Advance care planning in Norwegian nursing homes - limited awareness of the residents' preferences and values? A qualitative study.

Background: 52% of all deaths in Norway occur in nursing homes. Still advance care planning (ACP) is scarce and heterogeneous. To improve the implementation and practice of ACP in nursing homes, knowledge about health care professionals' views on ACP is vital.

Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers.

Advance care planning (ACP) performed by regular staff, which also includes patients with cognitive impairment and their next of kin, is scarcely studied. Thus, we planned an implementation study including key stakeholders (patients, next of kin, and health care personnel) using a whole-ward/system approach to ACP. We explored how they experienced ACP and its significance.

Improved patient participation through advance care planning in nursing homes-A cluster randomized clinical trial.

Objective: To improve patient participation in advance care planning in nursing homes where most patients have some degree of cognitive impairment.

Methods: This was a pair-matched cluster randomized clinical trial with eight wards in eight Norwegian nursing homes. We randomized one ward from each of the matched pairs to the intervention group.

Implementing advance care planning in nursing homes - study protocol of a cluster-randomized clinical trial.

Background: Close to half of all deaths in Norway occur in nursing homes, which signals a need for good communication on end-of-life care. Advance care planning (ACP) is one means to that end, but in Norwegian nursing homes, ACP is not common. This paper describes the protocol of a project evaluating an ACP-intervention in Norwegian nursing homes.

The significance of ethics reflection groups in mental health care: a focus group study among health care professionals.

Background: Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion.

Methods: In 2013 and 2014, 20 focus group interviews with 127 participants were conducted.

How to succeed with ethics reflection groups in community healthcare? Professionals' perceptions.

Background: Healthcare personnel in the municipal healthcare systems experience many ethical challenges in their everyday work. In Norway, 243 municipalities participated in a national ethics project, aimed to increase ethical competence in municipal healthcare services. In this study, we wanted to map out what participants in ethics reflection groups experienced as promoters or as barriers to successful reflection.

Advance care planning in Norwegian nursing homes.

Background: Nursing home patients are often frail and have a number of chronic conditions. Increased risk of critical events, hospitalisations and death indicates the need for dialogue with patients and their next of kin about the future, how to agree on sound decisions and what should happen if the patient’s health condition deteriorates. Previous studies have shown that only a minority of nursing homes practise this type of advance care planning.

"I just think that we should be informed" a qualitative study of family involvement in advance care planning in nursing homes.

Background: As part of the research project "End-of-life Communication in Nursing Homes. Patient Preferences and Participation", we have studied how Advance Care Planning (ACP) is carried out in eight Norwegian nursing homes. The concept of ACP is a process for improving patient autonomy and communication in the context of progressive illness, anticipated deterioration and end-of-life care.

The Norwegian national project for ethics support in community health and care services.

Background: Internationally, clinical ethics support has yet to be implemented systematically in community health and care services. A large-scale Norwegian project (2007-2015) attempted to increase ethical competence in community services through facilitating the implementation of ethics support activities in 241 Norwegian municipalities. The article describes the ethics project and the ethics activities that ensued.

Ethics support in community care makes a difference for practice.

Background: Through the Norwegian ethics project, ethics activities have been implemented in the health and care sector in more than 200 municipalities.

Objectives: To study outcomes of the ethics activities and examine which factors promote and inhibit significance and sustainability of the activities.

Research Design: Two online questionnaires about the municipal ethics activities.

End-of-life care communications and shared decision-making in Norwegian nursing homes--experiences and perspectives of patients and relatives.

Background: Involving nursing home patients and their relatives in end-of-life care conversations and treatment decisions has recently gained increased importance in several Western countries. However, there is little knowledge about how the patients themselves and their next-of-kin look upon involvement in end-of-life care decisions. The purpose of this paper is to explore nursing home patients' and next-of-kin's experiences with- and perspectives on end-of-life care conversations, information and shared decision-making.

Ethics reflection groups in community health services: an evaluation study.

Background: Systematic ethics support in community health services in Norway is in the initial phase. There are few evaluation studies about the significance of ethics reflection on care. The aim of this study was to evaluate systematic ethics reflection in groups in community health (including nursing homes and residency), - from the perspectives of employees participating in the groups, the group facilitators and the service managers.

Coercion in nursing homes: Perspectives of patients and relatives.

Background: Studies have demonstrated the extensive use of coercion in Norwegian nursing homes, which represents ethical, professional as well as legal challenges to the staff. We have, however, limited knowledge of the experiences and views of nursing home patients and their relatives.

Objectives: The aim of this study is to explore the perspectives of nursing home patients and next of kin on the use of coercion; are there situations where the use of coercion can be defended, and if so, under which circumstances?

Methods: The data are based on individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 60 relatives.

Ethical challenges and how to develop ethics support in primary health care.

Ethics support in primary health care has been sparser than in hospitals, the need for ethics support is probably no less. We have, however, limited knowledge about how to develop ethics support that responds to primary health-care workers' needs. In this article, we present a survey with a mixture of closed- and open-ended questions concerning: How frequent and how distressed various types of ethical challenges make the primary health-care workers feel, how important they think it is to deal with these challenges better and what kind of ethics support they want.