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Nursing home manager's knowledge, attitudes and beliefs about advance care planning for people with dementia in long-term care settings: a cross-sectional survey.
J Clin Nurs. 2017 Sep; 26(17-18):2633-2645.JC

Abstract

AIMS AND OBJECTIVES

To examine nursing home managers' knowledge, attitudes, beliefs and current practice regarding advance care planning for people with dementia in long-term care settings informed by the theory of planned behaviour.

BACKGROUND

Internationally, advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective. This study reports on their role with regard to advance care planning and the perceived factors which influence this.

DESIGN

A cross-sectional postal survey was carried out as part of a larger scale sequential explanatory mixed-methods study between January-March 2015.

SETTING AND PARTICIPANTS

Nursing home managers in a region in the UK (n = 178).

RESULTS

A response rate of 66% (n = 116) was achieved. Nursing home managers demonstrated a lack of knowledge of advance care planning, with negative attitudes underpinned by concerns regarding the capacity and lack of perceived benefits to the person with dementia. Currently, they do not view advance care planning as part of their role, with lack of ownership impacting upon current practice behaviours.

CONCLUSIONS

Whilst nursing home managers recognise the potential benefits of advance care planning, barriers and challenges create a reluctance to facilitate. Targeted training to address the knowledge deficit is required, with the wider components of advance care planning promoted. There is a need for greater role clarification to ensure nurses in long-term care settings identify with the process in the future. A gap between rhetoric and reality of implementation is evident; therefore, long-term care settings must critically examine system, organisational and individual factors for failure to implement advance care planning for people with dementia.

RELEVANCE TO CLINICAL PRACTICE

Increased cognisance of the context in which advance care planning takes place is vital for improved implementation in this context. In addition strong nursing leadership is imperative to facilitate initiation, engagement and re-evaluation of the process of advance care planning.

Authors+Show Affiliations

Institute of Nursing and Health Research, University of Ulster, Newtownabbey, UK.All Ireland Institute of Hospice and Palliative Care, University of Ulster, Newtownabbey, UK.University of Ulster, Belfast, UK.University of Ulster and Bamford Centre for Mental Health, Londonderry, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27995678

Citation

Beck, Esther-Ruth, et al. "Nursing Home Manager's Knowledge, Attitudes and Beliefs About Advance Care Planning for People With Dementia in Long-term Care Settings: a Cross-sectional Survey." Journal of Clinical Nursing, vol. 26, no. 17-18, 2017, pp. 2633-2645.
Beck ER, McIlfatrick S, Hasson F, et al. Nursing home manager's knowledge, attitudes and beliefs about advance care planning for people with dementia in long-term care settings: a cross-sectional survey. J Clin Nurs. 2017;26(17-18):2633-2645.
Beck, E. R., McIlfatrick, S., Hasson, F., & Leavey, G. (2017). Nursing home manager's knowledge, attitudes and beliefs about advance care planning for people with dementia in long-term care settings: a cross-sectional survey. Journal of Clinical Nursing, 26(17-18), 2633-2645. https://doi.org/10.1111/jocn.13690
Beck ER, et al. Nursing Home Manager's Knowledge, Attitudes and Beliefs About Advance Care Planning for People With Dementia in Long-term Care Settings: a Cross-sectional Survey. J Clin Nurs. 2017;26(17-18):2633-2645. PubMed PMID: 27995678.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nursing home manager's knowledge, attitudes and beliefs about advance care planning for people with dementia in long-term care settings: a cross-sectional survey. AU - Beck,Esther-Ruth, AU - McIlfatrick,Sonja, AU - Hasson,Felicity, AU - Leavey,Gerry, Y1 - 2017/02/09/ PY - 2016/12/03/accepted PY - 2016/12/21/pubmed PY - 2017/12/19/medline PY - 2016/12/21/entrez KW - advance care planning KW - attitudes KW - cognitive impairment KW - dementia KW - knowledge KW - long-term care settings: Nursing Homes KW - nurses KW - practice SP - 2633 EP - 2645 JF - Journal of clinical nursing JO - J Clin Nurs VL - 26 IS - 17-18 N2 - AIMS AND OBJECTIVES: To examine nursing home managers' knowledge, attitudes, beliefs and current practice regarding advance care planning for people with dementia in long-term care settings informed by the theory of planned behaviour. BACKGROUND: Internationally, advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective. This study reports on their role with regard to advance care planning and the perceived factors which influence this. DESIGN: A cross-sectional postal survey was carried out as part of a larger scale sequential explanatory mixed-methods study between January-March 2015. SETTING AND PARTICIPANTS: Nursing home managers in a region in the UK (n = 178). RESULTS: A response rate of 66% (n = 116) was achieved. Nursing home managers demonstrated a lack of knowledge of advance care planning, with negative attitudes underpinned by concerns regarding the capacity and lack of perceived benefits to the person with dementia. Currently, they do not view advance care planning as part of their role, with lack of ownership impacting upon current practice behaviours. CONCLUSIONS: Whilst nursing home managers recognise the potential benefits of advance care planning, barriers and challenges create a reluctance to facilitate. Targeted training to address the knowledge deficit is required, with the wider components of advance care planning promoted. There is a need for greater role clarification to ensure nurses in long-term care settings identify with the process in the future. A gap between rhetoric and reality of implementation is evident; therefore, long-term care settings must critically examine system, organisational and individual factors for failure to implement advance care planning for people with dementia. RELEVANCE TO CLINICAL PRACTICE: Increased cognisance of the context in which advance care planning takes place is vital for improved implementation in this context. In addition strong nursing leadership is imperative to facilitate initiation, engagement and re-evaluation of the process of advance care planning. SN - 1365-2702 UR - https://www.unboundmedicine.com/medline/citation/27995678/Nursing_home_manager's_knowledge_attitudes_and_beliefs_about_advance_care_planning_for_people_with_dementia_in_long_term_care_settings:_a_cross_sectional_survey_ L2 - https://doi.org/10.1111/jocn.13690 DB - PRIME DP - Unbound Medicine ER -