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

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.

Barriers, enablers and initiatives for uptake of advance care planning in general practice: a systematic review and critical interpretive synthesis

“…Barriers associated with uptake of electronic medical record reminder prompts were identified 59. Context specific issues were described, for example, lack of suitable funding mechanisms was problematic in some jurisdictions 56 60. One study suggested that because there was no performance monitoring of providers’ ACP activity it was not important.…”

General practice palliative care: patient and carer expectations, advance care plans and place of death—a systematic review

“…There is a paucity of literature in this regard, however in Australia work focusing on the role of practice nurses at the end of life is underway. 79 It is likely that literature around the role and the impact of practice nurses will flourish in the near future.…”

Advance care decision making and planning

“…Practice nurses are interested in and enthusiastic about receiving additional training so that they could become more involved in discussing ACP with patients. 24 The involvement of the nurses could allow GPs to focus on the 'medical' aspects, clarifying patients' concerns and signing or witnessing ACDs or other documents. A free online training program has been developed to support Australian practice nurses in initiating ACP and conducting supportive care assessments (www.caresearch.com.au/advance).…”