{"title":"Perspectives of Nursing Home Staff in Advance Care Planning Conversations: Experiences from the APPROACHES Project","authors":"","doi":"10.1016/j.jamda.2024.105265","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences – a Role offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP.</div></div><div><h3>Design</h3><div>Qualitative interviews regarding ACP specialists’ experiences and perceived intervention impact.</div></div><div><h3>Setting and Participants</h3><div>Staff of intervention-assigned nursing home facilities who completed a minimum of 10 ACP conversations with residents during APPROACHES program implementation.</div></div><div><h3>Methods</h3><div>Fourteen staff were interviewed. Interviews were transcribed and coded by the research team.</div></div><div><h3>Results</h3><div>There were 21 codes identified that were then distilled into the following 5 themes: (1) experiences with the ACP specialist program, (2) engaging in ACP conversations, (3) considerations related to dementia, (4) benefits and challenges of ACP, and (5) involvement of multiple people in the ACP process. Participant responses suggested variability in experiences with the ACP specialist program and highlighted many aspects relevant to engaging in conversations with families and residents, particularly those living with dementia. Benefits of ACP, including relationship building and increased preparedness for changes in health status, were balanced with challenges related to sensitive conversation topics and logistical difficulties in scheduling ACP discussions. ACP specialists discussed the multiple roles that others played in the ACP process.</div></div><div><h3>Conclusions and Implications</h3><div>Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Medical Directors Association","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S152586102400687X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives
Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences – a Role offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP.
Design
Qualitative interviews regarding ACP specialists’ experiences and perceived intervention impact.
Setting and Participants
Staff of intervention-assigned nursing home facilities who completed a minimum of 10 ACP conversations with residents during APPROACHES program implementation.
Methods
Fourteen staff were interviewed. Interviews were transcribed and coded by the research team.
Results
There were 21 codes identified that were then distilled into the following 5 themes: (1) experiences with the ACP specialist program, (2) engaging in ACP conversations, (3) considerations related to dementia, (4) benefits and challenges of ACP, and (5) involvement of multiple people in the ACP process. Participant responses suggested variability in experiences with the ACP specialist program and highlighted many aspects relevant to engaging in conversations with families and residents, particularly those living with dementia. Benefits of ACP, including relationship building and increased preparedness for changes in health status, were balanced with challenges related to sensitive conversation topics and logistical difficulties in scheduling ACP discussions. ACP specialists discussed the multiple roles that others played in the ACP process.
Conclusions and Implications
Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.
期刊介绍：
JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates.
The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality
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