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Advance care planning for institutionalised older people: An integrative review of the literature

机译：机构化老年人的预先护理计划：文献的综合回顾

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Background: This integrative review of the literature describes the evolution in knowledge and the paradigm shift that is necessary to switch from advance directives to advance care planning. Aims and objectives: It presents an analysis of concepts, trends, models and experiments that enables identification of the best treatment strategies, particularly for older people living in nursing homes. Design: Based on 23 articles published between 1999 and 2012, this review distinguishes theoretical from empirical research and presents a classification of studies based on their methodological robustness (descriptive, qualitative, associative or experimental). Results: It thus provides nursing professionals with evidence-based information in the form of a synthetic vision and conceptual framework to support the development of innovative care practices in the end-of-life context. While theoretical work places particular emphasis on the impact of changes in practice on the quality of care received by residents, empirical research highlights the importance of communication between the different persons involved about care preferences at the end of life and the need for agreement between them. Conclusions: The concept of quality of life and the dimensions and factors that compose it form the basis of Advance care planning (ACP) and enable the identification of the similarities and differences between various actors. They inform professionals of the need to ease off the biomedical approach to consider the attributes prioritised by those concerned, whether patients or families, so as to improve the quality of care at the end of life. Implications for practice: It is particularly recommended that all professionals involved take into account key stakeholders' expectations concerning what is essential at the end of life, to enable enhanced communication and decision-making when faced with this difficult subject.
机译：背景：对文献的综合回顾描述了知识的发展和从预先指示转为预先护理计划所必需的范式转变。目的和目标：它提供了对概念，趋势，模型和实验的分析，从而可以确定最佳的治疗策略，特别是针对住在疗养院中的老年人。设计：根据1999年至2012年发表的23篇文章，本综述将理论研究与实证研究区分开来，并根据其方法的鲁棒性（描述性，定性，关联性或实验性）对研究进行分类。结果：因此，它以综合的愿景和概念框架的形式为护理专业人员提供了基于证据的信息，以支持在生命周期结束时开发创新的护理方法。尽管理论工作特别强调实践中的变化对居民所获得的护理质量的影响，但实证研究强调，涉及生命终期的护理偏好的不同人士之间进行交流的重要性以及他们之间达成协议的必要性。结论：生活质量的概念以及构成生活质量的维度和因素构成了预先护理计划（ACP）的基础，并使人们能够识别不同行为者之间的异同。他们告知专业人员，有必要简化生物医学方法，以考虑相关人员（患者或家庭）的优先考虑的属性，以提高生命终结时的护理质量。对实践的影响：特别建议所有相关专业人士考虑关键利益相关者对生命终结中必不可少的期望，以便在面对这一难题时能够加强沟通和决策。

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