BACKGROUND 52% of all deaths in Norway occur in nursing homes. Still advance care planning (ACP) is scarce and heterogeneous. To improve the implementation and practice of ACP in nursing homes, knowledge about health care professionals' views on ACP is vital. The objective of this study is to explore nurses and physicians' aims and experiences with carrying out ACP in nursing homes. METHODS Semi-structured group interviews were conducted with 20 health care professionals, recruited from nursing homes where ACP was performed regularly. Qualitative content analysis was used to analyse the data. RESULTS The primary aim of the nursing home professionals when doing ACP in nursing homes were to build alliances with next of kin to avoid misunderstandings and future conflicts. Two main experiences with ACP were described: i) due to the sensitivity of ACP issues, it was important to balance directness with being sensitive, and ii) when the physicians raised questions concerning future medical treatment, the answers from residents as well as next of kin were often hesitant and unclear. CONCLUSION Our study add insights into how ACP is practiced in nursing homes and the professionals' agenda. A focus on medical issues and achieving consensus with next of kin may result in lack of involvement of the residents and limited awareness of the residents' needs. Interdisciplinary approaches, ACP-training and tailored guidelines may improve the implementation and practice of ACP.

中文翻译：

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挪威疗养院的预先护理计划 - 对居民偏好和价值观的认识有限？定性研究。

背景 挪威 52% 的死亡发生在疗养院。预先护理计划（ACP）仍然稀缺且参差不齐。为了改善疗养院 ACP 的实施和实践，了解医疗保健专业人员对 ACP 的看法至关重要。本研究的目的是探讨护士和医生在疗养院实施 ACP 的目标和经验。方法 对 20 名医疗保健专业人员进行半结构化小组访谈，这些专业人员是从定期进行 ACP 的疗养院招募的。使用定性内容分析来分析数据。结果 疗养院专业人员在疗养院进行 ACP 时的主要目的是与近亲建立联盟，以避免误解和未来的冲突。描述了 ACP 的两个主要经验：i）由于 ACP 问题的敏感性，平衡直接性和敏感很重要；ii）当医生提出有关未来医疗的问题时，居民的回答以及下一步亲戚们常常犹豫不决、不清楚。结论 我们的研究深入了解了 ACP 在疗养院的实施方式以及专业人士的议程。关注医疗问题并与近亲达成共识可能会导致居民缺乏参与以及对居民需求的认识有限。跨学科方法、ACP 培训和量身定制的指南可以改善 ACP 的实施和实践。