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Davy C, Windle A, Marshall A, Harvey G. Leading the way: implementing aged care innovations. JBI Evid Implement 2024:02205615-990000000-00132. [PMID: 39291725 DOI: 10.1097/xeb.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
OBJECTIVES The objective of this study was to identify the key characteristics of leaders that support the implementation of innovations in aged care settings. METHODS We conducted a secondary analysis of papers from a large scoping review that identified how leaders supported the implementation of innovations in aged care. Once imported into NVivo12, the findings were deductively coded using the domains of Bloom's taxonomy of learning. Each parent code was then inductively analyzed to identify key characteristics within each domain. RESULTS Our review identified four types of knowledge, five skills, and six attitudes that leaders should exhibit to better support the implementation of innovations within aged care settings. In addition to our findings regarding Bloom's learning domains, we identified nine leadership behaviors that participants in the included papers perceived as valuable for enhancing the implementation process. Furthermore, we identified four key organizational elements that support leaders in navigating and facilitating the implementation of innovations within aged care settings. CONCLUSION Our review identified the characteristics that leaders should demonstrate when supporting the implementation of innovations in aged care. Importantly, our findings also emphasized the changing role of leadership from a hierarchical approach to a more collaborative, supportive, and empowering style. The insights identified in this review will help to guide aged care leaders, stressing the significance of adaptable and relational leadership styles that will guide the implementation of innovations within the aged care sector. SPANISH ABSTRACT http://links.lww.com/IJEBH/A271.
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Affiliation(s)
- Carol Davy
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Alice Windle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Marshall
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Davy CP, Windle A, Harvey G. Fostering an aged care organizational culture that supports innovation. JBI Evid Implement 2024:02205615-990000000-00131. [PMID: 39291719 DOI: 10.1097/xeb.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
AIM This study aimed to identify how aged care organizations can foster a culture that supports the implementation of innovation. INTRODUCTION The aged care sector must innovate to meet clients' evolving needs and increased regulatory requirements. Given the need to account for the values, beliefs, expectations, and assumptions held by a diverse range of stakeholders, implementing innovations within aged care can be exceptionally complex. Fostering a supportive organizational culture can facilitate the implementation of these critical innovations. METHODS Papers from a large scoping review that identified organizational culture as a barrier and/or enabler to implementing innovations in aged care were imported into NVivo. Data relating to how organizations fostered (or could foster) a culture that supported the implementation of innovations were then extracted, inductively coded, interpreted, and grouped into approaches. RESULTS Of the 193 papers from the original scoping review, 109 were included in this secondary analysis. From these 109 papers, we identified six key approaches: cultivating collaboration; valuing contributions; ensuring alignment between the organizational vision, culture, and innovation; demonstrating organizational commitment; developing and communicating the implementation plan; and accounting for stability. CONCLUSIONS Our study outlines effective approaches that can be used by aged care organizations to cultivate a culture that supports the implementation of innovations. However, these approaches should not be viewed in isolation; rather, they are interconnected and mutually reinforcing. Together, these insights offer practical guidance for aged care entities seeking to adapt and evolve through innovation implementation. SPANISH ABSTRACT http://links.lww.com/IJEBH/A264.
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Affiliation(s)
- Carol Patricia Davy
- Aged Care Research and Industry Innovation Australia, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Alice Windle
- Aged Care Research and Industry Innovation Australia, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Aged Care Research and Industry Innovation Australia, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Royani, Hamid AYS, Rekawati E, Darmawan ES. Exploring the implementation of multidisciplinary collaboration at nursing homes in Jakarta, Indonesia: A descriptive phenomenological study. BELITUNG NURSING JOURNAL 2024; 10:332-340. [PMID: 38947308 PMCID: PMC11211744 DOI: 10.33546/bnj.3226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/21/2024] [Accepted: 04/16/2024] [Indexed: 07/02/2024] Open
Abstract
Background A well-functioning multidisciplinary team optimizes resource utilization and reduces care redundancy, fragmentation, and wastage. Collaborative efforts yield a clearer understanding of older people's needs and desires, significantly reducing hospitalization days. Despite limited studies, particularly in Indonesia, investigating professionals' experiences in implementing multidisciplinary collaboration in government nursing homes, nursing care quality remains a concern. Objective This study aimed to explore the implementation of multidisciplinary collaboration in nursing homes from the perspectives of various disciplines. Methods A descriptive phenomenological study was used with semi-structured interviews and focus group discussions with multidisciplinary care providers, including nurses, doctors, social workers, physiotherapists, psychologists, occupational and recreational activity instructors, and clergy in nursing homes owned by the Jakarta provincial government. A total of 64 participants were involved, and data were collected from September 2022 to July 2023. Data were analyzed using content-based analysis. Results Three main themes emerged: 1) context of multiple collaborations, 2) barriers to implementing multiple collaborations, and 3) impacts of non-optimal multidisciplinary collaborations. Nursing home management's multidisciplinary teams predominantly implement professional-centered care with limited support systems. While providers generally perceive collaboration positively, shared responsibility and joint work among professionals are lacking. Conclusion This study highlights the need to improve multidisciplinary collaboration in nursing homes to enhance care quality for older individuals. While providers view collaboration positively, barriers like a lack of shared responsibility and joint work persist. Enhancing teamwork cohesion through improved communication and integrated case reporting systems is crucial. Addressing human resource and systemic barriers is also vital. By overcoming these challenges, nursing homes can optimize resource use, reduce care redundancy, and better meet the diverse needs of older residents.
