Manami Ochi, Aya Isumi, Tsuguhiko Kato, Satomi Doi, Takeo Fujiwara
Adachi Child Health Impact of Living Difficulty (A-CHILD) Study: Research Protocol and Profiles of Participants
Journal of epidemiology
residents longterm care homes ltchs often diagnosed chronic lifelimiting illnesses common site provide high levels care eventual death urgent need address communication gaps uncertainties surrounding residents end life preferences nurses well situated key facilitators necessary advance care planning acp ensuring residents discussions family substitute decisionmakers healthcare providers regarding future health personal care preferences however ltchs present unique challenges nurses due complex comorbidities also staffing dynamics study explored experiences perceptions registered nurses rns registered practical nurse rpns ltchs regarding role engaging residents families acp discussions qualitative interpretive descriptive methodology used data collected two ltchs southern ontario sample 15 nurses 7 rns 8 rpns analysis involved review semistructured interviews field notes utilizing constant comparison within inductive approach power authority dynamics ltchs overarching theme data four subthemes 1 nurses lacking clarity acp 2 nurses uncertainty regarding role acp 3 nurses feeling uncomfortable engaging acp discussions 4 nurses struggling support families acp discussions recommendations nurses healthcare providers ltch administrators policy makers include 1 development policies support systemic level nurses feel safe engaging acp 2 reassessing ltchs hierarchical structure clarifying rn rpn interdisciplinary team members roles acp 3 developing culture change allows team personcentered approach acp 4 providing ongoing education mentorship nurses manage family dynamics expand understanding acp beyond biomedical lens