The Role of Nurses in Advance Care Planning Within Long-Term Care Homes

Abstract

Residents in long-term care homes (LTCHs), are often diagnosed with chronic life-limiting illnesses, require high levels of care and die with complex comorbidities. Advance care planning (ACP) is crucial in this setting because it empowers residents to have discussions with family, substitute decision-makers and healthcare providers regarding future health and personal care preferences. Evidence suggests, that nurses are well situated to engage residents and their families in ACP. The purpose of this study was to explore the experiences and perceptions of Registered Nurses (RNs) and Registered Practical Nurse (RPNs) in LTCHs with respect to their role in engaging residents and families in ACP discussions. Qualitative interpretive descriptive methodology was used. Data were collected from two LTCHs in Southern Ontario with a total sample of 15 nurses (n=7 RNs, n=8 RPNs). Data were analyzed through the use of semi-structured interviews, field notes, and the researcher’s reflexivity journal. A constant comparison and inductive approach was used in the analysis of the data. Power and authority dynamics in LTCH’s was an overarching theme in the data, that was highlighted across four sub themes: (1) Nurses lacking clarity about ACP, (2) Nurses’ uncertainty regarding their role in ACP, (3) Nurses feeling uncomfortable engaging in ACP discussions, and (4) Nurses struggling to support families in ACP discussions. The study findings provide many implications for policy, practice, education and research for nurses working in LTCHs, healthcare providers, policy makers and administrators. Recommendations include: (1) development of policies which support from a systemic level, encouraging nurses to practice ACP within the context of Ontario’s legislation, (2) reassessing LTCH’s hierarchal structure, and developing culture change that allows a team and person-centered approach to ACP and (3) providing more and ongoing education and mentorship for nurses to build greater comfort and confidence when engaging in ACP.