A broader understanding of care managers' attitudes of advance care planning: A concurrent nested design.
*Attitude of Health Personnel; *Health Knowledge; Adult; Advance Care Planning; Advance Care Planning/*standards; Attitudes; Case Managers; Chi Square Test; community health; Concurrent Prospective Studies; Convenience Sample; decision-making; Discussion; end of life; Female; Focus Groups; Funding Source; Health Services Accessibility/standards; Human; Humans; Male; Middle Age; Middle Aged; Midwestern United States; Multicenter Studies; Multimethod Studies; Nurse Attitudes; nurses; Practice; qualitative; Qualitative Research; quantitative; Questionnaires; Surveys; Surveys and Questionnaires; Thematic Analysis
AIMS AND OBJECTIVES: To examine barriers of advance care planning (ACP) experienced by care managers (CMs) through a mixed methods approach. A concurrent nested design was used to acquire a deeper understanding of ACP and to identify nuances between quantitative and qualitative data. BACKGROUND: Past quantitative studies on providers have identified barriers related to time, culture, knowledge, responsibility and availability of legal documents. These barriers, and accompanying attitudes and feelings, have been taken at face value without rich qualitative data to identify under what conditions and to what extent a barrier impacts care. DESIGN: A two-part multisite, mixed methods study was conducted using surveys and focus groups. METHODS: Surveys were completed by 458 CMs at 10 Area Agencies on Aging and 62 participated in one of eight focus groups. Data were analysed using a concurrent nested design with individual data analysis and a merged data approach. RESULTS: There were three main distinctions between the quantitative and qualitative data. First, while CMs reported on the survey that ACP was not too time consuming, focus group data revealed that time was an issue especially related to competing priorities. Second on the survey 60% of the CMS reported they had enough knowledge, but qualitative data revealed about more nuances. Last, the reported comfort levels in the quantitative data were less overt in the qualitative date where additional feelings and attitudes were revealed, for example, frustration with families, preferences for more physician involvement. CONCLUSIONS: Care managers reported their attitudes about ACP, clarified through a rigorous mixed methods analysis. Care managers can successfully lead ACP discussions, but require further education, resources and team-based guidance. RELEVANCE TO CLINICAL PRACTICE: Advance care planning is essential for reducing emotional, social and financial burdens associated with healthcare decision-making, and CMs can positively impact ACP discussions when appropriately supported by the clinical community. The many nuances in the ACP process that we found illustrate the need for ongoing discussions, education and research on this important topic.
Aultman Julie; Baughman Kristin R; Ludwick Ruth
Journal of clinical nursing
2018
2018-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jocn.14531" target="_blank" rel="noreferrer noopener">10.1111/jocn.14531</a>
Surveying the hidden attitudes of hospital nurses' towards poverty.
*Attitude of Health Personnel; *Healthcare Disparities; *Poverty; Adult; Age Factors; Attitude Measures; attitudes; Coefficient Alpha; Convenience Sample; Cross Sectional Studies; Cross-Sectional Studies; Descriptive Research; Descriptive Statistics; Educational Status; Female; health disparities; health inequities; Health Status Disparities; Hospital; Hospital/*psychology; Human; Humans; Income; Job Experience; Male; Middle Age; Middle Aged; Multivariate Analysis; Nurse Attitudes – Evaluation; nurses; Nursing Staff; Ohio; Politics; poverty; Poverty; Registered Nurses; Regression; Regression Analysis; Summated Rating Scaling; Surveys and Questionnaires; Young Adult
AIMS AND OBJECTIVES: To explore the attitudes held by registered nurses about persons living in poverty. BACKGROUND: As a profession, nursing has strong commitment to advocating for the socioeconomically disadvantaged. The links among poverty and health disparities are well established and research demonstrates that attitudes of providers can influence how those in poverty use health services. Although nurses are the largest sector of healthcare providers globally, little research has been published on their attitudes towards patients they care for who live in poverty. DESIGN: Cross-sectional survey. METHODS: Used a convenience sample of 117 registered nurses who completed the Attitudes Towards Poverty Short Form that contained three subscales. Regression analysis was used to examine the associations between the nurses' age, education, and years of experience, political views and financial security with their total score and subscale scores. RESULTS: Nurses were more likely to agree with stigmatising statements than statements that attributed poverty to personal deficiency or structural factors. In the multivariate analysis, years of experience were associated with more positive attitudes towards those living in poverty. Nurses with the most experience had less stigmatising beliefs about poverty and were more likely to endorse structural explanations. Those with a baccalaureate education were also more likely to endorse structural explanations for poverty. CONCLUSIONS: Gaining knowledge about attitudes towards and the factors influencing those attitudes, for example, education, are important in helping combat the disparities associated with poverty. RELEVANCE TO CLINICAL PRACTICE: Nurses have a duty to evaluate their individual attitudes and biases towards those living in poverty and how those attitudes and biases may influence daily practice. Assessing nurses' attitudes towards poverty may aid in better means of empowering nurses to seek solutions that will improve health conditions for those living in poverty.
Wittenauer James; Ludwick Ruth; Baughman Kristin; Fishbein Rebecca
Journal of clinical nursing
2015
2015-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jocn.12794" target="_blank" rel="noreferrer noopener">10.1111/jocn.12794</a>