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Affiliation(s)
- Royani
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
- Sekolah Tinggi Ilmu Kesehatan Banten, Banten, Indonesia
| | | | - Etty Rekawati
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Ede Surya Darmawan
- Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
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Hillebrecht AL, Höfer K, Blasi A, Wicht MJ, Barbe AG. Comparison of facilitators and barriers to providing oral hygiene measures in dependent older people and young children: A systematic review. Gerodontology 2024; 41:111-124. [PMID: 36924414 DOI: 10.1111/ger.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The objective of the study was to systematically compare barriers/facilitators providing oral hygiene to young children and dependent older people and to generate ideas to improve the implementation of oral hygiene measures. BACKGROUND Many older people, like children, rely on third-party assistance for teeth cleaning. Barriers/facilitators in providing oral care services have been described in recent works. The aim of our study was to compare these results for both groups and to increase knowledge on analogies/differences in barriers/intermediaries. METHODS We performed a systematic review. Studies reporting on knowledge, attitudes and beliefs acting as barriers/facilitators for provision of teeth cleaning were included. Thematic analysis was used and identified themes translated to domains and constructs of the theoretical domains framework and aligned to the behaviour change wheel. Based on three published reviews in children or older people, our search (PubMed via Medline), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science, Google Scholar, last search (21 January 2023) encompassed both populations dated from their last publication (28 February 2018). The review was registered (Prospero, CRD42021278944). For quality assessment, the Newcastle-Ottawa Scale (NOS) was used. RESULTS Seventeen articles were identified (older people (n = 8), children (n = 9)). Deficits exist for both in terms of "knowledge/skills" among caregivers, with special difficulties in children with challenging behaviour and older people. "Capability" as one of the main elements of behavioural factors that are the basis for behaviour to take place (COM-B, Capability, Opportunity, Motivation-Behaviour) is most often mentioned for children and "opportunity" for older people. CONCLUSIONS Most of the facilitators and barriers affecting oral care provision in children are also relevant in older people. Approaches for the development of strategies for better implementation of oral hygiene measures in older people are presented.
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Affiliation(s)
- Anna-Lena Hillebrecht
- Department of Prosthetic Dentistry, Centre for Dental Medicine, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Karolin Höfer
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
| | - Alicia Blasi
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
| | - Michael J Wicht
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
| | - Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
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Windle A, Marshall A, de la Perrelle L, Champion S, Ross PD, Harvey G, Davy C. Factors that influence the implementation of innovation in aged care: a scoping review. JBI Evid Implement 2023; 22:02205615-990000000-00072. [PMID: 38153118 PMCID: PMC11163893 DOI: 10.1097/xeb.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care. INTRODUCTION Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care. INCLUSION CRITERIA This review included studies of any design, that examined the implementation of innovations in aged care settings. METHODS Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops. RESULTS Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies. CONCLUSIONS Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.
