'Getting Everyone on the Same Page': Long-Term-Care Nurses' Experiences With Advance Care Planning

Area of Science:

• Gerontology
• Nursing Science
• Healthcare Management

Background:

• Limited research exists on long-term care (LTC) nurses' perspectives on advance care planning (ACP).
• Nurses are pivotal in facilitating ACP for LTC residents and their families.
• This study addresses the gap in understanding nurses' experiences with ACP in LTC.

Purpose of the Study:

• To develop an inductively derived empirical model of LTC nurses' experiences with advance care planning.
• To understand the processes and strategies nurses use to facilitate ACP and optimize resident comfort.

Main Methods:

• A constructivist grounded theory (CGT) methodology was employed.
• 25 nurses from 18 LTC facilities in central Canada participated.
• Data collection included questionnaires, interviews, field notes, and memos, analyzed using descriptive statistics and CGT coding.

Main Results:

• The core social process identified was nurses identifying ACP levels and creating care plans to optimize resident comfort.
• The resulting model, "orchestrating comfort: getting everyone on the same page," details nurses' strategies.
• Key components include upgrading/downgrading ACP levels, piecing together the big picture, and selling the big picture.

Conclusions:

• Ensuring LTC resident comfort, especially at end-of-life, is a complex process requiring alignment among all stakeholders.
• Nurses' ability to adjust ACP levels is influenced by resident, family, provider, and contextual factors.
• Improving ACP requires addressing these multifaceted influences to effectively orchestrate comfort.