An Action Research on Advance care planning for Older Residents in Long-Term Care Facilities and Their Families
Date Issued
2016
Date
2016
Author(s)
Lee, Hsin-Tzu Sophie
Abstract
【Background and Purpose】 Currently, in Taiwan, the evidence shows hospice-palliative care services are poorly undertaken in long-term care facilities due to some clinical concern. Thus researchers recommended that implementing ACP or signning ADs not only can increase opportunities for older residents to have hospice-palliative care to decrease their discomfortable symptoms, but also can achieve the goal of good death. However, results have presented the contradictory phenomenon that the elderly in nursing home have the high rates of willingness but low rates to sign any kind of ADs. Therefore, the purpose of this study is to understand or develop related issues and guideline in long-term care facilities: 1. To learn what issues were older residents and their families felt unspeakable or concern; 2. To understand what difficulties did older residents and their families meet when they need to sign ADs; 3. To develop the ACP interview guideline and care model improve the rate of signing ADs in long-term care facilities. 【Methods】 Data collections were conducted into two stages. The first stage: the purposive sampling was adopted and data collection was done in the long-term care facility in the eastern of Taiwan. First, researcher used the interview tool of ""Complete life – ACP: to choose the best care for yourself "" to allow older residents to recall their life course and to understand what issues related to end-of-life care that older residents concerned. Later on, the content of ADs and hospice-palliative care would be introduced. After finishing interviews with older residents, the researcher would interview families to understand what issues related to end-of-life- care for older residents that families concerned and tell them what older residents thought about end-of-life care for themselves and introduce hospice-palliative care and ADs to families. The secondary stage: To establish the care model through the action research, the researcher would have meetings with the staff to identify the problem for each older resident and their family and to make a care plan and to be implemented to the next pair of older resident and their families, and finally to evaluate the result. This process as above continued a total of ten times. In addition, the unconscious residents’ families were also interviewed by the researcher. After completing each interview with older residents or their families, the researcher would listen to the record and type in the computer and turn into verbatim text, then, the content analysis would be used as a tool to analyze those data. 【Results】 There were 30 persons took part in this study. Results of the first stage were: 1. Issues of concerned during the process of ACP: (1) Five themes from older residents: let go of everything, want to have a good death, choice dying place, to die peacefully is better than to live miserably, follow or get rid of the traditional culture. (2) Six themes from families (conscious clear residents): need to say goodbye on one day, give them a good death, obey the decision from residents, follow the culture of filial piety or the past medical experience, hands are tied, and choice the dying place by fate. (3) Five themes from families (unconscious residents): need to say goodbye on one day, give them a good death, get rid of the shackle of Filial Piety culture, hands are tied, and choice the dying place for different concerns. 2. Reasons for unspeakable during the process of ACP: (1) Four themes from older residents: something to worry about, unwilling to touch issues of death, cannot be self-centered, and in a perplexing situation. (2) Six themes from families (conscious clear residents): fear of opening discussion of death, wait for the right time, keep in step with residents’, refuse to make hypothetical decision for the future, put the interests of the family above everything else, and have no right to discuss. (3) Five themes from families (unconscious residents): inability to communicate, something to worry about, prepare for taking care of older residents for a long time, put the interests of the family above everything else, and have no right to discuss. 3. Difficulties for Signing ADs: (1) Five themes from older residents: an inspired sign, inability to sign, the shackle of traditional culture, unwilling to face the fact of signing, individual needs unmet. (2) Four themes from families (conscious clear residents): decision-making by residents, decision-making by the family, have no right to make decisions, and decision-making by opportunity. (3) Three themes from families (unconscious residents): decision-making by the family, have no right to make decisions, and decision-making by opportunity. Results of the second stage, For older residents: 1. To start the interview with the interview guidelines named as "" Complete life – ACP: to choose the best care for yourself "" 2. To introduce the content of ADs documents and hospice care from the perspective of good death; 3. to assist older residents to sign these documents, and review them every six months. For families: 1. To explain to the families about the disease of older residents and the influence in the quality of life in the future; 2. To introduce the topic about end-of-life care; 3. To make the care plan with families for older residents together. Finally, to assist families to sign and review these documents every six months. 【Conclusions】 Results of this study showed that this guideline will not only become the guideline for implementing ACP process in long-term care facility, but also to promote older residents and their families to participate in the ACP process to improve the quality of life and care for older residents during their end-of-life.
Subjects
advance directives
advanced care planning
autonomy
older residents
long-term care facility
action research
Type
thesis
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