Abstract
BackgroundAdvance Care Planning (ACP) by Registered Nurses (RNs) has been emerging. However, there is limited understanding about what RNs experience as they incorporate ACP into their practice. This study aimed to elicit the experiences of ACP RNs with the implementation of a normalised ACP (NACP) service in hospital and community care settings.MethodsA qualitative descriptive study invited four ACP RNs who delivered a nurse-led NACP for a 6 months duration at two hospital and two community health care settings in New South Wales (NSW), Australia. The experiences of the ACP RNs were captured through a semi-structured interview and weekly debriefing meetings. The interview recordings were transcribed verbatim and the minutes of weekly debriefing meetings were utilized. Data were analysed by two independent researchers using thematic analysis with the Normalisation Process Theory (NPT) as a methodological framework.FindingsThe ACP RNs were females with a mean age of 43 years old. Their nursing experiences ranged 2 to 25 years but they had minimal experiences with ACP and had not attended any education about ACP previously. The following four themes were identified in the experiences of the ACP RNs; 1) Embracing NACP service; 2) Enablers and barriers related to patients and health professionals; 3) Enablers and barriers related to ACP RNs; and 4) What it means to be an ACP RN.ConclusionThe introduction of a NACP service into existing clinical systems is complex. The study demonstrated the capacity of RNs to engage in ACP processes, and their willingness to deliver an NACP service with a raft of locally specific enablers and barriers.Trial registrationThe study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). The URL of the trial registry record
Highlights
Advance Care Planning (ACP) by Registered Nurses (RNs) has been emerging
The study demonstrated the capacity of RNs to engage in ACP processes, and their willingness to deliver an normalised ACP (NACP) service with a raft of locally specific enablers and barriers
The experiences of ACP RNs with the implementation of NACP service as a routine service was described in four inter-related themes; 1) Embracing NACP service; 2) Enablers and barriers related to patients and health professionals; 3) Enablers and barriers related to ACP RNs; and 4) What it means to be an ACP RN
Summary
Advance Care Planning (ACP) by Registered Nurses (RNs) has been emerging. there is limited understanding about what RNs experience as they incorporate ACP into their practice. Whilst there has been consensus that nurses have crucial roles to play in ACP, there have been consistent reports that nurses perceived barriers despite their positive attitudes towards ACP [11,12,13]. This is of concern as it may imply a lack of commitment and action by nursing profession. While patients themselves can initiate ACP, there are many reasons why uptake is low [17]. One consensus is that health professionals are the ones to initiate ACP to assist patients [20]. General Practitioners in Australia have positioned themselves to initiate and promote ACP through ongoing and trusted relationships with their patients [23]
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