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Show Advance Care Planning Training Increases Long Term Care RNs’ Intent to Practice Carol S. Redfield, BSN, MN, DNP Student METHODS PURPOSE Problem: Insufficient training in Advance Care Planning (ACP) for registered nurses (RNs) has been identified as a barrier to fully engaging in conversations about future care with Long Term Care (LTC) residents Aim: Empower RNs as ACP facilitators & knowledge informants to be better prepared in guiding complex, future care decisions with residents and/or families, through a 2-hr competency-based training (CBT), using Graham’s Knowledge-to-Action Process Objectives: • Assess current RN role & responsibilities related to ACP in LTC settings • Develop CBT training for ACP skill acquisition • Conduct a pilot program with 6-9 LTC RNs • Evaluate training impact on RN’s intent to practice Participants: RNs (N=10) from 5 LTC facilities of greater Salt Lake City in a Lunch & Learn session at a centralized facility Procedure: A 2-hr training with 3 sections: • 45 minute lecture with 1 handout • 20 minute video viewing & discussion with 2 handouts • 20 minute simulation & debriefing with reflection on lessons learned plus intention to practice Data Collection: 5 time intervals: pre-training, post-lecture, postvideo viewing, post-simulation & 30 days after training Instruments: • Neph RN Perception of Advance Care Planning Instrument (Haras, 2015, modified) • Knowledge Content Assessment • Reflection Note (latter two developed by student) Variable BACKGROUND • Quality of Life (QoL) in LTC resident is from: individualized care plan, which is from: expressed preferences based on conversations with staff • ACP has many benefits, yet many are without (50% to 90%) Ethnicity Project Chair: Larry Garrett, PhD, RN Content Experts: Beth Fahlberg, PhD, RN Kathryn Anderson, PhD, RN Members: Gillian Tufts, DNP, FNP Pamela Hardin, PhD, RN 10 Female Mean Range Mean (100) 29 - 44 36.5 3 - 14 7.9 8 (80) 34 - 44 38 -- 7.75 Male Asian 2 (20) 29 - 32 30.5 -- 8.5 1 (10) Caucasian 9 (90) N (Percent) 9 -- Associate degree 9 (90) Diploma 1 (10) 8 DON 1 (10) 7 3 (30) 6 MDS 1 (10) MDS-CMS 2 (20) Years in LTC Education level Role Title Years as RN Range Variable ADON • RNs are charged to do ACP per Nursing Code of Ethics* • Barrier factors identified: Resident/patient Structural** Family Healthcare/Professional** *Also per American Nurses Association & Institute of Medicine **Modifiable by RNs (Percent) Age/Gender/Years as RN Total • RNs, when trained, can increase ACP documentation & assurance of “carry through” with resident goals/wishes • Lack of ACP training leads to poor RN competence which negatively impacts quality of care & QoL for residents and/or families N Age Mean Training Background 4 No formal; yes informal training (10) 2 Management 1 (10) 1 No answer 1 (10) 0 4 No formal; no informal training 1 2 1 Yes Discussed ACP Not Discussed ACP RESULTS (Quantitative) Trends Over Time In Outcomes (T1 to T5) Confidence Comfort Attitude Knowledge Post-Video Viewing: • Conversations shifted to “how to live & living” preceding EoL; 77% of responses referred to the words: live, living, QoL • Expressed feeling better prepared & confident with tools to initiate conversations/ask questions • 100% reported ACP as a core RN role, not specialty role • Emerging: begin earlier, extend to more people, implement, resident control “…[I] have better knowledge [&] resources to help ease the conversation” “How do you want to live at end of life” “That we as a community need to talk more about this. I like that I got more tools to assist w/ this.” Post-Simulation: • Recognized conversations have a direct link to QoL & resident control when documented & implemented; less mention of EoL • Better informed, prepared & confident to proceed • 100% wrote ‘intent to practice’ plans for self & others 30 Days After: RNs reported practice change & educated others 2 Yes formal; yes informal training 1 “I understand the importance of it, I am learning a lot of sta[tis]tics about it.” “I have knowledge to start conversation, but do not know all alternatives” “I would like to have 10 encounters [in next 30 days]” “Next RN meeting, I will educate and monitor [ACP] documentation…By next mo. ACP will be discussed in every IDT meeting” 5 Unit Manager Post-Lecture: • 50% gained more information regarding current ACP status • No further mention of POLST but recognized conversations as key component to End of Life (EoL) goals & decisions • Began to understand that ACP is every RN’s role & responsibility • Challenges: family dynamics, carrying out wishes, communication “It is scary to think about how many people do not have this. I should start the conversations and impower floor nurses to do the same” 7.98 3 RESULTS (Qualitative) METHODS Support “Yes, I have started the conversation myself and encouraged floor nurses” DISCUSSION Benefits: Through experiential learning, RNs: • Understood the value of their role in ACP process with residents • Expressed being more prepared with knowledge & tools/resources • Reported increased confident to start conversations, not merely inform • Aimed to improve practice & desire to teach others; some succeeded Limitations: Small sample, no control group, RN in management/specialty roles, all belong to same employer, low 30-day data • Confidence, comfort & knowledge significantly increased over time • Low variances observed between participant responses in knowledge • Initial baseline was lowest in confidence & highest in attitude • Knowledge continued to increase with simulation T1 to T3 T1 to T4 Recommendations: Larger sample size, multiple practice sites, varying RN roles, address challenges/concerns, validate qualitative data, urge training across RN settings (basic training to continuing education) CONCLUSION ACP RN training has the potential to enhance a resident’s life quality if: • Delivered systematically (cognitive process practice) • More attention is given to knowledge tools, resources & the “how” process • RN responsibility is clarified & improved practice is emphasized |
