Advance care planning in residential aged care facilities

Blackford, Jeanine; Strickland, Elizabeth; Morris, Bridget

doi:10.5172/conu.2007.27.1.141

Cited by 26 publications

(59 citation statements)

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“…Education in SDM was not a focus of any of the articles retrieved, however, many of them utilised education to execute and embed models of care [30] [43] or enact organisational change to adopt new processes [44] [45] and are thus particularly relevant to SDM in RAC if it is to be implemented.…”

Section: Educationmentioning

confidence: 99%

“…There were six articles concerned with the components of documentation, communication and execution of care in RAC settings, three articles used a quantitative research design [29] [33] [44], a case study [45], and three used qualitative methodology [29]. Arendts et al [29] provides perspectives of staff, residents and families, while the other articles focus on staff [34] [44] or families [33] alone, or is purely descriptive [45].…”

Section: Documentation Communication and Enactmentmentioning

confidence: 99%

“…Barriers to execution of wishes include a lack of documented resident preferences [33], or inadequate planning and communication [29]. Systematic operationalization of an intervention requires regular and ongoing education of all stakeholders [44] as well as auditing of existing processes, policies and strategic planning about organisational changes that may be required for success [28] [37]. High staff turn-over and changes to management of RAC is a threat to sustainability of interventions [44].…”

Section: Documentation Communication and Enactmentmentioning

confidence: 99%

“…Systematic operationalization of an intervention requires regular and ongoing education of all stakeholders [44] as well as auditing of existing processes, policies and strategic planning about organisational changes that may be required for success [28] [37]. High staff turn-over and changes to management of RAC is a threat to sustainability of interventions [44]. Blackford et al [44] describe a system-wide approach to documentation, communication and dissemination of a residents wishes as paramount to success.…”

Section: Documentation Communication and Enactmentmentioning

confidence: 99%

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Shared Decision Making in Residential Aged Care: A Framework Synthesis

Ervin¹,

Blackberry²,

Haines³

2017

OJN

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Very little is known about shared decision making (SDM) in residential aged care, despite world-wide policy and imperatives that encourage resident choice and autonomy. This paper provides a framework synthesis of SDM in residential aged care (RAC) and potential barriers and enablers to implement SDM utilising a theoretical framework of implementation. A review of the literature on SDM in RAC from 2005 to 2016 was undertaken, using MEDLINE (Ovid), CINAHL, PsychINFO and Scopus. The articles were synthesised by utilising an implementation theory framework to better understand what may facilitate or hinder the introduction of SDM. Eighteen studies were identified and analysed to determine barriers and enablers to SDM in RAC from the perspectives of staff, residents and relatives. A workplace culture of person-centred care and judicious use of research evidence are enablers of SDM. There is a potential need for additional resources, such as education for staff and families to enable implementation of SDM. Implementation of any health care intervention, including SDM, relies on many complex factors but these are predominantly related to capacity. Determining current uptake and readiness of RAC organisations, residents and their families to adopt SDM is an essential starting point.

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Section: Educationmentioning

confidence: 99%

Section: Documentation Communication and Enactmentmentioning

confidence: 99%

Section: Documentation Communication and Enactmentmentioning

confidence: 99%

Section: Documentation Communication and Enactmentmentioning

confidence: 99%

See 2 more Smart Citations

Shared Decision Making in Residential Aged Care: A Framework Synthesis

Ervin¹,

Blackberry²,

Haines³

2017

OJN

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“…Those residents without an AD were more likely to die in acute care than those with; and those with legal or informal ADs that died in acute care had shorter length of stays. 19 Each AD represented~9.2 hospital occupied bed-days avoided at the end of life (J. Field, TQEH, unpubl.…”

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confidence: 99%

Health advance directives, policy and clinical practice: a perspective on the synergy of an effective advance care planning framework

Seal¹

2010

Aust. Health Review

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The delivery of quality care at the end of life should be seamless across all health care settings and independent from variables such as institutional largeness, charismatic leadership, funding sources and blind luck . . . People have come to fear the prospect of a technologically protracted death or abandonment with untreated emotional and physical stress. (Field and Castle cited in Fins et al.,. 1 Australians are entitled to plan in advance the medical treatments they would allow in the event of incapacity using advance directives (ADs). A critical role of ADs is protecting people from unwanted inappropriate cardiopulmonary resuscitation (CPR) at the end stage of life. Generally, ADs are enacted in the context of medical evaluation. However, first responders to a potential cardiac arrest are often non-medical, and in the absence of medical instruction, default CPR applies. However, the efficacy of AD CPR refusal depends on the synergy of prevailing AD legislation and ensuing policy. When delivery fails, then democratic AD law is bypassed by paradigms such as the Physician Orders for Life-Sustaining Treatment (POLST) community form, as flagged in Australian Resuscitation Council guidelines. 2 Amidst Australian AD review and statute reform this paper offers a perspective on the attributes of a working AD model, drawing on the Respecting Patient Choices Program (RPCP) experience at The Queen Elizabeth Hospital (TQEH) under SA law. The SA Consent to Medical Treatment and Palliative Care Act 1995 and its 'Anticipatory Direction' has been foundational to policy enabling non-medical first responders to honour ADs when the patient is at the end stage of life with no real prospect of recovery. 3 The 'Anticipatory Direction' provision stands also to direct appointed surrogate decision-makers. It attunes with health discipline ethics codes; does not require a pre-existing medical condition and can be completed independently in the community. Conceivably, the model offers a national AD option, able to deliver AD CPR refusals, as an adjunct to existing common law and statute provisions. This paper only represents the views of the author and it does not constitute legal advice.What is known about the topic? Differences in advance directive (AD) frameworks across Australian states and territories and between legislated and common law can be confusing. 4 Therefore, health professionals need policy clarifying their expected response. Although it is assumed that ADs, including CPR refusals at the end of life will be respected, unless statute legislation is conducive to policy authorising that non-medical first responders to an emergency can observe clear AD CPR refusals, the provision may be ineffectual. Inappropriate, unwanted CPR can render a person indefinitely in a condition they may have previously deemed intolerable. Such intervention also causes distress to staff and families and ties up resources in high demand settings. What does this paper add? That effectual AD law needs to not only enshrine the rights of in...

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Advance Care Planning and Dying in Nursing Homes in Flanders, Belgium: A Nationwide Survey

Gendt

Bilsen

Stichele

et al. 2013

Journal of Pain and Symptom Management

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Prevalence of ACPs and formal authorization of a legal representative was low among the deceased NH residents in Flanders, Belgium. There was a higher prevalence of physicians' orders, often established after the resident had lost capacity. Initiatives should be developed to stimulate more advance discussion on care options and making end-of-life decision with the residents while they retain capacity.

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Advance care planning in residential aged care facilities

Cited by 26 publications

References 0 publications

Shared Decision Making in Residential Aged Care: A Framework Synthesis

Shared Decision Making in Residential Aged Care: A Framework Synthesis

Health advance directives, policy and clinical practice: a perspective on the synergy of an effective advance care planning framework

Advance Care Planning and Dying in Nursing Homes in Flanders, Belgium: A Nationwide Survey

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