Community nurses’ perceptions on the use of advance care planning: a qualitative study

Abstract

Background: In order to meet the needs of patients, it is important that healthcare professionals know what these needs are. Advance care planning (ACP) is a method for recording those needs and preferences with the patient. ACP could decrease uncomfortable life-sustaining treatment and care transitions in the palliative phase, reduce stress and anxiety and increase the chance of dying at the preferred place. The frequency of ACP conversations remains low and is often conducted late in the disease trajectory. Community nurses seem suitable to carry out ACP because of their patient population and holistic vision, but research of ACP in community care is lacking. Insight in perceptions of community nurses could create potential improvements which can contribute to the feasibility of ACP. Objective: Explore perceptions of community nurses towards the use of ACP. Methods: A qualitative descriptive exploratory research design, in which bachelor degree nurses participated, was conducted. Thematic analysis was used to identify themes. Results: Fifteen community nurses from eight different home healthcare organisations were individually interviewed. Six themes were identified after analysis: nurses’ own beliefs towards ACP, time to start ACP, prerequisites for the use of ACP, collaboration between involved professionals in ACP, carrying out ACP and ACP as part of usual community care. Conclusion: Six themes regarding perceptions of community nurses on ACP were found: it is thought to be a tough topic, timing of ACP, the need for a trust-based therapeutic relationship, sufficient time, collaboration with other disciplines and too little awareness in home healthcare organisations with no available methods and tools. Community nurses are suitable to conduct ACP because they have time to carry out ACP and the opportunity to build a trust-based relationship with patients. Training and tools are necessary to support community nurses in ACP.