Advance care planning in rural Montana: exploring the nurse's role

Abstract

Background: It is recommended that advance care planning (ACP) take place across the lifespan. Rural populations have a heightened risk for poor quality and high cost of end-of-life care. Advance care planning can be led by nurses to ensure end-of-lifecare reflects patients' wishes. Purpose: A doctoral project was completed to assess rural nurses' knowledge, attitudes and experiences with advance directives (ADs). Information gained was used to develop evidence-based recommendations to facilitate nurses in ACP. Sample: Participants were nurses who practice in rural settings (N = 22). Average age was 46.4 years. All were Caucasian (n = 22) and the majority were baccalaureate prepared (n = 12). Practice settings were primarily in home care (50%) and hospice (27%). Methods: The Knowledge, Attitudinal, and Experimental Surveys on Advance Directives were distributed. Descriptive statistics were used for analysis. Results: The overall knowledge scores on ADs were low (57%). Nurses felt confident in counseling (n = 19) and initiating (n = 20) discussions with patients and families. Nurses believed they have administrative support (82%), but less physician support (50%) in ACP. Less than half of the nurses stated they are part of the ACP team at their facility (45%). Nurses described the need for more education, training and knowledge on ACP (n = 13). Nurses reported receiving no training on health perceptions of rural dwellers (64%) and some reported no training on providing culturally sensitive care to rural dwellers (45%). The majority reported access to AD resources (90%) and mentorship of younger nurses (95%) would be beneficial. Conclusions: Participants were confident in initiating and counseling patients with ADs, but indicated a need for additional education, time, and support from administration and physicians to better assist patients in ACP. Implications: A continuing education presentation was given in Cascade County on the survey results and recommendations for facilitation of nurses in the ACP process. Recommendations include: Providing workplace education, supporting nurses in ACP, mentoring young nurses in ACP, providing ACP resources, and providing cultural sensitivity through the incorporation of the Rural Nursing Theory. Project findings were published in The Pulse for dissemination on a statewide level.