How acute care nurses facilitate advance care planning for older adults with unplanned hospitalizations: A...

To explore how nurses facilitate advance care planning (ACP) for older adults with unplanned hospitalizations in acute care settings.

We conducted a grounded theory study using semi-structured interviews with 22 nurses regarding their successful ACP experiences.

We conceptualized ACP facilitation as a strategic baton-passing process. Rather than being conducted by a single nurse, it is orchestrated by multiple nurses and, occasionally, other professionals. Each contributes what they can in the moment, anticipating handoffs as patients are transferred, involving multiple providers. Nurses elucidated the following collective activities: First, some nurses (1) squeeze in time to lay the groundwork for ACP conversations-namely, estimating time remaining, gaining patients' trust, rapidly assembling fragmented information, and bridging communication across providers. Meanwhile, others (2) seize the right moment to step into ACP conversations: If time is limited, nurses initiate the conversation without waiting for ideal timing. If time permits, they carefully gauge the appropriate moment after the emergency phase has passed. Subsequently, others (3) start developing a tentative ACP blueprint with the patient/family, adapting to the situation, and clarifying future directions. Nurses shift fluidly between roles across patients and situations, integrating fragmented efforts into a continuous process while respecting patient values across care transitions. Their pivotal role lies in orchestrating this process-ACP facilitation in acute care is thus likened to passing a baton in a sprint relay.

Acute care nurses' adaptability and networking are critical in achieving ACP for older adults with unplanned hospitalization in hectic acute care settings.