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2. Advance Directives in the Context of Uncertain Prognosis for Residents of Nursing Homes

Author

Norah Keating, Beryl E. Cable-Williams, and Donna M Wilson

Subjects
Advance care planning, education.field_of_study, Palliative care, business.industry, Population, Context (language use), Directive, Nursing, Life support, Medicine, Meaning (existential), business, education, Nursing homes
Abstract

This report documents the findings of a mixed-methods study focused on the advanced directives of 182 residents of three LTC facilities in southern Ontario, Canada. Although almost all had a completed advance directive within 3 months of death, most did not have a palliative designation or directive until a few days before they died. Each facility's written Progress Notes revealed staff members usually sought additional confirmation of care preferences from residents' substitute decision-makers within a few days of the death. It was thus common for advance directives to change from a more interventionist approach to the least interventionist approach near death. This change indicates that the meaning and significance of advance care planning and resulting advance directives must be considered in light of the processes and temporal factors involved in their completion and use within this distinct population. The relational nature of advance care planning and concern about ageism as a factor for withholding or withdrawing life support for LTC residents are considered as possible explanatory factors. These findings and their implications are described in relation to end-of-life care policies and practices in LTC facilities.

Published
2014
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3. Dying and death within the culture of long-term care facilities in Canada

Author

Beryl E. Cable-Williams and Donna M Wilson

Subjects
medicine.medical_specialty, Attitude to Death, Palliative care, Attitude of Health Personnel, Acknowledgement, Pain, 03 medical and health sciences, 0302 clinical medicine, Nursing, Ambulatory care, 030502 gerontology, Critical care nursing, Health care, Humans, Medicine, 030212 general & internal medicine, Curative care, Aged, 80 and over, Ontario, business.industry, Palliative Care, Long-Term Care, Organizational Culture, Focus group, Long-term care, Family medicine, Nursing Staff, Nurse-Patient Relations, 0305 other medical science, business, Gerontology
Abstract

Aim and objective To identify the influence of the culture in Canadian long-term care facilities on the awareness of impending death and initiation of a palliative approach to care for residents aged 85 years and older. Background Many long-term care residents die after long, dwindling dying trajectories, yet palliative care is often not provided until within a few hours or days of death. Design Focused ethnography. Methods Data were collected in three long-term care facilities in south-central Ontario, Canada, through interviews with residents, family members and staff members, observation, artefact review and a focus group. Data were analysed using a constant comparative technique. Results Four cultural influences on the awareness of impending death and consequent initiation of a palliative approach to care were identified: (i) the care demands in long-term care facilities and the resources available to meet these demands; (ii) the belief that long-term care facilities are for living; (iii) the belief that no one should die in pain; and (iv) the belief that no one should die alone. Conclusions Commonly held beliefs about the role of long-term care facilities and what is viewed as acceptable care in them mediated the acknowledgement of dying. Late initiation of palliative care was the consequence. In addition, the contextual factors of a low staff-to-resident ratio and reduced staff preparation for palliative care were also influential for a delayed response to dying. Implications for practice Because strongly held long-term care cultural beliefs underlie care, more timely palliative care for long-term care residents is likely to require the development of an understanding that living and dying are not dichotomous, but rather unfold together from admission until death. Enhanced staff-to-resident ratios and staff training on palliative care will also be necessary to permit long-term care facility staff to focus beyond the currently expected day-to-day care of living residents to provide high-quality end-of-life care throughout the often protracted decline to death for residents of long-term care facilities.

Published
2016
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4. Developing Palliative Care Competencies for the Education of Entry Level Baccalaureate Prepared Canadian Nurses

Author

Holly R L Richardson, Larry Librach, Darcee Bidgood, Mireille Lavoie, Brenda Jacono, Heather Jewers, Beryl E. Cable-Williams, Lynne Young, Mitzi G. Mitchell, and Cynthia Baker

Subjects
Gerontology, Canada, Medical education, Consensus, Palliative care, Process (engineering), Task force, business.industry, Palliative Care, Entry Level, Education, Nursing, Baccalaureate, Competency-Based Education, Education, Work (electrical), Health Care Surveys, Task Performance and Analysis, Curriculum development, Humans, Medicine, Program Development, business, End-of-life care, Curriculum, Needs Assessment, General Nursing
Abstract

Educational preparation of health professionals for Palliative and End of Life Care (PEOLC) is inadequate, and nurses are no exception. In 2004, the Canadian Association of Schools of Nursing struck a Task Force to develop PEOLC competencies to address this issue. The development of national PEOLC nursing competencies involved a multi-step, emergent, interactive, and iterative process. An overarching principle guiding this process was building national consensus about the essential PEOLC specific competencies for nurses among experts in this field while simultaneously generating, revising, and refining them. There have been three stages in this iterative, multi-step process: 1) Generating a preliminary set of competencies, 2) Building a national consensus among educators and experts in the field on PEOLC specific competencies for nurses, and 3) Refining the consensus based competencies for curriculum development. Ongoing follow up work for this project is focusing on the integration of these competencies into nursing curricula.

