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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

A self-reported survey on the confidence levels and motivation of New South Wales practice nurses on conducting advance-care planning (ACP) initiatives in the general-practice setting

Emilia Fan A B and Joel J. Rhee A
+ Author Affiliations
- Author Affiliations

A School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052, Australia.

B Corresponding author. Email: emilia_fan_aimin@ttsh.com.sg

Australian Journal of Primary Health 23(1) 80-86 https://doi.org/10.1071/PY15174
Submitted: 8 November 2015  Accepted: 11 April 2016   Published: 5 August 2016

Abstract

Nurses are well positioned to initiate and conduct advance-care planning (ACP) conversations; however, there has been limited research on practice nurses performing this role in Australia. The aim of the present study was to understand the beliefs, attitudes, perceptions, confidence, training and educational needs of New South Wales practice nurses with regards to involvement in ACP. A cross-sectional online survey was conducted in August to October 2014. Nurses were recruited through nursing organisations and Medicare Locals. There were 147 completed surveys (n = 147). Participants were mostly female registered nurses, with a median age of 50, and 6 years of practice-nurse experience. Practice nurses were generally positive towards their involvement in ACP and believed it would be beneficial for the community. Their confidence in initiating ACP increased as their familiarity with patients increased. They showed a high level of interest in participating in training and education in ACP. Barriers to their involvement in ACP included the lack of a good documentation system, limited patient-education resources and unclear source of remuneration. Nurses were also concerned over legalities of ACP, ethical considerations and their understanding of end-of-life care options. Nevertheless, they were highly receptive of integrating ACP discussions and were willing to enhance their skills. These findings uncover a need for further training and development of practice nurses for ACP discussions.


References

Australian Health Ministers’ Advisory Council (2011) A national framework for advance directives. Available at http://www.gpnsw.com.au/__data/assets/pdf_file/0019/2863/GP-NSW-Submission–National-Framework-for-Advance-Care-Directives-Oct-2010.pdf [Verified 20 August 2014]

Australian Medicare Local Alliance (2012) General practice nurse national survey report. Available at http://www.apna.asn.au/lib/pdf/Resources/AMLA2012-General-Practice-Nurse-National-Survey-Report[1].pdf [Verified 3 August 2014]

Badzek LA, Leslie N, Schwertfeger RU, Deiriggi P, Glover J, Friend L (2006) Advanced care planning: a study on home health nurses. Applied Nursing Research 19, 56–62.
Advanced care planning: a study on home health nurses.Crossref | GoogleScholarGoogle Scholar | 16728288PubMed |

Baughman KR, Aultman J, Hazelett S, Palmisano B, O’Neill A, Ludwick R, Sanders M (2012) Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process. Journal of Gerontological Social Work 55, 721–737.
Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process.Crossref | GoogleScholarGoogle Scholar | 23078607PubMed |

Black K, Emmet C (2006) Nurses’ advance care planning communication: an investigation. Geriatric Nursing 27, 222–227.
Nurses’ advance care planning communication: an investigation.Crossref | GoogleScholarGoogle Scholar | 16890103PubMed |

Boddy J, Chenoweth L, McLennan V, Daly M (2013) It’s just too hard! Australian health care practitioner perspectives on barriers to advance care planning. Australian Journal of Primary Health 19, 38–45.
It’s just too hard! Australian health care practitioner perspectives on barriers to advance care planning.Crossref | GoogleScholarGoogle Scholar | 22951247PubMed |

Briggs L, Colvin E (2002) The nurse’s role in end-of-life decision-making for patients and families. Geriatric Nursing 23, 302–310.
The nurse’s role in end-of-life decision-making for patients and families.Crossref | GoogleScholarGoogle Scholar | 12494001PubMed |

Butterworth AM (2003) Reality check: 10 barriers to advance planning. The Nurse Practitioner 28, 42–43.
Reality check: 10 barriers to advance planning.Crossref | GoogleScholarGoogle Scholar | 12792268PubMed |

Clinical Excellence Commission (2013) Care for the dying in NSW. A review of the data from 2012 quality systems assessment. Available at http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/259309/cec-care-for-the-dying-may-2013.pdf [Verified 30 September 2015]

Decision Assist (2015) About Decision Assist. Available at http://www.caresearch.com.au/caresearch/tabid/3106/Default.aspx [Verified 28 February 2016]

Detering K, Silvester W, Corke C, Milnes S, Fullam R, Lewis V, Renton J (2014) Teaching general practitioners and doctors-in-training to discuss advance care planning: evaluation of a brief multimodality education programme. BMJ Supportive & Palliative Care 4, 313–321.
Teaching general practitioners and doctors-in-training to discuss advance care planning: evaluation of a brief multimodality education programme.Crossref | GoogleScholarGoogle Scholar |

