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Rietze LL, Stajduhar KI, Purkis ME, Cloutier D. The Challenges of Advance Care Planning for Acute Care Registered Nurses. Can J Nurs Res 2024:8445621241244532. [PMID: 38576275 DOI: 10.1177/08445621241244532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
STUDY BACKGROUND The practice of acute care nurses is shaped by organizational factors such as lack of privacy, heavy workloads, unclear roles, lack of time, and lack of specific policies and procedures. We know little about the social and organizational structures and processes that influence nurses' uptake of valuable patient-centered discussions like advance care planning (ACP). ACP is beneficial for patients, their substitute decision makers, and healthcare providers. PURPOSE To describe the operational, organizational, and societal influences shaping nurses' ACP work in acute care settings. METHODS This ethnographic study purposively sampled 14 registered nurses and 9 administrators who worked in two acute care hospitals in Northeastern Ontario. Methods consisted of 23 open-ended, semi-structured interviews, 20 hours of observational fieldwork, and a collection of publicly available organizational documents. Data were inductively analyzed using an iterative constant comparative approach. RESULTS Nurses were challenged to meet multiple competing demands, leaving them to scramble to manage complex and critically ill acute care patients while also fulfilling organizational tasks aligned with funding metrics, accreditation, and strategic planning priorities. Such factors limited nurses' capacity to engage their patients in ACP. CONCLUSIONS Acute care settings that align patient values and medical treatment need to foster ACP practices by revising organizational policies and processes to support this outcome, analyzing the tasks of healthcare providers to determine who might best address it, and budgeting how to support it with additional resources.
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Affiliation(s)
- Lori L Rietze
- School of Nursing, Laurentian University, Sudbury, ON, Canada
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Wong J, Pedersen J, Tennety N, DuBois L, Chiu R, Shah D, Malecki G, Wafford QE, Heinemann AW. Service-Delivery Competencies in Home and Community-Based Services Needed to Achieve Person-Centered Planning and Practices: A Systematic Review. J Appl Gerontol 2023; 42:493-504. [PMID: 36384346 DOI: 10.1177/07334648221139476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Home and community-based services (HCBS) assist people with disabilities and older adults to remain in their homes. Direct support professionals and care managers who facilitate the development of support plans need to employ person-centered approaches to ensure services are tailored to peoples' needs and preferences. The aims were to identify the key competencies needed for delivery of person-centered supports and examine the relationship between HCBS and its' outcomes in the United States. We used the competencies developed by the National Center on advancing Person-Centered Practices and Systems as a framework. We conducted a systematic review to identify the skills necessary to deliver person-centered HCBS. We coded 43 articles and identified seven competencies. Most frequently mentioned competencies related to culturally informed practice, cultivating connections, and promoting rights, choice, and control. Policy makers should create training standards for person-centered practices to ensure that people receiving HCBS live the lives they want.
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Affiliation(s)
- Jasin Wong
- 34881National Tsing-Hua University, Hsinchu City, Taiwan
| | - Jessica Pedersen
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Niveda Tennety
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Lindsay DuBois
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | | | - Dhrumil Shah
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Glenn Malecki
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Q Eileen Wafford
- 491146Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allen W Heinemann
- Center for Rehabilitation and Outcomes Research, 581932Shirley Ryan AbilityLab, Chicago, IL, USA.,12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ludwick R, Baughman KR. Education, Policy, and Advocacy in Predicting Use of Do-Not-Hospitalize Orders in Skilled Nursing Facilities. J Gerontol Nurs 2022; 48:45-52. [PMID: 36286504 DOI: 10.3928/00989134-20221003-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nurses and social workers are uniquely positioned to advocate for patients' wishes for do-not-hospitalize (DNH) directives. The purpose of the current study was to explore the impact of DNH education, policy, and advocacy on the use of DNH orders by nurses (RNs and licensed practical nurses [LPNs]) and social workers employed in skilled nursing facilities (SNFs). This multisite secondary analysis used cross-sectional survey data and analyzed responses of RNs, LPNs, and social workers (N = 354) from 29 urban SNFs. Mixed model regression was used to examine possible predictors of frequency of DNH orders within SNFs while adjusting for random effects. Results showed that having a DNH written policy, education on DNH orders, and having an advanced care planning advocate in the facility were strongly associated with a higher reported frequency of DNH discussions with residents and their families (p < 0.01 for each variable). [Journal of Gerontological Nursing, 48(11), 45-52.].
