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

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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.
Original languageEnglish
Pages (from-to)2633-2645
Number of pages13
JournalJournal of Clinical Nursing
Volume26
Issue number17-18
Early online date20 Dec 2016
DOIs
Publication statusPublished (in print/issue) - 1 Sept 2017

Keywords

  • Advance care planning
  • cognitive impairment
  • Dementia
  • Long-term care settings: Nursing Homes
  • Nurses
  • Knowledge
  • Attitudes
  • Practice

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