- Title
- Gerotranscendence: a case study of the phenomenon of Advance Care Planning (ACP)
- Creator
- Jeong, Yeun-Sim (Sarah)
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2008
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Current advanced medical technology allows people to survive longer than ever before, however, prolonged life may not necessarily equate to quality of life. Health-care professionals often have to face situations in which a patient is no longer able to make his/her own end-of-life care decisions. Consequently families are left in the uncomfortable position of wondering what the wishes of their loved ones may have been. Advance Care Planning (ACP), the focus of this study, is defined as the process of preparing for likely scenarios in end-of-life decision-making, which may or may not result in documenting an Advance Care Directive (ACD). An ACD is a statement made by a mentally competent person concerning how s/he wishes to be treated, if s/he loses mental capacity. The benefits of ACP are discussed in the literature and older people, especially in long-term care facilities, are considered as the best candidates for ACP, due to their multiple pathophysiological degenerative health breakdown with minimal chance of recovery. However, the available evidence suggests that the practices of ACP and the use of ACDs in particular in residential aged care are limited in Australia. The experience of people with ACP is only anecdotal. This study was conducted to identify the implementation process of ACP by the Clinical Nurse Consultant (CNC) in Residential Aged Care Facilities (RACFs), to investigate the outcomes of ACP and experiences of people involved in ACP and ACDs, including residents, families, and nursing staff in RACFs, and to determine the extent of nursing participation and the scope of practice for nurses in the ACP process and the use of ACD. Case-study research was chosen to enrich the understanding of the phenomena and to collect data in a natural setting using a range of data-collection methods. Data were collected through intensive participant observation over seven months, using field notes, semi-structured interviews with residents, family members, and RNs, and analysis of documents relevant to the study aims. Participants and three RACFs in NSW were selected because of their involvement in the ACP program. The data collected from interviews and field notes were gathered and highlighted using critical incident technique (CIT) where it concerned behaviours, feelings, attitudes, opinions, comments, and perceptions in relation to each research question, for further extensive thematic content analysis. The software program ‘NVivo 7’ was used to code and categorise large amounts of narrative text which were collected from open-ended interviews. The raw data to which the CIT and thematic content analysis were applied generated 50 narratives. Four major images created by these narratives in relation to each research question comprised the montage of the phenomenon of ACP in RACFs. The research identified the conceptual framework which elaborated the elements in an ‘Input, Throughput, and Output system’ required for implementation of ACP. The study revealed that the residents’, family members’, and nurses’ experience with ACP was positive as it promoted one’s essence of being and autonomy. An understanding of the feelings, emotions, beliefs, and concerns of older people and their family members about ACP was achieved. The use of ACDs has confirmed that there are roles for nurses in the success of ACP and it has provided them with a new way to approach our ageing population in health-care decision-making for end-of-life care. One area of the significant findings of this case-study research is that it captured how the older people themselves see and approach their explication of their own ‘sense of self’ and that of others in later life, and that they accept dying and death. The phenomenon of ACP is not limited to the end-of-life decision-making processes and/or documentation of treatment preferences at the end of life. Rather it expanded the extent to which nurses engage themselves with older people and their family members onto the level that is person centred and that enhances gerotranscendence through ACP. The current study of the phenomenon of ACP has made a contribution to greater awareness of what constitutes ‘dying well’ and how it can be achieved through ‘A nursing theory of successful dying/gerotranscendence in end-of-life through ACP’. The study highlights the need to expand the domain of research to involve an exploration of experiences of ‘successful dying’.
- Subject
- advance care planning; older people; end-of-life care; residential aged care
- Identifier
- http://hdl.handle.net/1959.13/1045385
- Identifier
- uon:14452
- Rights
- Copyright 2007 Yeun-Sim (Sarah) Jeong
- Language
- eng
- Full Text
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