Punia Harveer, Kaasalainen Sharon, Ploeg Jenny, Strachan Patricia, Sussman Tamara
School of Nursing, McMaster University, Hamilton, Canada.
School of Social Work, McGill University, Montreal, Canada.
SAGE Open Nurs. 2024 Apr 29;10:23779608241249335. doi: 10.1177/23779608241249335. eCollection 2024 Jan-Dec.
Residents in long-term care homes (LTCHs) are often diagnosed with chronic, life-limiting illnesses, and it is now a common site to provide high levels of care and eventual death. There is an urgent need to address communication gaps and uncertainties surrounding resident's end of life preferences. Nurses are well situated to be key facilitators of necessary advance care planning (ACP), ensuring residents have discussions with family, substitute decision-makers and healthcare providers regarding future health and personal care preferences. However, LTCHs present unique challenges for nurses due to not only complex comorbidities but also staffing dynamics.
This study explored the experiences and perceptions of Registered Nurses (RNs) and Registered Practical Nurse (RPNs) in LTCHs regarding their role in engaging residents and families in ACP discussions.
Qualitative interpretive descriptive methodology was used. Data were collected from two LTCHs in Southern Ontario with a sample of 15 nurses (7 RNs and 8 RPNs). Analysis involved review of semistructured interviews, field notes, and utilizing constant comparison within an inductive approach.
Power and authority dynamics in LTCH's was an overarching theme in the data, with four subthemes: (1) Nurses lacking clarity about ACP, (2) nurses' uncertainty regarding their role in ACP, (3) nurses feeling uncomfortable engaging in ACP discussions, and (4) nurses struggling to support families in ACP discussions.
Recommendations for nurses, healthcare providers, LTCH administrators, and policy makers include: (1) development of policies which support, from a systemic level, nurses to feel safe while engaging in ACP; (2) reassessing LTCH's hierarchical structure, and clarifying RN, RPN, and interdisciplinary team members roles in ACP; (3) developing culture change that allows a team and person-centered approach to ACP; and (4) providing ongoing education and mentorship for nurses to manage family dynamics and expand their understanding of ACP beyond a biomedical lens.
长期护理机构（LTCHs）中的居民常被诊断患有慢性、危及生命的疾病，如今这里已成为提供高水平护理并最终走向死亡的常见场所。迫切需要解决围绕居民临终偏好的沟通差距和不确定性问题。护士非常适合成为必要的预先护理计划（ACP）的关键推动者，确保居民与家人、替代决策者以及医疗保健提供者就未来的健康和个人护理偏好进行讨论。然而，LTCHs给护士带来了独特的挑战，这不仅是因为复杂的合并症，还因为人员配置动态。
本研究探讨了LTCHs中注册护士（RNs）和注册实用护士（RPNs）在促使居民和家庭参与ACP讨论方面的角色体验和看法。
采用定性解释性描述方法。从安大略省南部的两家LTCHs收集数据，样本为15名护士（7名RNs和8名RPNs）。分析包括对半结构化访谈、实地记录的审查，并采用归纳法进行持续比较。
LTCHs中的权力和权威动态是数据中的一个总体主题，有四个子主题：（1）护士对ACP缺乏清晰认识；（2）护士对自己在ACP中的角色不确定；（3）护士对参与ACP讨论感到不舒服；（4）护士在ACP讨论中难以支持家庭。
对护士、医疗保健提供者、LTCH管理人员和政策制定者的建议包括：（1）制定政策，从系统层面支持护士在参与ACP时感到安全；（2）重新评估LTCH的等级结构，明确RN、RPN和跨学科团队成员在ACP中的角色；（3）开展文化变革，允许采用以团队和个人为中心的ACP方法；（4）为护士提供持续教育和指导，以管理家庭动态，并拓宽他们对ACP的理解，超越生物医学视角。
