Training Nursing Home Staff in Advance Care Planning Using Medical Orders for Scope of Treatment

2015 ◽  
Vol 16 (3) ◽  
pp. B15
Author(s):  
Preetkanwal Brar ◽  
Preetkanwal Brar ◽  
Amity Onders ◽  
Elizabeth Gatten ◽  
Amelia Kiser ◽  
...  
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Care Planning ◽  
Nursing Home Staff ◽  
Advance Care

scholarly journals Advance care planning in nursing homes: new conversation and documentation tools

2021 ◽  
pp. bmjspcare-2021-003008
Author(s):  
Annelien Wendrich-van Dael ◽  
Joni Gilissen ◽  
Liesbeth Van Humbeeck ◽  
Luc Deliens ◽  
Robert Vander Stichele ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Advance Care Planning ◽  
Healthcare Professionals ◽  
Nursing Home Residents ◽  
Care Staff ◽  
Care Planning ◽  
Nursing Home Staff ◽  
Advance Care ◽  
Context Specific

Although advance care planning (ACP) is highly relevant for nursing home residents, its uptake in nursing homes is low. To meet the need for context-specific ACP tools to support nursing home staff in conducting ACP conversations, we developed the ACP+intervention. At its core, we designed three ACP tools to aid care staff in discussing and documenting nursing home resident’s wishes and preferences for future treatment and care: (1) an extensive ACP conversation guide, (2) a one-page conversation tool and (3) an ACP document to record outcomes of conversations. These nursing home-specific ACP tools aim to avoid a purely document-driven or ‘tick-box’ approach to the ACP process and to involve residents, including those living with dementia according to their capacity, their families and healthcare professionals.

scholarly journals Differences in advance care planning among nursing home care staff

2021 ◽  
pp. 096973302199418
Author(s):  
Gilissen Joni ◽  
Wendrich-van Dael Annelien ◽  
Gastmans Chris ◽  
Vander Stichele Robert ◽  
Deliens Luc ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Confidence Interval ◽  
Advance Care Planning ◽  
Self Efficacy ◽  
Odds Ratio ◽  
Mean Difference ◽  
Care Staff ◽  
Care Planning ◽  
Advance Care

Background A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. Objectives To examine to what extent engagement in advance care planning practices (e.g. conversations, advance directives), knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. Design Survey study. Participants/setting The study involved a purposive sample of 14 nursing homes in Flanders, Belgium. Nurses, care assistants and allied care staff (e.g. social workers, physical therapists) completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels (B.U.N. 143201834759), as part of a cluster randomized controlled trial (clinicaltrials.gov NCT03521206). Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated (67% response rate). After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations (odds ratio 4; 95% confidence interval 1.73–9.82; p < 0.001) and documented advance care planning (odds ratio 2.67; 95% confidence interval 1.29–5.56; p < 0.001); differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses (estimated mean difference 0.13 (score range 0–1); 95% confidence interval 0.08–0.17; p < 0.001) and allied staff (estimated mean difference 0.07; 95% confidence interval 0.03–0.12; p < 0.001) scoring higher than care assistants. We found no significant differences regarding self-efficacy. Discussion While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. Conclusions Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage.

scholarly journals Nursing Home Characteristics Associated With Implementation of an Advance Care Planning Video Intervention

2019 ◽  
Vol 20 (7) ◽  
pp. 804-809.e1 ◽  
Author(s):  
Lacey Loomer ◽  
Ellen McCreedy ◽  
Emmanuelle Belanger ◽  
Jennifer A. Palmer ◽  
Susan L. Mitchell ◽  
...  
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Care Planning ◽  
Video Intervention ◽  
Advance Care

scholarly journals PRagmatic trial Of Video Education in Nursing homes: The design and rationale for a pragmatic cluster randomized trial in the nursing home setting

2017 ◽  
Vol 14 (2) ◽  
pp. 140-151 ◽  
Author(s):  
Vincent Mor ◽  
Angelo E Volandes ◽  
Roee Gutman ◽  
Constantine Gatsonis ◽  
Susan L Mitchell
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Advance Care Planning ◽  
Pragmatic Trial ◽  
Healthcare Systems ◽  
Care Planning ◽  
Home Setting ◽  
Randomized Controlled ◽  
Advance Care ◽  
Video Education

Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the “real world” application of an Advance Care Planning Video Program in two large US nursing home healthcare systems. Methods PRagmatic trial Of Video Education in Nursing homes was conducted in 360 nursing homes (N = 119 intervention/N = 241 control) owned by two healthcare systems. Over an 18-month implementation period, intervention facilities were instructed to offer the Advance Care Planning Video Program to all patients. Control facilities employed usual advance care planning practices. Patient characteristics and outcomes were ascertained from Medicare Claims, Minimum Data Set assessments, and facility electronic medical record data. Intervention adherence was measured using a Video Status Report embedded into electronic medical record systems. The primary outcome was the number of hospitalizations/person-day alive among long-stay patients with advanced dementia or cardiopulmonary disease. The rationale for the approaches to facility randomization and recruitment, intervention implementation, population selection, data acquisition, regulatory issues, and statistical analyses are discussed. Results The large number of well-characterized candidate facilities enabled several unique design features including stratification on historical hospitalization rates, randomization prior to recruitment, and 2:1 control to intervention facilities ratio. Strong endorsement from corporate leadership made randomization prior to recruitment feasible with 100% participation of facilities randomized to the intervention arm. Critical regulatory issues included minimal risk determination, waiver of informed consent, and determination that nursing home providers were not engaged in human subjects research. Intervention training and implementation were initiated on 5 January 2016 using corporate infrastructures for new program roll-out guided by standardized training elements designed by the research team. Video Status Reports in facilities’ electronic medical records permitted “real-time” adherence monitoring and corrective actions. The Centers for Medicare and Medicaid Services Virtual Research Data Center allowed for rapid outcomes ascertainment. Conclusion We must rigorously evaluate interventions to deliver more patient-focused care to an increasingly frail nursing home population. Video decision support is a practical approach to improve advance care planning. PRagmatic trial Of Video Education in Nursing homes has the potential to promote goal-directed care among millions of older Americans in nursing homes and establish a methodology for future pragmatic randomized controlled trials in this complex healthcare setting.

scholarly journals Advance care planning and hospital in the nursing home

2006 ◽  
Vol 35 (6) ◽  
pp. 581-585 ◽  
Author(s):  
Gideon A. Caplan ◽  
Anne Meller ◽  
Barbara Squires ◽  
Stella Chan ◽  
Wendy Willett
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

scholarly journals Advance Care Planning Video Intervention Among Long-Stay Nursing Home Residents

2020 ◽  
Vol 180 (8) ◽  
pp. 1070 ◽  
Author(s):  
Susan L. Mitchell ◽  
Angelo E. Volandes ◽  
Roee Gutman ◽  
Pedro L. Gozalo ◽  
Jessica A. Ogarek ◽  
...  
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Nursing Home Residents ◽  
Care Planning ◽  
Video Intervention ◽  
Advance Care

scholarly journals Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer A. Palmer ◽  
Victoria A. Parker ◽  
Vincent Mor ◽  
Angelo E. Volandes ◽  
Lacey R. Barre ◽  
...  
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Pragmatic Trial ◽  
Barriers And Facilitators ◽  
Care Planning ◽  
Home Setting ◽  
Nursing Home Setting ◽  
Advance Care
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