the resident, family, healthcare providers and the context in which the ACP discussions take place.

Implications of Practice

Providing ACP/dementia information in LTC admission packages and through informational sessions can raise family awareness of these topics and dementia's complications. Clinical rotations in LTC facilities for medical, nursing, and paramedic students could also improve their understanding of the sector's complexities.

让每个人都站在同一起跑线上":长期护理护士对预先护理计划的体验
许多研究长期护理(LTC)中预先护理计划(ACP)经验的文献都是从居民及其家庭的角度出发的。文献中基本上没有LTC护士的观点,他们是医疗团队的关键成员,与LTC居民/家庭关系最密切,有利于促进ACP过程。本研究的目的是开发一个归纳推导的经验模型,以解决这一差距的经验知识。方法采用建构主义扎根理论(CGT)方法,对加拿大中部18个不同的LTC机构的25名护士进行研究。使用人口调查问卷收集数据;深入、半结构化、录音和面对面/电话采访;专业笔记;和备忘录。采用描述性统计和特定的CGT编码程序对数据进行分析。结果从数据中出现的基本社会过程是护士试图确定ACP水平并制定相应的护理计划,他们认为这将优化住院患者在急性医疗事件和生命终结(EOL)期间在LTC中的舒适度。经验推导的理论模型捕捉了护士的经验、过程和策略,以解决已确定的社会过程,这是精心安排的安慰:让每个人都在同一页上。该模型包含两个主要过程,即ACP水平的降级和升级,以及两个前提条件,即拼凑大局和销售大局。通过让每个人都在同一页面上确保LTC患者在生命末期或急性事件期间的舒适是一个复杂的过程。护士降低或提高ACP水平以协调LTC住院患者舒适度的能力涉及与住院患者、家庭、医疗保健提供者和ACP讨论发生的背景有关的许多因素。在LTC入院包中提供ACP/痴呆信息,并通过介绍会提高家庭对这些话题和痴呆并发症的认识。医疗、护理和护理专业的学生在LTC机构进行临床轮转,也可以提高他们对该部门复杂性的理解。
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来源期刊
CiteScore
3.60
自引率
9.10%
发文量
77
期刊介绍: International Journal of Older People Nursing welcomes scholarly papers on all aspects of older people nursing including research, practice, education, management, and policy. We publish manuscripts that further scholarly inquiry and improve practice through innovation and creativity in all aspects of gerontological nursing. We encourage submission of integrative and systematic reviews; original quantitative, qualitative, and mixed methods research; secondary analyses of existing data; historical works; theoretical and conceptual analyses; evidence based practice projects and other practice improvement reports; and policy analyses. All submissions must reflect consideration of IJOPN''s international readership and include explicit perspective on gerontological nursing. We particularly welcome submissions from regions of the world underrepresented in the gerontological nursing literature and from settings and situations not typically addressed in that literature. Editorial perspectives are published in each issue. Editorial perspectives are submitted by invitation only.
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