Abstract
Background52% of all deaths in Norway occur in nursing homes. Still advance care planning (ACP) is scarce and heterogeneous. To improve the implementation and practice of ACP in nursing homes, knowledge about health care professionals’ views on ACP is vital. The objective of this study is to explore nurses and physicians’ aims and experiences with carrying out ACP in nursing homes.MethodsSemi-structured group interviews were conducted with 20 health care professionals, recruited from nursing homes where ACP was performed regularly. Qualitative content analysis was used to analyse the data.ResultsThe primary aim of the nursing home professionals when doing ACP in nursing homes were to build alliances with next of kin to avoid misunderstandings and future conflicts. Two main experiences with ACP were described: i) due to the sensitivity of ACP issues, it was important to balance directness with being sensitive, and ii) when the physicians raised questions concerning future medical treatment, the answers from residents as well as next of kin were often hesitant and unclear.ConclusionOur study add insights into how ACP is practiced in nursing homes and the professionals’ agenda. A focus on medical issues and achieving consensus with next of kin may result in lack of involvement of the residents and limited awareness of the residents’ needs. Interdisciplinary approaches, ACP-training and tailored guidelines may improve the implementation and practice of ACP.
Highlights
Enabling patients to express their goals and preferences regarding future medical treatment and care is emphasized in health care, not the least in geriatrics and palliative care [1,2,3]
The primary aim of advance care planning (ACP): to build alliances with of kin to avoid misunderstandings and future conflicts Even though residents and of kin were asked about future preferences, exploring resident preferences was not the main motivation for facilitating conversations concerning end-of-life care
Our study adds insight into how advance care planning is practiced in nursing homes (NH), where the staff members have with little or no training and implementation support
Summary
Enabling patients to express their goals and preferences regarding future medical treatment and care is emphasized in health care, not the least in geriatrics and palliative care [1,2,3]. In Norway, white papers as well as legal rights state the patients’ right to participate in health care decisions [4]. These rights are strong when death is approaching. Thoresen et al BMC Geriatrics (2019) 19:363 experiences with carrying out ACP in “ordinary” NHsi.e. NHs where there has been little or no systematic ACP implementation or training. NHs where there has been little or no systematic ACP implementation or training Such knowledge is probably vital to improve the implementation and practice of ACP
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