Department of Nursing Science, University of Turku, Turku, Finland.
Satakunta Hospital District, Pori, Finland.
J Clin Nurs. 2021 Mar;30(5-6):633-644. doi: 10.1111/jocn.15578. Epub 2020 Dec 14.
To describe healthcare professionals' perceptions of advance care planning (ACP) in palliative care unit in hospital ward or outpatient clinic.
Clinical guidelines recommend timely ACP as a central component of patient-centred palliative care. However, the ACP concept and terminology have been judged to be confusing, and practices are not established. Professionals' views are needed for ACP adoption and usage.
Qualitative descriptive design.
The study used purposive sampling. The data were collected through focus group interviews with registered nurses and practical nurses and individual or couple interviews with physicians and social workers. The data (n = 33) were analysed by inductive content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Three main categories emerged: Information content of ACP, coordination of care activities through ACP, and support for patients' and family members' coping. The information content of ACP included assessment of need for patient care, preparing for changes in patient's state of health and proactive medication. Coordination of care activities through ACP contained ACP care planning, cooperation and work practices between healthcare professionals. Support for patients' and family members' coping included communication between patient, family members and professionals and promoting patient self-care.
ACP is a useful and proactive tool for integrating patient-centred information, care and services as well as support for patients' and family members' coping. Palliative care activities can be coordinated through ACP in a multidisciplinary manner. ACP is significant and relevant for both professionals' work and patient care throughout the service system.
Results highlight the importance of proactive, concrete and holistic ACP. ACP should be up to date to reflect patient's current wishes. Raising professional awareness and implementing ACP into work processes are essential. Results can be utilised in planning and implementing interprofessional in-service training.
描述医护人员对医院病房或门诊姑息治疗单位中预先医疗指示（ACP）的看法。
临床指南建议及时进行 ACP，作为以患者为中心的姑息治疗的核心组成部分。然而，ACP 概念和术语被认为令人困惑，并且实践尚未确立。需要专业人员的意见来采纳和使用 ACP。
定性描述性设计。
本研究采用了目的性抽样。通过与注册护士和执业护士进行焦点小组访谈，以及与医生和社会工作者进行个人或夫妻访谈，收集数据。通过归纳内容分析对数据（n=33）进行分析。本研究符合《定性研究报告的统一标准》（COREQ）清单的要求。
出现了三个主要类别：ACP 的信息内容、通过 ACP 协调护理活动以及为患者和家庭成员的应对提供支持。ACP 的信息内容包括评估患者护理需求、为患者健康状况的变化做准备以及主动用药。通过 ACP 协调护理活动包括 ACP 护理计划、医护人员之间的合作和工作实践。为患者和家庭成员的应对提供支持包括患者、家庭成员和专业人员之间的沟通以及促进患者的自我护理。
ACP 是整合以患者为中心的信息、护理和服务以及为患者和家庭成员的应对提供支持的有用和积极主动的工具。可以通过 ACP 以多学科的方式协调姑息治疗活动。ACP 对整个服务系统中专业人员的工作和患者护理都具有重要意义和相关性。
研究结果强调了积极主动、具体和全面的 ACP 的重要性。ACP 应及时反映患者当前的意愿。提高专业意识并将 ACP 纳入工作流程至关重要。研究结果可用于规划和实施跨专业在职培训。