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Greco A, Annovazzi C, Palena N, Camussi E, Rossi G, Steca P. Self-Efficacy Beliefs of University Students: Examining Factor Validity and Measurement Invariance of the New Academic Self-Efficacy Scale. Front Psychol 2022; 12:498824. [PMID: 35095624 PMCID: PMC8793353 DOI: 10.3389/fpsyg.2021.498824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 07/14/2021] [Indexed: 12/18/2022] Open
Abstract
Academic self-efficacy beliefs influence students' academic and career choices, as well as motivational factors and learning strategies promoting effective academic success. Nevertheless, few studies have focused on the academic self-efficacy of university students in comparison to students at other levels. Furthermore, extant measures present several limitations. The first aim of this study was to develop a reliable and valid scale assessing university students' self-efficacy beliefs in managing academic tasks. The second aim was to investigate differences in academic self-efficacy due to gender, years of enrollment, and student status. The study involved 831 students (age M = 21.09 years; SD = 1.34 years; 66.3% women) enrolled in undergraduate programs. Indicators of academic experiences and performance (i.e., number of exams passed and average exam rating) were collected. A new scale measuring students' academic self-efficacy beliefs was administered. Results from a preliminary Exploratory Factor Analysis were consistently supported by findings from a Confirmatory Factor Analysis. Multigroup CFA supported the presence of measurement invariance. Analyses revealed that the new scale has eight factors: "Planning Academic Activities," "Learning Strategies," "Information Retrieval," "Working in Groups," "Management of Relationships with Teachers," "Managing Lessons," "Stress Management," and "Thesis Work." Self-efficacy dimensions showed significant relations with academic experiences and students' performance indicators, as well as differences due to gender, years of enrollment, and student status. Findings are discussed in terms of practical implications for the implementation of intervention programs aimed at fostering self-efficacy beliefs and academic success.
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Affiliation(s)
- Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Chiara Annovazzi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Nicola Palena
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Germano Rossi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Patrizia Steca
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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van der Plas A, Glaudemans J, Onwuteaka-Philipsen B. Advance care planning in Dutch primary care: a pre/post-implementation study. BMJ Support Palliat Care 2021; 12:bmjspcare-2020-002762. [PMID: 33785547 PMCID: PMC9380501 DOI: 10.1136/bmjspcare-2020-002762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite known advantages of advance care planning (ACP) and a positive attitude towards ACP by older people living in the community and general practitioners (GPs), such conversations are not yet commonplace in GP practices. AIM To implement ACP as part of routine care in general practice and thereby increasing the number of ACP conversations and advance directives; to investigate characteristics of older people with and without an ACP conversation. METHODS (1) A pre-evaluation and post-evaluation study using questionnaire data from people aged 75 years or older living in the community. (2) A prospective study using data provided by healthcare professionals (people they started an ACP conversation with). RESULTS After implementation of ACP, significantly more people had spoken to their GP about hospitalisations, intensive care admission and treatment preferences in certain circumstances, compared with before. Advance directives were drawn up more often. People who had an ACP conversation were older, have had a cerebrovascular accident, had a clear idea about future health problems, had a preference to start ACP before they were ill, already had an ACP conversation at pre-measurement and indicated at pre-measurement that their GP knows their preferences. CONCLUSION Results in number of ACP conversations and advance drectives were modest but positive. ACP was implemented as routine care. GPs select people with whom they have a conversation. This can be an efficient use of time, but there is a risk that certain groups may be underserved (for example, patients with multimorbidity or patients with less health skills).
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Affiliation(s)
- Annicka van der Plas
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jolien Glaudemans
- Department of General Practice, Amsterdam UMC, Amsterdam, The Netherlands
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The Impact of Organizational Factors on Nurses' Knowledge, Perceptions, and Behaviors Around Advance Care Planning. J Hosp Palliat Nurs 2020; 22:283-291. [PMID: 32568936 DOI: 10.1097/njh.0000000000000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to understand the organizational context of nurses' use of advance care plans (ACPs). We use a modified version of Bandera's social cognitive theory model to understand relationships between organizational constructs such as experience with ACPs and satisfaction with organizational support and oncology nurses' knowledge, behaviors, and perceptions around ACPs. The sample included practicing registered nurses with a major focus in oncology who were members of the Oncology Nursing Society in the United States, and nurses at medical hospital or community care settings were included. Institutional review board approval was obtained, and permission was granted from the oncology nursing organization for online surveys. A validated ACP survey was used to measure nurses' experiences and perceptions of working with ACP. Perceptions of ACP by patients, vicarious experience with ACP, direct experience of ACP, having received training, and perceptions of organizational support for ACP were all predictive of total ACP behaviors in the workplace. The final regression model had 3 independent variables and accounted for 33% of the variance in total ACP behaviors. Both vicarious and direct experience with ACP was associated with ACP behaviors in workplaces. This implies the need for more vicarious and direct training experiences, as well as organization support, to build self-efficacy to perform ACP.
