Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies.
OBJECTIVE
To explore nurses' views regarding implementing advance care planning for older people.


BACKGROUND
Advance care planning is recommended as a way for older people to discuss their future care with family members and health professionals. Nurses play key roles in the process of advance care planning, including ensuring that patients are informed of their rights and that decisions are known to, and respected by, the health care team. Thus, understanding of nurses' experiences and perspectives regarding implementing advance care planning for older people is a significant topic for review.


METHODS
Qualitative meta-synthesis.


METHODS
Four databases including CINAHL plus, Medline [EBSCOhost], EMBASE, and PsycINFO were searched, and 1844 articles were initially screened. Finally, 18 articles were critically appraised and a thematic synthesis was undertaken.


RESULTS
Four themes were identified regarding implementation of advance care planning: perceived disadvantages and advantages of advance directives; nurses' responsibility and roles; facilitators and barriers; and nurses' needs and recommendations. Nurses felt that advance directives provided more advantages than disadvantages. Nurses generally believed that they were well positioned to engage in advance care planning conversations. Nurses perceived barriers relating to older people, families, environment, time, culture, cost, language and knowledge of health care teams with regard to advance care planning. In nurses' needs, education and support were highlighted.


CONCLUSIONS
This study provides useful knowledge for implementing advance care planning through illustrating nurses' experiences and perspectives. The results showed that nurses were more concerned about barriers in relation to working environment, teamwork, time and knowledge of health care team members than older people's characteristics, when implementing advance care planning.


CONCLUSIONS
The findings provide nurses and administrators with information to develop related policies and education. Additionally, the appointment of nurses to formal roles related to advance care planning is appropriate and warranted.
School of Nursing in National Taiwan University, Department of Nursing, Taipei Veterans General Hospital, Beitou District, Taipei, Taiwan.
Li-Shan
http://orcid.org/0000-0003-3267-9196
LS
Ke
School of Nursing and Midwifery, Monash University, Frankston, Vic., Australia.
Xiaoyan
X
Huang
Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, Vic., Australia.
Margaret
M
O'Connor
Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, Vic., Australia.
Susan
S
Lee
D032722:Advance Care Planning; D000368:Aged; D001291:Attitude of Health Personnel; D005851:Geriatric Nursing; D006299:Health Services for the Aged; D006801:Humans; D009736:Nursing Process
advance care planning; advance directives; meta-synthesis; nurses; systematic review