Krishnan Preetha, McClement Susan, Thompson Genevieve, Edwards Marie, St John Philip
Winnipeg Regional Health Authority, Misericordia Health Centre, Winnipeg, Manitoba, Canada.
Rady Faculty of Health Sciences College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
Int J Older People Nurs. 2025 Mar;20(2):e70013. doi: 10.1111/opn.70013.
Much of the literature examining the experiences of advance care planning (ACP) in long-term care (LTC) has been from the perspectives of residents and their families. Largely absent from the literature are the perspectives of LTC nurses, who are key members of the healthcare team most involved with LTC residents/families and well positioned to facilitate the ACP process. The purpose of this study was to develop an inductively derived empirical model to address this gap in empirical knowledge.
A constructivist grounded theory (CGT) methodology was used in this study of 25 nurses working in 18 different LTC facilities in central Canada. Data were collected using a demographic questionnaire; in-depth, semi-structured, audio-recorded and face-to-face/telephone interviews; field notes; and memos. Descriptive statistics and specific CGT coding procedures were used to analyse the data.
The basic social process that emerged from the data was that of nurses trying to identify an ACP level and craft a corresponding care plan that they believed would optimise residents' comfort in LTC during both acute medical events and at the end-of-life (EOL). The empirically derived theoretical model that captured the experiences, processes and strategies of nurses to address the identified social process was orchestrating comfort: getting everyone on the same page. This model encompassed two main processes, downgrading and upgrading ACP levels, and two preconditions, piecing together the big picture and selling the big picture.
Ensuring comfort for LTC residents at the end-of-life or during acute events by getting everyone on the same page is a complex process. The ability of nurses to downgrade or upgrade the ACP level to orchestrate comfort for LTC residents involves many factors related to the resident, family, healthcare providers and the context in which the ACP discussions take place.
Providing ACP/dementia information in LTC admission packages and through informational sessions can raise family awareness of these topics and dementia's complications. Clinical rotations in LTC facilities for medical, nursing, and paramedic students could also improve their understanding of the sector's complexities.
许多探讨长期护理（LTC）中预先护理计划（ACP）经验的文献都是从居民及其家庭的角度出发的。长期护理护士的观点在文献中基本缺失，而他们是医疗团队中与长期护理居民/家庭关系最为密切的关键成员，并且最有能力推动预先护理计划的进程。本研究的目的是建立一个归纳得出的实证模型，以填补这一实证知识的空白。
本研究采用建构主义扎根理论（CGT）方法，对加拿大中部18个不同长期护理机构的25名护士进行了研究。通过人口统计问卷、深入的半结构化录音及面对面/电话访谈、实地记录和备忘录收集数据。使用描述性统计和特定的扎根理论编码程序对数据进行分析。
从数据中浮现出的基本社会过程是，护士们试图确定预先护理计划的水平，并制定相应的护理计划，他们认为这将在急性医疗事件期间和临终时优化居民在长期护理中的舒适度。捕捉护士应对已确定社会过程的经验、过程和策略的实证理论模型是“精心安排舒适：让每个人达成共识”。该模型包括两个主要过程，即降低和提高预先护理计划水平，以及两个前提条件，即拼凑全局和推销全局。
让每个人达成共识以确保长期护理居民在临终时或急性事件期间的舒适度是一个复杂的过程。护士降低或提高预先护理计划水平以精心安排长期护理居民舒适度的能力涉及许多与居民、家庭、医疗服务提供者以及预先护理计划讨论发生的背景相关的因素。
在长期护理入院套餐中并通过信息会议提供预先护理计划/痴呆症信息，可以提高家庭对这些主题和痴呆症并发症的认识。为医学、护理和护理辅助专业学生安排长期护理机构的临床轮转，也可以增进他们对该领域复杂性的理解。