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Affiliation(s)
- Alice Windle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Marshall
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Lenore de la Perrelle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Stephanie Champion
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Paul D.S. Ross
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Carol Davy
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Stensvik GT, Helvik AS, Haugan G, Steinsbekk A, Salvesen Ø, Nakrem S. The short-term effect of a modified comprehensive geriatric assessment and regularly case conferencing on neuropsychiatric symptoms in nursing homes: a cluster randomized trial. BMC Geriatr 2022; 22:316. [PMID: 35410145 PMCID: PMC8996560 DOI: 10.1186/s12877-022-02976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Aims To investigate the short-term effect of implementing a modified comprehensive geriatric assessment and regularly case conferencing in nursing homes on neuropsychiatric symptoms. Background Neuropsychiatric symptoms are common and may persist over time in nursing home residents. Evidence of effective interventions is scarce. Design A parallel cluster-randomised controlled trial. Methods The intervention was monthly standardised case conferencing in combination with a modified comprehensive geriatric assessment. The control group received care as usual. Main outcome measure. The total score on the short version of the Neuropsychiatric Inventory (NPI-Q, 12-items). Results A total of 309 residents at 34 long-term care wards in 17 nursing homes (unit of randomisation) were included. The intervention care units conducted on average two case conference-meetings (range 1–3), discussing a mean of 4.8 (range 1–8) residents. After 3 months, there were no difference of NPI-Q total score between the intervention (-0.4) and the control group (0.5) (estimated mean difference = -1.0, 95% CI -2.4 to 0.5, p = 0.19). There was a difference in favour of the intervention group on one of the secondary outcome measures, the apathy symptoms (-0.5 95% CI: -0.9 to -0.1, p = 0.03). Conclusion In this study there were no short-term effect of case conferencing and modified comprehensive geriatric assessments after three months on the total score on neuropsychiatric symptoms. The intervention group had less apathy at 3 months follow-up compared to those receiving care as usual. The findings suggest that a more comprehensive intervention is needed to improve the total Neuropsychiatric symptoms burden and complex symptoms. Trial registration Due to delays in the organisation, the study was registered after study start, i.e. retrospectively in Clinicaltrials.gov # NCT02790372 at https://clinicaltrials.gov/; Date of clinical trial registration: 03/06/2016.
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Affiliation(s)
- Geir-Tore Stensvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Gørill Haugan
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian Centre for E-health Research, Tromsø, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Mjørud M, Røsvik J. You can tell it works - Experiences from using the VIPS practice model in primary healthcare. DEMENTIA 2021; 21:579-594. [PMID: 34854785 DOI: 10.1177/14713012211053979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Person-centred care is a philosophy rather than a method ready for implementation and utilization in daily clinical work. Internationally, few methods for person-centred care have been widely adopted in clinical dementia care practice. In Norway, the VIPS practice model is one that is commonly used for the implementation and use of person-centred care in primary healthcare. METHOD Nursing home physicians, managers and leaders in the municipalities, care institutions and domestic nursing care services were eligible for inclusion if their workplace had implemented and used the VIPS practice model for a minimum of 12 months. Individual interviews were conducted via Facetime, Skype or telephone and analysed with qualitative content analysis. FINDINGS In all, 20 respondents were included: one manager of health and care services in the municipality, six managers and leaders working in domestic care or daytime activity centres and 10 managers/leaders and three physicians working in nursing homes. Two global categories emerged: category 1: Change in staff's professional reasoning with two sub-categories: (a) an enhanced professional level in discussions and (b) a change in focus from task to person; and category 2: Changes in the clinical work, with three sub-categories: (a) effective interventions, (b) a person-centred work environment and (c) changes in cooperation between stakeholders. CONCLUSION Regular use of the VIPS practice model appeared to change the work culture for the benefit of both service users and frontline staff. Increased cooperation between frontline staff, nurses, physicians and next of kin was described. Staff were more focused on the needs of the service users, which resulted in care interventions tailored to the needs of the individual with dementia, loyalty to care plans and fewer complaints from next of kin.
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Affiliation(s)
- Marit Mjørud
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Janne Røsvik
- 60512Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Teupen S, Holle D, Roes M. Types of implementation of the dementia-specific case conference concept WELCOME-IdA in nursing homes: a qualitative process evaluation of the FallDem effectiveness trial. Implement Sci Commun 2021; 2:90. [PMID: 34407887 PMCID: PMC8371834 DOI: 10.1186/s43058-021-00191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Dementia is regularly associated with behavioral and psychological symptoms of dementia (BPSD, also referred to as challenging behavior). Structured dementia-specific case conferences (DSCCs) enable nursing staff in nursing homes (NHs) to analyze and handle the BPSD of residents with dementia. The FallDem trial estimated the effectiveness of the structured DSCC intervention WELCOME-IdA (Wittener model of case conferences for people with dementia – the Innovative dementia-oriented Assessment tool) in NHs in Germany. No significant change in the overall prevalence of challenging behavior was found. A multipart process evaluation was conducted to explain this result. Methods This qualitative process evaluation of the response of individuals, perceived maintenance, effectiveness, and unintended consequences was part of the multipart process evaluation that followed the framework by Grant et al. (Trials 14: 15, 2013). It used the data from semi-structured telephone interviews and focus group interviews with nurses and managers as secondary data. Selected domains of the Consolidated Framework for Implementation Research (CFIR) were used as deductive categories for a directed content analysis. Results The interviewees in all NHs appraised WELCOME-IdA as generating positive change, although it proved important that some adjustments were made to the intervention and the organization. Thirteen CFIR constructs out of the domains intervention characteristics, inner setting, and process proved to be essential for understanding the different course that the implementation of WELCOME-IdA took in each of the four NHs. This is reflected in three types of WELCOME-IdA implementation: (1) priority on adjusting the intervention to fit the organization, (2) priority on adjusting the organization to fit the intervention, and (3) no setting of priorities in adjusting either the organization or the intervention. Conclusion The unsatisfying results of the FallDem effectiveness trial can in part be explained with regard to the interplay between the intervention and the implementation which was revealed in the processes that occurred in the organizations during the implementation of the WELCOME-IdA intervention. Future implementation of WELCOME-IdA should be tailored based on an analysis of the organization’s readiness, resources, and capacities and should also define custom-made intervention and implementation outcomes to measure success. Furthermore, our results confirm that the CFIR can be used beneficially to conduct process evaluations. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00191-0.
