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Original Research

Advance Care Planning

An Exploration of the Beliefs, Self-Efficacy, Education, and Practices of RNs and LPNs

Contrada, Emily

AJN The American Journal of Nursing: December 2018 - Volume 118 - Issue 12 - p 33,42
doi: 10.1097/01.NAJ.0000549665.43827.87
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Advance Care Planning: An Exploration of the Beliefs, Self-Efficacy, Education, and Practices of RNs and LPNs

GENERAL PURPOSE:

To present the details of a study done to compare the advance care planning–related beliefs, sense of self-efficacy, education, and practices of RNs and LPNs.

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LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you should be able to

  • summarize the findings of the review of the literature.
  • describe the methods and participant demographics of this study.
  • discuss the authors’ findings and implications for practice.
  1. According to estimates, by 2020, what percentage of Americans will likely die in nursing homes?
    1. up to 40%
    2. about 50%
    3. nearly 60%
  2. In long-term care settings, active engagement in advance care planning (ACP) typically occurs with
    1. a majority of older adults.
    2. about half of older adults.
    3. a minority of older adults.
  3. An example of a system-based factor that presents a barrier to ACP is
    1. discomfort in discussing ACP.
    2. inadequate facility policies.
    3. lack of family involvement.
  4. Data for the authors’ study were drawn from urban skilled nursing facilities in zip code areas wherein African Americans constituted what percentage of the population?
    1. about 4%
    2. just under 7%
    3. more than 10%
  5. About three-fourths of the respondents in the authors’ study were
    1. white.
    2. black.
    3. Hispanic.
  6. Compared with RN respondents, LPN respondents
    1. were significantly older.
    2. spent more time in direct contact with residents.
    3. had fewer years of service within their current facility.
  7. Compared with RNs, how likely were LPNs to agree with the statement “I believe it is not my role to initiate discussions about ACP”?
    1. significantly more likely
    2. about as likely
    3. significantly less likely
  8. Overall, compared with LPNs, how did RNs score their sense of self-efficacy regarding ACP?
    1. significantly lower
    2. about the same
    3. significantly higher
  9. What proportion of LPNs reported having an advance directive in place for themselves?
    1. about one-quarter
    2. about one-third
    3. about half
  10. More than half of both RNs and LPNs reported having discussed ACP with residents within the past
    1. week.
    2. month.
    3. 6 months.
  11. At each increasing level of negative beliefs, nurses discussed ACP with a
    1. lower percentage of residents.
    2. slightly higher percentage of residents.
    3. significantly higher percentage of residents.
  12. Data from the most recent National Nursing Workforce Survey indicate that, compared with RNs, the LPN workforce is
    1. more diverse.
    2. about as diverse.
    3. less diverse.
  13. In the authors’ study, compared with RNs, LPNs reported their knowledge level about diseases and disease progression as
    1. higher.
    2. about the same.
    3. lower.
  14. In general, compared with LPNs, RNs tend to handle more duties that are
    1. clinical.
    2. administrative.
    3. culturally sensitive.
  15. According to earlier research by Baughman and colleagues, nurses were more likely to decide that ACP was indicated when
    1. the family requested it.
    2. the patient was admitted to the long-term care facility.
    3. the patient was at higher risk for hospitalization.
  16. Coffey and colleagues found that increased nursing education and confidence were significantly and positively correlated with end-of-life care that is more
    1. comprehensive.
    2. skills based.
    3. supportive.
  17. In a study among RNs, Lipson and colleagues found that which of the following was correlated with a higher probability of discussing advance directives with patients?
    1. graduate education that addressed such discussions
    2. higher self-confidence about holding such discussions
    3. personal experience in holding such discussions
  18. Limitations of the authors’ study included all of the following except
    1. the use of self-report.
    2. possible administrative biases.
    3. sample recruitment from assisted living facilities.
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