Advance Care Planning:
Empowering Nurses with ACP literacy
In the complex landscape of healthcare decision-making, especially when patients lack the capacity to articulate their preferences, advance care planning emerges as a guiding light. An effective advance care planning strategy positively influences the quality of life by preemptively addressing and documenting patients' desires before critical situations arise.
However, many individuals progress to advanced illness without the chance to express their wishes, causing distress among family members navigating the challenging terrain of decision-making.
Advance care planning communication and documentation are often inadequate, leading to care that is inconsistent with patients’ preferences and moral dilemmas for family members.
Nurses are patient advocates optimally positioned to initiate advance care planning, but many feel that they lack the training and skills to navigate these conversations. a recent pilot project revealed a significant gap in nurses' comfort and confidence in conducting these discussions. Despite recognising the importance of such conversations, a lack of adequate education hindered their ability to engage effectively.
This gap underscores the urgency to equip nurses with the necessary skills and knowledge to navigate these high-stakes conversations.
A best practice implementation project, guided by the JBI evidence implementation framework, was developed and implemented at a medicine transitional care unit. The objective was to enhance nurses' capacities to initiate and document advance care planning conversations.
By empowering nurses with advance care planning literacy, the aim was to foster a collaborative relationship with patients and families, ensuring care that aligns with individuals' values and preferences.
JBI PACES audit tools were used to incorporate advance care planning into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing advance care planning notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability.
The follow-up audit results demonstrate the project’s success. For example, compliance with the best practice recommendation for nurses to engage in advance care planning discussions increased from 55% to 80%.
The project represents a pivotal step in addressing the critical need for nurses to engage in advance care planning discussions confidently. It stands as a testament to the importance of empowering nurses as advocates, fostering compassionate, patient-centred care through informed, empathetic conversations.
A paper on the best practice implementation project is available in the fourth issue of JBI Evidence Implementation, published in December 2023:
Garcia, Philip; Kim, Hannah Jang; Barbour, Susan; Cooper, Adam S.
JBI Evidence Implementation. 21(4):310-324, December 2023