Certified nursing assistants’ perspectives on their role in advance care planning for older persons: a qualitative study

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Abstract Background Advance care planning in older persons with palliative care needs is often not (timely) initiated. Certified nursing assistants are closely involved in the (daily) care for older persons and have important insights regarding their clients’ care preferences and quality of life. However, their role in advance care planning is currently overlooked. Aim To examine the perspectives of nursing assistants on their role in advance care planning for older persons. Design A qualitative descriptive study design using semi-structured interviews. Setting/participants Fifteen nursing assistants working in community care and nursing homes in the Netherlands were interviewed between March and December 2023. A combined inductive and deductive thematic analysis was performed using the Capability, Opportunity, Motivation Behavioral model. Results Most nursing assistants were not structurally involved in advance care planning and were in need of additional knowledge and skills (capability). The team culture affected nursing assistants’ opportunities and motivation to participate in advance care planning both positively and negatively. The opportunity was further shaped by nursing assistants’ relationship with clients and relatives and time management, while motivation also depended on personal circumstances. Conclusion This study found several barriers and facilitators affecting nursing assistants’ role in advance care planning for older persons. Structurally involving nursing assistants in advance care planning, supporting their work environment, and empowering them can foster equal collaboration with other healthcare professionals. This might contribute to the timely initiation of advance care planning and palliative care for older persons. Key statements i) What is already known about the topic? Advance care planning enables patients, relatives, and involved healthcare professionals to define and discuss goals and preferences for current and future medical treatment and care. Certified nursing assistants are often closely involved in the (daily) care for older persons and their relatives, providing important insights into their preferences and quality of life. Nursing assistants are currently not structurally involved in the interprofessional collaboration regarding advance care planning. ii) What this paper adds Variation was observed in nursing assistants’ roles in advance care planning across care teams and settings, with most indicating a need for additional knowledge and skills (capability). The team culture affected nursing assistants’ opportunities and motivation to participate in advance care planning both positively and negatively. The opportunity was further shaped by nursing assistants’ relationship with clients and relatives and time management, while motivation was also depended on personal circumstances. iii) Implications for practice Structural involvement of certified nursing assistants in advance care planning can contribute to timely initiation of advance care planning and palliative care for older persons. A supportive work environment that enables nursing assistants to develop their skills and grow professionally can facilitate an advance care planning process involving the expertise of all healthcare professionals. The empowerment of nursing assistants could help them to become a more equal partner in advance care planning in collaboration with other involved professionals.

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