Forskningsartikler

Abstract

Aim
This study explores nurses’ experience and reflections on the use of advance care planning (ACP) for older adult patients in home care services.
Method
The study employs an explorative qualitative design. Five focus groups with 21 nurses in home care services were conducted and analyzed using content analysis.
Results
Three main categories were identified; 1) limited experience with the use of ACP, 2) reflections on systematic use of ACP and 3) prerequisites for successful ACP conversations. The participants revealed limited experience with ACP but recognized that such conversations could provide important clarifications for patient and family caregiver support. The use of ACP needs to be individually tailored, involving family caregivers, and being conducted in collaboration with a physician. The need for open conversations initiated by the patient or family caregivers should be addressed. For successful implementation, competence building, a planned process, and support from management are essential.
Conclusion
ACP could be beneficial in the follow-up of older, chronically ill patients living at home, but should not substitute the need for individualized spontaneous conversations.

Beth Helen Tomren Løken & Anne Marie Mork Rokstad

Abstract:

Objective: What are the core capabilities physiotherapists need to deliver quality care when working with people with dementia and their families/caregivers?

Design: A three-round modified e-Delphi study.

Participants: Panel members were physiotherapists experienced in working with people with dementia and/or educating and/or researching in the dementia field.

Methods: A steering group (16 international physiotherapists and a consumer) developed a draft framework including 129 core capabilities across 5 domains for panel members to rate their appropriateness for inclusion as a core capability to provide high quality care to people with dementia and their caregivers/families. The RAND/UCLA method was used to assess consensus.

Results: Thirty-five physiotherapists from 11 countries participated in Round 1, 31 (89%) in Round 2 and 28 (80% of Round 1) in Round 3. All core capabilities were rated appropriate for inclusion in each round. Panel members recommended wording refinements across the rounds and suggested 51 core capabilities for consideration. Three rounds were needed to reach consensus, resulting in 137 core capabilities rated appropriate for inclusion across 5 domains: 1) Knowledge and understanding, n = 36; 2) Assessment, n = 39; 3) Management, interventions and prevention n = 40; 4) Communication, therapeutic relationship and person-centred care, n = 17; and 5) Physiotherapists self-management and improvement, n = 5.

Conclusions: This e-Delphi study outlines the core capabilities physiotherapists need to provide high quality care to people with dementia and their families/caregivers. These core capabilities can be used by physiotherapists to help identify knowledge/skill gaps, as well as by educators to improve their training of undergraduate and postgraduate students, and clinicians.

Morag E Taylor, Karen Sverdrup, Julie Ries, Erik Rosendahl, Gro Gujord Tangen, Elisabeth Telenius, Katherine Lawler, Keith Hill, Annika Toots, Hans Hobbelen, Vanina Dal Bello-Haas, Abi Hall, Susan W Hunter, Victoria A Goodwin, Julie Whitney, Michele L Callisaya