Advance care planning for nursing home residents with dementia: Influence of ‘we DECide’ on policy and practice

What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

“…Table 1 displays characteristics of included studies. Most of the studies were from the Netherlands [19,21,29,30,37,42] and the UK [23,25,28,32,33,40] (each n = 6), followed by Australia [24,34,41], Canada [20,22,27], Norway [26,31,36] (each n = 3), Germany [38,39], and Belgium [18,43] (each n = 2). One multinational study took place in Italy and the Netherlands [35].…”

“…Data concerning barriers and facilitators were collected through interviews [10,43] (n = 24), by means of questionnaires [19,23,24,31,38] (n = 6), field notes or process data notes [26,32,37,38] (n = 4), observation [25,39,40] (n = 3), workshops [36] (n = 1), written evaluations by trainers/instructors [37] (n = 1), residents' records [38] (n = 1) and/or by asking openended questions [18] (n = 1). Qualitative data were analysed using thematic or content analysis [18-27, 29, 31-42] (n = 23) or framework analysis [28,32] (n = 2).…”

“…Barriers: The category organisational culture and vision summarizes influencing factors. Distinctive hierarchical structures [18,27,28,36,38,39], inadequate regulations within the organisation [21,35] and a taskfocused, functional culture of care [34,38,39] are examples for hindering factors within this category. Furthermore, authors of several studies report a lack of management and leader support and engagement as a hindering factor [21, 28, 31-33, 36-38, 40].…”

Associations between Length of Stay in Long Term Care Facilities and End of Life Care. Analysis of the PACE Cross-Sectional Study

“…The term "end of life care" is often used synonymously with palliative care in the UK, and refers to "an extended period of 1 to 2 years during which the patient/family and health professionals become aware of the life-limiting nature of their illness" [11]. Previous studies have found that the adoption of a palliative care approach in LTCFs led to a reduction in deaths outside the LTCF [12], an increase in the numbers of completed advance directives [13], improvements in end-of-life communication between residents, relatives and health professionals [14-16] and improvements in staff knowledge [17][18][19].Numerous interventions have been developed to improve the provision and quality of end of life care in LTCFs, including staff education [20,21], inter-professional collaborations and care coordination [22,23], either through individual initiatives or as part of multicomponent interventions, such as the Liverpool Care Pathway [24], Gold Standards Framework for Care Homes [25] or the Steps to Success intervention [26]. The time point at which these initiatives aim to change the care provided to a resident varies; whereas the Liverpool Care Pathways focuses on care in the last days of life [24], interventions focusing on communicating preferences at end of life may be introduced either at admission or four to six weeks post admission.…”

“…Numerous interventions have been developed to improve the provision and quality of end of life care in LTCFs, including staff education [20,21], inter-professional collaborations and care coordination [22,23], either through individual initiatives or as part of multicomponent interventions, such as the Liverpool Care Pathway [24], Gold Standards Framework for Care Homes [25] or the Steps to Success intervention [26]. The time point at which these initiatives aim to change the care provided to a resident varies; whereas the Liverpool Care Pathways focuses on care in the last days of life [24], interventions focusing on communicating preferences at end of life may be introduced either at admission or four to six weeks post admission.…”