Published
2011
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6. CONTRIBUTORS

Author

Judith A. Aberg, Amy P. Abernethy, Janet L. Abrahm, Michael Adolph, Michael Aherne, K. Allsopp, Rogelio Altisent, Carmen Fernandez Alvarez, Pablo Amigo, Wendy G. Anderson, Sik Kim Ang, Tiziana Antonelli, John Armstrong, Wendy S. Armstrong, Robert M. Arnold, Pilar Arranz, Koen Augustyns, Isabel Barreiro-Meiro Sáenz-Diez, Pilar Barreto, Debra Barton, Ursula Bates, Maria B. Fernandez-Creuchet Santos, Jacinto Bátiz, Costantino Benedetti, Nabila Bennani-Baiti, Michael I. Bennett, Kevin Berger, Mamta Bhatnagar, Lesley Bicanovsky, Lynda Blue, Barton Bobb, Jean-Jacques Body, Gian Domenico Borasio, Claudia Borreani, Federico Bozzetti, Valentina Bozzetti, Jason Braybrooke, William Breitbart, Barry Bresnihan, Bert Broeckaert, Eduardo Bruera, Kay Brune, Bradley Buckhout, Phyllis N. Butow, Ira Byock, Anthony Byrne, Clare Byrne, Beryl E. Cable-Williams, Sarah E. Callin, David Casarett, David Casper, Eric J. Cassell, Barrie Cassileth, Emanuele Castagno, Carlos Centeno, Walter Ceranski, Lucas Ceulemans, Meghna Chadha, Bruce H. Chamberlain, Eric L. Chang, Victor T. Chang, Harvey Max Chochinov, Edward Chow, Grace Christ, Katherine Clark, Stephen Clarke, Josephine M. Clayton, James F. Cleary, Lawrence J. Clein, Katri Elina Clemens, Libby Clemens, Robert Colebunders, Steven R. Connor, Viviane Conraads, Colm Cooney, Massimo Costantini, Azucena Couceiro, Holly Covington, John D. Cowan, Patrick Coyne, Garnet Crawford, Brian Creedon, Hilary Cronin, Garret Cullen, Jennifer E. Cummings, David C. Currow, Paul J. Daeninck, Pamela Dalinis, Prajnan Das, Mellar P. Davis, Sara N. Davison, Catherine Deamant, Liliana de Lima, Conor P. Delany, Peter Demeulenaere, Lena Dergham, Noël Derycke, Rajeev Dhupar, Mario Dicato, Edwin D. Dickerson, Andrew Dickman, Maria Dietrich, Pamela Dixon, Philip C. Dodd, James T. D'Olimpio, Per Dombernowsky, Michael Dooley, Deborah Dudgeon, Geoffrey P. Dunn, David Dunwoodie, Jane Eades, Badi El Osta, Katja Elbert-Avila, John Ellershaw, Bassam Estfan, Louise Exton, Alysa Fairchild, Matthew Farrelly, Konrad Fassbender, Jason Faulhaber, Kenneth C.H. Fearon, Lynda E. Fenelon, Peter F. Ferson, Petra Feyer, Marilene Filbet, Pam Firth, Susan F. FitzGerald, Hugh D. Flood, Francesca Crippa Floriani, Paul J. Ford, Barry Fortner, Darlene Foth, Bridget Fowler, Karen Frame, Thomas G. Fraser, Fred Frost, Michael J. Fulham, Pierre R. Gagnon, Lisa M. Gallagher, Maureen Gambles, Subhasis K. Giri, Paul Glare, Cynthia R. Goh, Xavier Gómez-Batiste, Leah Gramlich, Luigi Grassi, Phyllis A. Grauer, Claire Green, Gareth Griffiths, Yvona Griffo, Hunter Groninger, David A. Gruenewald, Jyothirmai Gubili, Terence L. Gutgsell, Elizabeth Gwyther, Paul S. Haber, Achiel Haemers, Mindi C. Haley, Mazen A. Hanna, Janet R. Hardy, Jodie Haselkorn, Katherine Hauser, Cathy Heaven, Michael Herman, Jørn Herrstedt, Stephen Higgins, Irene J. Higginson, Joanne M. Hilden, Kathryn L. Hillenbrand, Burkhard Hinz, Jade Homsi, Kerry Hood, Juliet Y. Hou, Guy Hubens, Peter Hudson, John G. Hughes, John Hunt, Craig A. Hurwitz, James Ibinson, Nora Janjan, Birgit Jaspers, Thomas Jehser, A. Mark Joffe, Laurence John, Jennie Johnstone, J. Stephen Jones, Javier R. Kane, Matthew T. Karafa, Andrew P. Keaveny, Dorothy M.K. Keefe, Catherine McVearry Kelso, Rose Anne Kenny, Martina Kern, Dilara Seyidova Khoshknabi, Jordanka Kirkova, Kenneth L. Kirsh, David W. Kissane, Eberhard Klaschik, Seref Komurcu, Kandice Kottke-Marchant, Kathryn M. Kozell, Sunil Krishnan, Deborah