Involvement in decisions about intravenous treatment for nursing home patients: nursing homes versus hospital wards

Klomstad, Kristin; Pedersen, Reidar; Før­de, Rei­dun; Romøren, Maria

doi:10.1186/s12910-018-0258-5

Cited by 8 publications

(6 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recommendation that ACP should be part of everyday practice (28) but also integrated into the system to maintain good documentation access particularly during care transitions (27, 28) was a pattern throughout the material, regardless of degree of experience or working in hospitals or communities. Finally recognition and support from leadership (23,27,28), and speci c reimbursement for ACP counseling (32,37) and appropriate billing codes (28) were important barriers. This concerns the di culties in changing the service culture to ensure the provision of good services for older adults, and that support should be given at the policy level (22).…”

Section: Discussionmentioning

confidence: 99%

“…ACP has also been enshrined in political guidelines (14)(15)(16)(17), and Covid-19 has taught us such decisions would have to be made fast and be exible thus making the continual review element of ACP particularly relevant (18). But despite this, ACP remains an underutilized resource in practice (19)(20)(21)(22)(23)(24). The question is why?…”

Section: Evidence and Knowledge Gapmentioning

confidence: 99%

See 1 more Smart Citation

Barriers and facilitators to implementing advance care planning in naïve contexts. Where to look when plowing new terrain?

Westbye

Rostoft

Romøren

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Advance care planning (ACP) is a way of complying modern medicine to the principle of patient autonomy and ensuring that patients receive medical care that is consistent with their values, goals and preferences. Robust evidence supports the benefits of ACP, but it remains an underutilized resource in most countries. This paper goes from the naïve point of view and seeks to identify the barriers and facilitators to implementation in unfamiliarized contexts and in a whole system approach involving the clinical, institutional and policy level to improve the implementation of ACP. Methods:Qualitative interviews were chosen to enable an explorative, flexible design. 19 interviews were conducted with 40 health care professionals and leaders in hospitals and in municipalities. The thematic analysis was done following Braun and Clarke’s strategy for thematic analysis. Results: The main reported barriers were the lack of time, the lack of a common understanding on what ACP is, lack of training and lack of culture and leadership legitimating ACP. The most important reported facilitators were finding good arenas, creating meeting places and communication systems that allow ACP, as well as anchoring ACP in the leadership in hospitals and in the municipalities. Conclusions: The most important barriers reported were the lack of a legitimation of ACP, and not adopting facilitators such as implementing efficient communications systems, standardized approaches, and overall starting policy development and professional and public education on ACP.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Evidence and Knowledge Gapmentioning

confidence: 99%

Barriers and facilitators to implementing advance care planning in naïve contexts. Where to look when plowing new terrain?

Westbye

Rostoft

Romøren

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…According to a survey study (15), most of the discharged patients have guidance needs for the behavior of the disease, disease knowledge, treatment plan, and home care during the home care process. However, these needs are difficult to meet.…”

Section: Feasibility Analysis Of the Construction Of The Continuing Care Model For Children With Pnsmentioning

confidence: 99%

The status and model of children primary nephrotic syndrome in continuing nursing

Li¹,

Hou²,

Zhou³

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

Background: Nephrotic syndrome (NS) is a common glomerular disease in children. Nursing during hospitalization alone cannot solve the psychological, physiological and social health problems of children.Continuing care models may provide patients with more continuous and efficient care services. Therefore, the present study aimed to provide theoretical support for the implementation and development of children's primary nephrotic syndrome (PNS) and children's chronic disease continuing nursing through the construction of a children's PNS continuing nursing model. Methods: Each item of the transitional care model for children with PNS was demonstrated using the Delphi method for two rounds of correspondence. The main items included four components: the composition of personnel, the responsibilities of each member, the content of work, and the evaluation indicators.Results: A transitional care model for children with PNS was formed. The expert judgment coefficient of two rounds of correspondence was 0.84, the familiarity degree coefficient was 0.76, the authority degree coefficient was 0.80, the coefficient of variation was between 0.02 and 0.23, and the coordination coefficient was 0.458 and 0.327, respectively (P<0.01). Conclusions:The experts in the present research were highly motivated, had a high degree of authority, and presented consistent opinions. Hence, the construction of a transitional care model for children with PNS is scientifically feasible.

show abstract

“…It is well known that frail older adults and their relatives are often poorly involved in treatment and care decisions [ 6 , 7 ]. At the same time, the communication between the service levels during admission and discharge is often deficient [ 8 , 9 ]. This may lead to both over- and under treatment [ 7 , 10 ] and considerable and unnecessary risks, burdens, distrust, conflicts as well as costs, for example because of undue hospitalization [ 10 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of advance care planning in the routine care for acutely admitted patients in geriatric units: protocol for a cluster randomized controlled trial

Romøren,

Hermansen,

Sævareid

et al. 2024

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background Acutely ill and frail older adults and their next of kin are often poorly involved in treatment and care decisions. This may lead to either over- or undertreatment and unnecessary burdens. The aim of this project is to improve user involvement and health services for frail older adults living at home, and their relatives, by implementing advance care planning (ACP) in selected hospital wards, and to evaluate the clinical and the implementation interventions. Methods This is a cluster randomized trial with 12 hospital units. The intervention arm receives implementation support for 18 months; control units receive the same support afterwards. The ACP intervention consists of 1. Clinical intervention: ACP; 2. Implementation interventions: Implementation team, ACP coordinator, network meetings, training and supervision for health care personnel, documentation tools and other resources, and fidelity measurements with tailored feedback; 3. Implementation strategies: leadership commitment, whole ward approach and responsive evaluation. Fidelity will be measured three times in the intervention arm and twice in the control arm. Here, the primary outcome is the difference in fidelity changes between the arms. We will also include 420 geriatric patients with one close relative and an attending clinician in a triadic sub-study. Here, the primary outcomes are quality of communication and decision-making when approaching the end of life as perceived by patients and next of kin, and congruence between the patient’s preferences for information and involvement and the clinician’s perceptions of the same. For patients we will also collect clinical data and health register data. Additionally, all clinical staff in both arms will be invited to answer a questionnaire before and during the implementation period. To explore barriers and facilitators and further explore the significance of ACP, qualitative interviews will be performed in the intervention units with patients, next of kin, health care personnel and implementation teams, and with other stakeholders up to national level. Lastly, we will evaluate resource utilization, costs and health outcomes in a cost-effectiveness analysis. Discussion The project may contribute to improved implementation of ACP as well as valuable knowledge and methodological developments in the scientific fields of ACP, health service research and implementation science. Trial registration ClinicalTrials.gov Identifier NCT05681585. Registered 03.01.23.

show abstract

Involvement in decisions about intravenous treatment for nursing home patients: nursing homes versus hospital wards

Cited by 8 publications

References 22 publications

Barriers and facilitators to implementing advance care planning in naïve contexts. Where to look when plowing new terrain?

Barriers and facilitators to implementing advance care planning in naïve contexts. Where to look when plowing new terrain?

The status and model of children primary nephrotic syndrome in continuing nursing

Implementation of advance care planning in the routine care for acutely admitted patients in geriatric units: protocol for a cluster randomized controlled trial

Contact Info

Product

Resources

About