Components of the Advance Care Planning Process in the Nursing Home Setting.

J Hosp Palliat Nurs

Masako Mayahara, PhD, RN, CHPN, FPCN, is assistant professor, Department of Community Systems and Mental Health Nursing, Rush University College of Nursing, Chicago, Illinois. Arlene Michaels Miller, PhD, RN, FAAN, is professor, Community Systems and Mental Health Nursing, Rush University College of Nursing, Chicago, Illinois. Sean O'Mahony, MB, BCh, BAO, MS, FAAHPM, is section director, Palliative Medicine, Rush University Medical Center; associate professor, Rush Medical College, and associate professor, Rush College of Nursing, Chicago, Illinois.

Published: February 2018

AI Article Synopsis

  • The study examined the advance care planning process for nursing home residents and identified common concerns through content analysis of video-conferenced meetings involving residents and family members.
  • The Advance Care Planning Process Framework developed from the analysis consists of three phases: assessing the resident’s end-of-life care status, negotiating a realistic plan of care, and creating an action plan with complete advance directives.
  • The findings highlight that consultations led to effective action plans aligning residents' wishes with medical records, emphasizing the value of discussions facilitated by palliative care specialists.

Article Abstract

The purposes of this study were to describe the advance care planning process for nursing home residents and identify common concerns regarding advance care planning. We conducted a content analysis of video-conferenced advance care planning meetings in the nursing home. Fourteen nursing home residents and 10 family members were included in the analysis. Themes based on the participants' statements during the meetings were used to generate the Advance Care Planning Process Framework. The Advance Care Planning Process Framework has 3 primary phases: (1) assess resident's status regarding end-of-life care, which includes establishing common language; identifying resident's unrealistic goals and wishes; and identifying inconsistencies between resident's expressed wishes and the preferences documented in medical record; (2) negotiate realistic plan of care, which includes addressing inconsistencies between resident's and family's goals; rephrasing goals and wishes in hypothetical scenarios; and clarifying goals; and (3) create action plan, which includes complete advance directives and revisit/revise in the future as needed. Most of the consultations resulted in action plans to facilitate concordance between resident wishes and medical records. Advance care planning with palliative care specialists provided a valuable opportunity for nursing home residents and families to discuss advance directives and provided valuable clarification of their goals of care.

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Source
http://dx.doi.org/10.1097/NJH.0000000000000414DOI Listing

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