Gilissen Joni, Wendrich-van Dael Annelien, Gastmans Chris, Vander Stichele Robert, Deliens Luc, Detering Karen, Van den Block Lieve, Pivodic Lara
70493Vrije Universiteit Brussel (VUB), Belgium; University California San Francisco, USA.
70493Vrije Universiteit Brussel (VUB), Belgium.
Nurs Ethics. 2021 Nov-Dec;28(7-8):1210-1227. doi: 10.1177/0969733021994187. Epub 2021 May 5.
A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well.
To examine to what extent engagement in advance care planning practices (e.g. conversations, advance directives), knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes.
Survey study.
PARTICIPANTS/SETTING: The study involved a purposive sample of 14 nursing homes in Flanders, Belgium. Nurses, care assistants and allied care staff (e.g. social workers, physical therapists) completed a survey.
The study was approved by the University Hospital of Brussels (B.U.N. 143201834759), as part of a cluster randomized controlled trial (clinicaltrials.gov NCT03521206).
One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated (67% response rate). After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations (odds ratio 4; 95% confidence interval 1.73-9.82; p < 0.001) and documented advance care planning (odds ratio 2.67; 95% confidence interval 1.29-5.56; p < 0.001); differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses (estimated mean difference 0.13 (score range 0-1); 95% confidence interval 0.08-0.17; p < 0.001) and allied staff (estimated mean difference 0.07; 95% confidence interval 0.03-0.12; p < 0.001) scoring higher than care assistants. We found no significant differences regarding self-efficacy.
While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training.
Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage.
养老院的预立医疗计划一直提倡采用团队协作的方法。虽然通常认为护士应发挥主导作用，但其他专业人员能够在多大程度上参与其中尚不清楚。
研究养老院护士、护理助理和专职医护人员在参与预立医疗计划实践（如谈话、预立医嘱）、知识水平和自我效能方面的差异程度。
调查研究。
参与者/研究背景：该研究对比利时弗拉芒地区的14家养老院进行了立意抽样。护士、护理助理和专职医护人员（如社会工作者、物理治疗师）完成了一项调查。
该研究作为一项整群随机对照试验（clinicaltrials.gov NCT03521206）的一部分，已获得布鲁塞尔大学医院批准（B.U.N. 143201834759）。
196名护士、319名护理助理和169名专职医护人员参与了研究（回复率为67%）。在对混杂因素进行调整后，护士进行预立医疗计划谈话的可能性显著高于护理助理（优势比为4；95%置信区间为1.73 - 9.82；p < 0.001），且记录预立医疗计划的可能性也更高（优势比为2.67；95%置信区间为1.29 - 5.56；p < 0.001）；专职医护人员与护理助理之间未发现差异。预立医疗计划知识总分存在显著差异，护士（估计平均差异为0.13（分数范围0 - 1）；95%置信区间为0.08 - 0.17；p < 0.001）和专职医护人员（估计平均差异为0.07；95%置信区间为0.03 - 0.12；p < 0.001）的得分高于护理助理。自我效能方面未发现显著差异。
虽然养老院护士进行的预立医疗计划谈话和记录比专职医护人员和护理助理更多，但如果接受额外培训，这两个专业群体在进行预立医疗计划时可能会为护士提供宝贵支持。
如果得到适当培训，专职医护人员和护理助理可以更积极地参与预立医疗计划，与护士一道增强养老院居民的人际关系和个人自主性。未来旨在改进和实施预立医疗计划的研究应在干预开发阶段考虑这一发现。