Jeong SYS, Higgins I, McMillan M (2010) The essentials of advance care planning for end-of-life care for older people. Journal of Clinical Nursing 19, 389–397.
The essentials of advance care planning for end-of-life care for older people.Crossref | GoogleScholarGoogle Scholar |

NSW Ministry of Health (2013) Advance planning for quality care at end of life. Action plan 2013–2018. (NSW Ministry of Health: Sydney) Available at www.health.nsw.gov.au/patients/acp/pages/acp-plan-2013-2018.aspx [Verified 26 February 2016]

Ramsaroop SD, Reid MC, Adelman RD (2007) Completing an advance directive in the primary care setting: what do we need for success? Journal of the American Geriatrics Society 55, 277–283.
Completing an advance directive in the primary care setting: what do we need for success?Crossref | GoogleScholarGoogle Scholar | 17302667PubMed |

Ratner E, Norlander L, McSteen K (2001) Death at home following a targeted advance-care planning process at home: the kitchen table discussion. Journal of the American Geriatrics Society 49, 778–781.
Death at home following a targeted advance-care planning process at home: the kitchen table discussion.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvgtlGisA%3D%3D&md5=7d1cc670ac4893a7f09cd1826b1f05c2CAS | 11454117PubMed |

Rhee JJ, Zwar NA, Kemp LA (2012) Uptake and implementation of advance care planning in Australia: findings of key informant interviews. Australian Health Review 36, 98–104.
Uptake and implementation of advance care planning in Australia: findings of key informant interviews.Crossref | GoogleScholarGoogle Scholar | 22513028PubMed |

Rhee JJ, Zwar NA, Kemp LA (2013) Advance care planning and interpersonal relationships: a two-way street. Family Practice 30, 219–226.
Advance care planning and interpersonal relationships: a two-way street.Crossref | GoogleScholarGoogle Scholar | 23028000PubMed |

Robins-Browne K, Palmer V, Komesaroff P (2014) An unequivocal good? Acknowledging the complexities of advance care planning. Internal Medicine Journal 44, 957–960.
An unequivocal good? Acknowledging the complexities of advance care planning.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2M7psFektg%3D%3D&md5=cb7374d7d30729483c4a952460a2508aCAS | 25302719PubMed |

Robinson L, Dickinson C, Bamford C, Clark A, Hughes J, Exley C (2013) A qualitative study: professionals’ experiences of advance care planning in dementia and palliative care, ‘a good idea in theory but…’. Palliative Medicine 27, 401–408.
A qualitative study: professionals’ experiences of advance care planning in dementia and palliative care, ‘a good idea in theory but…’.Crossref | GoogleScholarGoogle Scholar | 23175508PubMed |

Seymour J, Almack K, Kennedy S (2010) Implementing advance care planning: a qualitative study of community nurses’ views and experiences. BMC Palliative Care 9, 4
Implementing advance care planning: a qualitative study of community nurses’ views and experiences.Crossref | GoogleScholarGoogle Scholar | 20377876PubMed |

Shanley C, Wall S (2004) Promoting patient autonomy and communication through advance care planning: a challenge for nurses in Australia. The Australian Journal of Advanced Nursing 21, 32–38.

Simon J, Porterfield P, Raffin BS, Heyland D (2015) ‘Not yet’ and ‘just ask’: barriers and facilitators to advance care planning – a qualitative descriptive study of the perspectives of seriously ill, older patients and their families. BMJ Supportive & Palliative Care 5, 54–62.
‘Not yet’ and ‘just ask’: barriers and facilitators to advance care planning – a qualitative descriptive study of the perspectives of seriously ill, older patients and their families.Crossref | GoogleScholarGoogle Scholar |

Sixty-Seventh World Health Assembly (2014) Strengthening of palliative care as a component of comprehensive care throughout the life course. Available at http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R19-en.pdf [Verified 22 August 2014]

Tung EE, North F (2009) Advance care planning in the primary care setting: a comparison of attending staff and resident barriers. American Journal of Hospice and Palliative Medicine 26, 456–463.
Advance care planning in the primary care setting: a comparison of attending staff and resident barriers.Crossref | GoogleScholarGoogle Scholar | 19648573PubMed |

Victorian Department of Health (2014) ‘Advance care planning: have the conversation. A strategy for Victorian health services 2014–2018.’ (Victorian Government: Melbourne) Available at https://www2.health.vic.gov.au/Api/downloadmedia/%7B11916C57-8E7A-40D4-8E6D-628B2D8FDA51%7D [Verified 28 February 2016]