ABSTRACT

Advance care planning involves a meaningful conversation about residents’ end of life goals with the health-care team and documenting these wishes in advance directives; however, these conversations are not taking place early enough or with strategies that allow nursing home residents’ preferences to be meaningfully integrated into care plans. This article outlines a new model that nursing home social workers can use to initiate advance care planning discussions called Take it to the Resident. This model was tested with 11 long-term stay nursing home residents. Data were collected through structured memos and field notes. Summative content analysis was utilized to analyze the data. Take it to the Resident facilitated a discussion about advance care planning and allowed residents to consider their wishes before engaging family members. Although discussions took place, some residents were hesitant to document their wishes formally through advance directives. The results of this study support the utility of continued testing of this model. Having empirically supported tools for nursing home social workers is critical to increasing advance care planning conversations and empowering residents to document their wishes.

摘要

预先护理计划涉及与医疗保健团队就居民临终目标进行有意义的对话，并在预先指示中记录这些愿望；然而，这些对话并没有足够早地进行，也没有采用将疗养院居民的偏好有意义地纳入护理计划的策略。本文概述了疗养院社会工作者可以用来发起预先护理计划讨论的新模式，称为将其带给居民。该模型在 11 名长期入住疗养院居民中进行了测试。数据是通过结构化的备忘录和现场笔记收集的。总结性内容分析用于分析数据。把它带到居民区t 促进了有关预先护理计划的讨论，并允许居民在与家庭成员接触之前考虑他们的意愿。尽管进行了讨论，但一些居民不愿通过预先指示正式记录他们的愿望。这项研究的结果支持继续测试该模型的效用。为疗养院社会工作者提供经验支持的工具对于增加预先护理计划对话和授权居民记录他们的愿望至关重要。