Experiences with advance care planning: nurses' perspective

jeong s.y.‐s., higgins i. & mcmillan m. (2011 ) Experiences with advance care planning: nurses’ perspective. International Journal of Older People Nursing  6 , 165–175 doi: 10.1111/j.1748‐3743.2009.00200.x Aims and objectives. The aim of this paper is to report the findings of a case study that explored the phenomenon of advanced care planning and advance care directives in residential care settings in Australia. In particular, this paper focuses on the experiences of Registered Nurses with advanced care planning and advance care directives. Background. Nurses need to know how to engage with residents and families when they invest time and effort on advanced care planning and documentation of advance care directives. Methods. A case‐study design involving participant observation, field note recording, semi structured interviews and document analysis was used. Data were collected over 7 months. Data analysis involved thematic content analysis. Findings. The factors that enhanced and inhibited the experiences of the Registered Nurses with advanced care planning were identified. The enhancing factors include; ‘it is their essence of who they are’, and ‘back‐up from family members and other nursing staff’. The inhibiting factors are ‘lack of time’, ‘a culture of do everything and don’t go there’, and ‘lack of family involvement’. Conclusion. The findings of the current study provided nurses with evidence of the positive nature of experiences of older people, family members, and nurses themselves with advanced care planning in an attempt to better implement and practise advanced care planning.     

Experiences with advance care planning: older people and family members' perspective

jeong s.y.‐s., higgins i. & mcmillan m. (2011) Experiences with advance care planning: older people and family members’ perspective. International Journal of Older People Nursing 6 , 176–186 doi: 10.1111/j.1748‐3743.2009.00201.x Aims and objectives. The aim of this study is to report the findings of a case study that explored the phenomenon of advance care planning and advanced care directives in residential care settings in Australia. In particular, this study focuses on the experiences of residents’ and family members’. Background. Understanding the phenomenon of advance care planning and advanced care directives is vital to end of life decision making. There are few studies that report the experiences of older people and family members in relation to advance care planning and advanced care directives. Methods. A case‐study research was conducted and data was collected over 7 months involving participant observation, field notes, semi‐structured interviews and document analysis. Findings. The participants’ early experiences with advance care planning were expressed in unpleasant, hostile and negative ways. However, those emotions and concerns were transformed to more stable, amenable and positive attitudes and feelings as issues were resolved. The factors that enhanced or inhibited the transition were described. Conclusion. Older people and families view the end of life with broader psychosocial and spiritual meanings shaped by a lifetime of experiences. Advance care planning led to a different level of appreciation of personal entity and transcendence. However, advance care planning demands concerted action and support by everyone involved.     

Care providers’ perceptions of the importance of oral care and its performance within everyday caregiving for nursing home residents with dementia

Scand J Caring Sci; 2011; 25; 92–99
Care providers’ perceptions of the importance of oral care and its performance within everyday caregiving for nursing home residents with dementia Background: The oral caregiving in nursing homes for persons with dementia often becomes complicated due to the patients’ lack of compliance, which in turn can result in giving oral care a low priority in daily care. Furthermore, directives for responsibilities are unclear. Objective: The aim of this article was to describe care providers’ perception of and reasoning for the oral care for nursing home residents with dementia and to describe registered nurses’ reasoning in relation to their responsibility for monitoring oral care interventions within the regular caregiving routines for nursing home residents with dementia. Methods: Two sub‐studies were carried out; focus group discussions with nine care providers and interviews with four nurses. All participants were staff in nursing home units specialized in dementia. Results: The focus group discussion revealed three themes: Art of caregiving, Barriers and Treatment strategies. Themes related to the nurses’ statements about oral hygiene within caregiving were Care, Responsibility for care and Information. Conclusion: Three main findings from the study are discussed: Unclear responsibilities of different staff members related to daily oral care for the nursing home patients; a lack of guidelines and routines for oral hygiene and a lack of guidelines for sharing information between the different professional groups.     

‘I feel like a salesperson’: the effect of multiple‐source care funding on the experiences and views of nursing home nurses in England

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses’ reluctance to work in these settings are determined. This paper considers the influence that multiple‐source care funding issues have on nursing home nurses’ experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with ‘selling beds’; and coping with self‐funding residents’ changing expectations of care. The findings of the study suggest that multiple‐source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention.     

Prescribing for older people in nursing homes: challenges for the future

As the population continues to age, long-term care for older people will be required, although the setting and method of delivery may differ depending on people's needs. We anticipate that nursing homes will continue to be part of the overall long-term care delivery model, but will face a number of challenges if they are to be considered as much sought-after places. This paper highlights three issues in relation to prescribing that have been largely ignored to date, but which need to be considered by practitioners, policy makers and researchers alike: culture; resident-centred decision-making and care at the end of life. There has been growing interest in culture within organisations and how this may influence behaviour and performance. In this paper, we will consider how culture may influence prescribing. Culture is important in how it contributes to resident-centred care and this leads to a consideration on how residents may be involved in decision-making, specifically in the area of medicines. Finally, care at the end of life in nursing homes, particularly in those with dementia, has been shown to be poor in quality, and this also encompasses the medicines that are prescribed. Palliative services need to be developed to meet the requirements of some of the most vulnerable residents in this care setting.     

Perspectives of healthy elders on advance care planning

Purpose: To present a qualitative study that explored the perspectives of healthy elders on advance care planning.
Data source: Data were gathered through four focus groups and a demographic questionnaire. The focus group data were analyzed using content analysis. A convenience sample of 20 healthy men and women, aged 60–94 years old, was drawn from one community senior center and two assisted living facilities.
Conclusions: The data reveal five major themes: advance care planning is strongly influenced by concern for others; elders assume that preferences are known to their trusted friends, family, and providers, even in the absence of explicit communication with these people; elders value a healthcare system that supports provider time, focus, and continuity; being "known" to a provider is critical to comfort that advance care planning preferences will be respected; and elders are generally ready and eager to discuss advance care planning. Additional findings include: elders are better prepared for the event of death than the dying process; lawyers and financial planners play a prominent role in guiding elders through end-of-life decisions; and elders believe that the optimal time for advance care planning discussion is during periods of relative wellness.
Implications for practice: Enhanced understanding of the patient perspective is key to incorporating advance care planning for healthy elders in the ideal milieu of primary care.