| ObjectiveTo investigate the cognition status of Advance Care Planning(ACP)among medical staffs and the elderly in nursing homes,identify the influencing factors and strengths,weaknesses,opportunities and threats of implementing ACP in nursing homes,and propose development countermeasures.Methods1.Research on knowledge,attitude and practice of ACP among medical staffs in nursing homesThrough conveniently sampling method,the questionnaire on general information of medical staffs,the ACP knowledge,attitude and practice questionnaire and hindrance factors questionnaire on promoting ACP were used to investigate the knowledge,attitude and practice among the medical staffs and hindrance factors of ACP in nursing homes in the main urban areas of chongqing.The semi-structured interview was conducted with the theme of "the practical experience of ACP amongmedical staffs in nursing homes".2.Study on the acceptance of ACP among the elderly in nursing homesThrough conveniently sampling method,the general information survey of the elderly and the ACP acceptance questionnaire were adopted to investigate the ACP acceptance of the elderly in nursing homes in the main urban areas of chongqing,and the semi-structured interview was conducted under the theme of "the ACP acceptance and influencing factors of the elderly in nursing homes".3.Research on SWOT analysis and countermeasures of implementing ACP in nursing homesSWOT analysis was used to summarize and analyze the strengths,weaknesses,opportunities and threats of implementing ACP in nursing homes and put forward development strategies based on the results of questionnaires and qualitative researches on the knowledge,attitude and practice of ACP among medical staffs in nursing homes,the obstacles to promoting ACP,the acceptance degree and influencing factors of ACP among the elderly.Results1.Research on knowledge attitudes and practice of ACP among medical staffs in nursing homesQuestionnaires were conducted among 432 medical staffs from 27 nursing homes in 9 major administrative regions of chongqing.The total score of ACP knowledge attitude and practice was(55.73±11.14),among which,ACP knowledge score was(20.42±6.27),ACP attitude score was(30.15±4.87),and ACP practice score was(5.16±2.28).medical staffs though there were many factors hindering the ACP promotion: "the treatment of dying elderly were usually decided by the opinions of the families",accounted for 75.7%,"families worried about the elderly were stimulated,reluctant to inform the real condition",accounted for 71.5%,"affected by the traditional concept of death taboo,the elderly and their families were reluctant to talk about death topic",accounted for 67.4%,"the elderly didn't know what was ACP",accounted for 64.6%,"the elderly didn't know the effective ways to ACP",accounted for62.3%.Multiple linear regression showed that education background,serious illness experience,bereavement experience,understanding of ACP were the influencing factors of ACP knowledge attitude and practice among medical staffs.16 medical staffs participated in the qualitative interview of ACP practical experience,and extracted 15 themes of 4 categories:(1)overall feeling: supporting the development of ACP,strengthening the study of ACP,promoting ACP should be combined with the specific situation of the elderly;(2)the strengths and weaknesses of implementing ACP:medical staffs know the elderly,with the professional authority ofmedical care,but there were problems of insufficient knowledge and skills of ACP;(3)external influencing factors: strong family concept,limited education and understanding of the elderly,the concept of death taboo,poor cognition of the elderly towards ACP,whether it was a medical-nursing combined institution,ACP lack of clear legal protection;(4)recommendations of promoting ACP in nursing homes: to strengthen ACP education and training,gradually publicity and implementation of the ACP,carrying out ACP work based on family-centered.2.Study on acceptance of ACP among the elderly in nursing homes515 elderly people from 27 nursing homes in 9 major administrative regions in chongqing completed the questionnaires.The total ACP acceptance score was(61.29±11.74),of which the ACP attitude was(9.61±2.83),ACP feeling was(35.90±6.79)and ACP intention was(15.78±3.08).Multiple linear regression showed that education level,chronic disease,understanding of life support treatment and understanding of ACP were the influencing factors of ACP acceptance among the elderly.Sixteen elderly participated in qualitative interview and condensed six topics: the importance of the quality of life in later life,the positive attitude towards ACP,Willing to discuss ACP,lack of necessity to discuss the ACP at this stage,the need for supporting from families toward ACP discussion,and the need for supporting from medical staffstoward ACP discussion.3.Research on SWOT analysis and countermeasures of implementing ACP in nursing homesThe strengths of promoting ACP in nursing homes(S): the positive attitudes of medical staffs toward ACP,the understanding of the elderly by medical staffs,and the professional authority of medical care.Weaknesses(W): insufficient cognition and practice of ACP among medical staffs.Opportunities available(O): population aging in China was accelerating,the state provided extremely policy supporting for the development of the elderly and hospice care,positive attitude of the elderly toward ACP.Challenges(T): traditional family and death constraints,poor awareness and acceptance of ACP among the elderly,and no legal guarantee for ACP implementation.Countermeasures to promote the implementation of ACP in nursing homes:(1)using opportunities,playing strengths,actively encouraging the ACP work(SO strategy);(2)relying on strengths,overcoming threats,breaking the traditional concept(ST strategy);(3)Overcoming the weaknesses,seizing the opportunities,establishing a diversified ACP training model(WO strategy);(4)reducing weaknesses,avoiding threats,building effective ACP implementation mode(WT strategy).Conclusion1.The knowledge attitude and practice of ACP among medical staffsin nursing homes is at a medium level.Education background,serious illness experience,bereavement experience,and knowledge of ACP will affect the knowledge attitude and practice of ACP among medical staffs.2.The implementation of ACP was hindered by internal factors such as insufficient knowledge and skills of medical staffs in nursing homes,constraints of traditional family concept and death view,low educational level of the elderly and lack of ACP awareness,no medical-nursing combined institutions,and lack of clear legal protection of ACP,etc.3.The acceptance of ACP among the elderly in nursing homes is at a medium level.Education level,knowledge of ACP,understanding of life support treatments,chronic illness,and support from family members and medical staffs will affect the acceptance of ACP among the elderly.4.Implementing ACP in nursing homes have the strengths of positive attitude of medical staffs,better understanding of the elderly,professional skills and authority in medical care;There are a lack of awareness and practice of ACP;There are great opportunities for an ageing population,strong policy support for the development of the elderly and hospice care,and more positive attitudes towards ACP among the elderly;Traditional family and death constraints,poor awareness and acceptance of ACP among the elderly,and lack of legal safeguards for ACP implementation are major threats.It is suggested that nursing homes should make full use of an aging population and the opportunity ofhospice care support in China,play the professional advantages of medical staffs in nursing homes,strengthen ACP publicity and training,effort to break the traditional concept,establish ACP legal protection,build diversified ACP practice mode,work actively and effectively promote ACP. |
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