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• W3107487918 abstract "To describe advance care planning in nursing homes when residents with cognitive impairment and/or their next of kin participated and identify associated challenges. A qualitative study of nine advance care planning conversations in four Norwegian nursing home wards. During the implementation of advance care planning, we purposively sampled residents with cognitive impairment, their next of kin and healthcare personnel. The implementation followed a “whole-ward” approach aimed at involving the whole ward in fostering an inclusive, holistic advance care planning discussion. Involving as many residents as possible, preferably together with their next of kin, were central. From observed and audio-recorded advance care planning conversations that took place from November 2015 to June 2016, we conducted a thematic analysis of the transcripts and field notes. Reporting adhered to the COREQ guidelines. Residents actively relayed their preferences regarding healthcare and end-of-life issues, despite the cognitive impairment. Next of kin provided constructive support and conversations were largely resident-focused. However, involving residents was also challenging, findings included: residents’ preferences were often vague, relevant medical information from healthcare personnel lacked and the next of kin were sometimes unaware of the resident's previously held preferences. Moreover, residents tended to focus more on the past and present than the future end-of-life care. Residents with cognitive impairment can participate actively and meaningfully in advance care planning, if the healthcare personnel actively listens. However, several challenges can arise. Supported decision-making can improve communication and resident involvement, reinforcing a relational understanding of autonomy. Persons with cognitive impairment should be invited to participate in advance care planning. Their participation may make its benefits and more person-centred care attainable to persons that are often not involved. Successful involvement of persons with cognitive impairment in advance care planning may rely on robust implementation. 对认知障碍养老院患者和/或其近亲参与的养老院预先护理计划进行说明,并确定相关的挑战。 针对四家挪威养老院的9项预先护理计划中的医患对话进行定性研究。在该计划的实施过程中,我们针对性地对有认知障碍的养老院患者、其近亲和医护人员进行了抽样调查。过程遵循“整体病房”的方法,旨在让整个病房参与讨论,提高预先护理计划的包容性、整体性。该计划的重点在于,让尽可能多的养老院患者,最好是和他们的近亲一起参与进来。 根据2015年11月至2016年6月期间观察和录音的预先护理计划对话,我们对转录物和现场记录进行主题分析。报告内容应符合COREQ指南。 尽管存在认知障碍,养老院患者仍积极传达了其对医疗保健和临终事项的偏好。亲属也提供了建设性的支持,而本次谈话主要以养老院患者为中心。然而,相关养老院患者同样面临挑战,调查结果包括:大部分情况下,养老院患者偏好模糊,医护人员缺乏相关医疗信息,亲属可能并不熟悉养老院患者过去的相关偏好。此外,养老院患者往往更关注过去和现在,而不是未来的临终关怀。 如果医护人员积极倾听,有认知障碍的养老院患者就可以积极、有意义地参与预先护理计划。然而,可能出现部分挑战。决策支持可用于改善沟通和养老院患者参与情况,强化养老院患者对自治关系的理解。 应邀请认知障碍患者参与预先护理计划。参与后,其可获益,并且,未参与的人员有机会获得更多以人为本的护理服务。如需确保认知障碍患者成功参与预先护理计划,应采取强有力的措施。 The peer review history for this article is available at https://publons.com/publon/10.1111/jan.14661." @default.
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• W3107487918 date "2020-11-24" @default.
• W3107487918 modified "2023-09-23" @default.
• W3107487918 title "Nursing home residents with cognitive impairment can participate in advance care planning: A qualitative study" @default.
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• W3107487918 doi "https://doi.org/10.1111/jan.14661" @default.
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