Kuban, Damian A. Laber, Ruth L. Lagman, Rajesh V. Lalla, Deforia Lane, Philip J. Larkin, Wael Lasheen, Peter Lawlor, Susan B. LeGrand, Vincent Lens, Dona Leskuski, Pamela Levack, Marcia Levetown, Jeanne G. Lewandowski, William R. Lewis, S. Lawrence Librach, Wendy G. Lichtenthal, J. Norelle Lickiss, Stefano Lijoi, Edward Lin, Arthur G. Lipman, Jean-Michel Livrozet, Mari Lloyd-Williams, Richard M. Logan, Francisco López-Lara Martín, Charles L. Loprinzi, John Loughnane, Michael Lucey, Laurie Lyckholm, Carol Macmillan, Frances Mair, Stephen N. Makoni, Bushra Malik, Kevin Malone, Marco Maltoni, Aruna Mani, Lucille R. Marchand, Darren P. Mareiniss, Anna L. Marsland, Joan Marston, Julia Romero Martinez, Isabel Martínez de Ubago, Lina M. Martins, Timothy S. Maughan, Catriona Mayland, Susan E. McClement, Ian McCutcheon, Michael F. McGee, Neil McGill, Stephen McNamara, Mary Lynn McPherson, Henry McQuay, Regina McQuillan, Robert E. McQuown, Michelle Meiring, Sebastiano Mercadante, Elaine C. Meyer, Randy D. Miller, Yvonne Millerick, Roberto Miniero, Armin Mohamed, Busi Mooka, Helen M. Morrison, J. Cameron Muir, Fiona Mulcahy, Hugh E. Mulcahy, Monica Muller, H. Christof Müller-Busch, Scott A. Murray, Friedemann Nauck, Katherine Neasham, Busisiwe Nkosi, Simon Noble, Antonio Noguera, Anna K. Nowak, Juan Nuñez-Olarte, Eugenie A.M.T. Obbens, Tony O'Brien, Megan Olden, Norma O'Leary, David Oliver, David Oliviere, Aurelius G. Omlin, Kaci Osenga, Diarmuid O'Shea, Christophe Ostgathe, Faith D. Ottery, Michel Ouellette, Edgar Turner Overton, Moné Palacios, Robert Palmer, Teresa Palmer, Carmen Paradis, Armida G. Parala, Antonio Pascual-López, Steven D. Passik, Timothy M. Pawlik, Malcolm Payne, Sheila Payne, Silvia Paz, José Pereira, George Perkins, Karin Peschardt, Hayley Pessin, Douglas E. Peterson, Vinod K. Podichetty, Robin Pollens, Eliza Pontifex, Susan Poole, Josep Porta-Sales, Graeme Poston, Ruth D. Powazki, William Powderly, Leopoldo Pozuelo, Eric Prommer, Christina M. Puchalski, Lukas Radbruch, David F.J. Raes, Jane Read, Anantha Reddy, Steven I. Reger, Susan J. Rehm, Stephen G. Reich, Javier Rocafort, Adam Rosenblatt, Cynda Hylton Rushton, K. Mitchell Russell, Karen Ryan, Lisa A. Rybicki, Paola Sacerdote, Vinod Sahgal, Mary Ann Sammon, Dirk Sandrock, Mark Sands, Denise L. Schilling, Valerie Nocent Schulz, Lisa N. Schum, Peter Selwyn, Joshua Shadd, Charles L. Shapiro, Aktham Sharif, Helen M. Sharp, Kirk V. Shepard, J. Timothy Sherwood, Nabin K. Shrestha, Richard J.E. Skipworth, Howard S. Smith, Mildred Z. Solomon, Diego Soto de Prado Otero, Denise Wells Spencer, Ron Spice, David Spiegel, Manish Srivastava, John N. Staffurth, Randall Starling, Grant D. Stewart, Jan Stjernswärd, Florian Strasser, Edna Strauss, Imke Strohscheer, Brett Taylor Summey, Graham Sutton, Nigel P. Sykes, Alan J. Taege, Marcello Tamburini, Yoko Tarumi, Davide Tassinari, Martin H.N. Tattersall, Karl S. Theil, Keri Thomas, Adrian Tookman, María P. Torrubia, Anna Towers, Daphne Tsoi, Rodney O. Tucker, James A. Tulsky, Rachel A. Tunick, Claire Turner, Martha L. Twaddle, Marie Twomey, Christina Ullrich, Catherine E. Urch, Mary L.S. Vachon, Bart Van den Eynden, Antonio Vigano, Erika Vlieghe, Angelo E. Volandes, Raymond Voltz, Paul W. Walker, Sharon Watanabe, Michael A. Weber, Elizabeth Weinstein, Sharon M. Weinstein, Kathryn L. Weise, Sherri Weisenfluh, John Welsh, Clare White, Donna M. Wilson, Joanne Wolfe, Tugba Yavuzsen, Albert J.M. Yee, Lisa M. Yerian, and Elena Zucchetti

Published
2009
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