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Affiliation(s)
- Sonja Teupen
- German Center for Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany. .,School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Daniela Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany.,Department of Nursing Science, University of Applied Sciences (HS Gesundheit), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Martina Roes
- German Center for Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany.,School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
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Rainsford S, Hall Dykgraaf S, Kasim R, Phillips C, Glasgow N. 'Traversing difficult terrain'. Advance care planning in residential aged care through multidisciplinary case conferences: A qualitative interview study exploring the experiences of families, staff and health professionals. Palliat Med 2021; 35:1148-1157. [PMID: 34015973 PMCID: PMC8189000 DOI: 10.1177/02692163211013250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Advance care planning improves the quality of end-of-life care for older persons in residential aged care; however, its uptake is low. Case conferencing facilitates advance care planning. AIM To explore the experience of participating in advance care planning discussions facilitated through multidisciplinary case conferences from the perspectives of families, staff and health professionals. DESIGN A qualitative study (February-July 2019) using semi-structured interviews. SETTING Two residential aged care facilities in one Australian rural town. PARTICIPANTS Fifteen informants [family (n = 4), staff (n = 5), health professionals (n = 6)] who had participated in advance care planning discussions facilitated through multidisciplinary case conferences. RESULTS Advance care planning was like navigating an emotional landscape while facing the looming loss of a loved one. This emotional burden was exacerbated for substitute decision-makers, but made easier if the resident had capacity to be involved or had previously made their wishes clearly known. The 'conversation' was not a simple task, and required preparation time. Multidisciplinary case conferences facilitated informed decision-making and shared responsibility. Opportunity to consider all care options provided families with clarity, control and a sense of comfort. This enabled multiple stakeholders to bond and connect around the resident. CONCLUSION While advance care planning is an important element of high quality care it involves significant emotional labour and burden for families, care staff and health professionals. It is not a simple administrative task to be completed, but a process that requires time and space for reflection and consensus-building to support well-considered decisions. Multidisciplinary case conferences support this process.
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Affiliation(s)
- Suzanne Rainsford
- Rural Clinical School, Medical School, Australian National University, Canberra, ACT, Australia.,Clare Holland House, Calvary Health Care Bruce, Canberra, ACT, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, Medical School, Australian National University, Canberra, ACT, Australia
| | - Rosny Kasim
- Rural Clinical School, Medical School, Australian National University, Canberra, ACT, Australia
| | - Christine Phillips
- Medical School, Australian National University, Canberra, ACT, Australia
| | - Nicholas Glasgow
- Clare Holland House, Calvary Health Care Bruce, Canberra, ACT, Australia.,Medical School, Australian National University, Canberra, ACT, Australia
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Rainsford S, Hall Dykgraaf S, Kasim R, Phillips C, Glasgow N. Strengthening advance care planning in rural residential aged care through multidisciplinary educational case conferences: A hybrid implementation-effectiveness study. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1872136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Suzanne Rainsford
- Rural Clinical School, Medical School, Australian National University, Canberra, Australia
- Clare Holland House, Calvary Health Care Bruce, Canberra, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, Medical School, Australian National University, Canberra, Australia
| | - Rosny Kasim
- Rural Clinical School, Medical School, Australian National University, Canberra, Australia
| | | | - Nicholas Glasgow
- Clare Holland House, Calvary Health Care Bruce, Canberra, Australia
- Medical School, Australian National University, Canberra, Australia
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