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Development and implementation of an advance care planning program in Catalonia, Spain. Palliat Support Care 2020; 17:415-424. [PMID: 30289094 DOI: 10.1017/s1478951518000561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Implementation of an advance care planning (ACP) program for people with advanced chronic conditions is a complex process. The aims of this paper are to describe (1) the development of the ACP program in Catalonia, Spain, for patients with advanced chronic conditions and complex needs and (2) the preliminary results of the implementation of this program in health and social services. METHOD The ACP program was developed and implemented in a four-stage process as follows: (1) design and organization of the project; (2) selection of the professionals to carry out the project; (3) creation of four working groups to develop the conceptual model, guidelines, training program, and perform a qualitative evaluation; and (4) project implementation. RESULT The following deliverables were completed: (1) conceptual framework document; (2) practical guidelines for the application of the ACP; (3) online training course (3,763 healthcare professionals completed the online course, with an overall satisfaction rating of 8.4 on a 10-point scale); and (4) additional training activities (conferences, short courses, and seminars) in between 2015 and 2017. SIGNIFICANCE OF RESULTS This project was led by the Catalan Ministry of Health. The strengths of the project development include the contribution of a wide range of professionals from the entire region, approval by the Catalan Bioethics Committee and the Social Services Ethics Committee, and the ongoing validation by members of the community. A standardized online training course was offered to all primary care professionals and included as a quality indicator for continuing education for those professionals in the period 2016-2020. The main outcome of this project is the establishment of a pragmatic ACP throughout the region and training of the health and social care professionals involved in the care of advanced chronic patients.
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CE: Original Research: Advance Care Planning: An Exploration of the Beliefs, Self-Efficacy, Education, and Practices of RNs and LPNs. Am J Nurs 2019; 118:26-32. [PMID: 30418182 DOI: 10.1097/01.naj.0000549664.43827.ce] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Objective: This study compared the advance care planning (ACP)-related beliefs, sense of self-efficacy, education, and practices of RNs and LPNs. METHODS Data were extrapolated from a larger multisite study that was conducted across seven counties in one midwestern state. The sample consisted of RNs and LPNs working in 29 urban skilled nursing facilities in zip code areas with greater than 10% African American residents. The survey tool, a self-administered written questionnaire, gathered data on participants' demographics and ACP-related beliefs, sense of self-efficacy, education, and practices. The two main outcome variables were the percentage of residents with whom a nurse discussed ACP and the timing of the most recent such discussion. RESULTS A total of 136 RNs and 178 LPNs completed the survey. Multivariate mixed-model analysis of the two main outcome variables showed that negative beliefs were not significantly associated with the percentage of residents with whom nurses discussed ACP but were significantly associated with the timing of the most recent ACP discussion. Having higher levels of ACP-related self-efficacy and education were significantly and positively associated with both outcome variables. RNs and LPNs did not differ significantly in their ACP-related beliefs, but RNs reported significantly higher levels of self-efficacy and education than LPNs did. CONCLUSIONS There has been a paucity of research comparing RNs and LPNs regarding their ACP practices in skilled nursing facilities. Better education and policies that empower nurses to take a more active role are critical to increasing conversations about ACP. Further research exploring how the complementary roles of RNs and LPNs can be used to improve ACP processes and inform ACP policies is needed.
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van der Plas AG, Francke AL, Vissers KC, Jansen WJ, Deliens L, Onwuteaka-Philipsen BD. Case management in primary palliative care is associated more strongly with organisational than with patient characteristics: results from a cross-sectional prospective study. BMC Palliat Care 2015; 14:31. [PMID: 26134403 PMCID: PMC4488052 DOI: 10.1186/s12904-015-0029-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Case managers have been introduced in Dutch primary palliative care; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner and home care nurses. This study aims to describe support and investigate what characteristics of patients and the organizational setting are related to the number of contacts and to the number of times topics are discussed between the case manager and patients and/or informal carers. METHODS Prospective study following cancer patients (n = 662) receiving support from a palliative care case manager in Dutch primary care, using registration forms filled out by the case manager after contact with the patient and/or informal carer. In backward linear regression, the association was studied between patient or organizational characteristics and the number of contacts and the number of times conversation topics were discussed. RESULTS Organizational characteristics add more to explained variability in data than patient characteristics. Case managers provide support in a flexible manner with regard to the number, mode, persons present, and duration of contacts. Support covered all domains of palliative care, with most attention given to physical complaints, life expectancy and psychological aspects. CONCLUSIONS Support offered by the case managers is prompted by characteristics of the organization for which they work. This is contradictory to the idea of patient centered care highly valued in palliative care.
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Affiliation(s)
- Annicka Gm van der Plas
- Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Anneke L Francke
- Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Kris C Vissers
- Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Wim Jj Jansen
- Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Anaesthesiology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Luc Deliens
- Vrije Universiteit Brussel and Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, B-1090, Brussels, Belgium.
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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