| Description |
The aim of this project was to educate Registered Nurses (RNs) who work in Long Term Care (LTC) settings on the importance of executing a key competency skill: guiding complex decisions and discussions such as Advance Care Planning (ACP) with residents/families. The LTC population encompasses those who are aging, with one or more chronic illnesses, experiencing disability and/or those in the post-acute stage. Services to these individuals include medical, non-medical and housing needs. For this project, LTC refers to institutional care (i.e. nursing home or supportive housing) where individuals require 24/7 paid staff for their everyday activities. For many in this population, health changes and/or gradual decline trajectory to end of life (EOL) require conversations about preferences for future care needs. Advanced care planning has proven to be effective in reducing undertreatment, overtreatment, or negligent care; it has proven to have better outcomes as care is aligned with individual desires. Preferences that create individualized care plans come out of repeated conversations. This ensures better quality care, which often translates to higher quality of life for the care recipients. Better outcomes include: having a voice in one's own care, less emotional distress such as anxiety and/or depression, less hospitalization, quality communication with increased satisfaction with healthcare, better end-of-life care, better death or successful dying, and reduced end-of-life healthcare cost. ACP has higher uptake when individuals are given the opportunity (even by nurses) to discuss their preferences, values, and beliefs. However, only 10-20% by one report versus 50% by another study of the LTC residents have completed ACP and many still die without preferences known to their families, caregivers, or healthcare providers. The American Nurses Association and the Institute of Medicine have identified a gap that nurses are poised to fill based on their responsibility as care planners as well as being most accessible to residents/families. Nurses can create opportunities for conversations towards resident autonomy and authority; hence, nurses play an important part in the quality improvement implementation as well as resident outcomes. The pilot training, based on Graham's Knowledge-to-Action framework, aimed to equip nurses to exercise their professional responsibility in initiating and facilitating ACP with confidence and ease. The objectives included developing and conducting a 2-hour, 3-segment, competency-based training for 6-9 nurses from two Utah facilities. Repeated time measures (pre- to 30-day post class) evaluated teaching, learning and practice change within the domains of knowledge, attitude, comfort, and support. Findings of this project validated a need for a formal education on ACP competency acquisition. Results will add to the body of literature identifying best practices for preparing nurses with competencies to work with LTC population in ACP uptake. |
