Difficulties in Implementation of Advance Care Planning by Visiting Nurses in Remote Areas and their Countermeasures

Abstract

Objective: The purpose of this study was to explore the difficulties, their countermeasures, and challenges of conducting advance care planning (ACP) by visiting nurses working in remote areas.

Methods: Six visiting nurses working at a visiting nursing station located in a remote area of Prefecture A participated in semi-structured interviews. We used a qualitative inductive analysis.

Results: 13 categories of difficulties in implementing ACP were extracted, including [inadequate acceptance of medical conditions by patients and their families], [difficulty in finding time to talk to patients], [lack of understanding of home care by hospital doctors], and [lack of hospital and home care personnel and facilities]. 11 categories regarding countermeasures and challenges were extracted, including [explanations according to the level of understanding and preparation without forcing the process], [mutually complementary collaboration between supporters and care offices], [tactics for information sharing among multiple professions], and [awareness raising and staff education to promote ACP].

Conclusion: In remote areas, there are few opportunities to experience practical support, and there is a shortage of resources and manpower, so there is a need for educational opportunities for those involved to improve their ACP qualities and measures to strengthen cooperation among local stakeholders, such as mutually complementary collaboration.