Life In The Slower Lane

Here is the PICO analysis for the article:

Full Article Title:

The essentials of Advance Care Planning for end-of-life care for older people

Authors: Jeong SY-S, Higgins I, McMillan M

Journal: Journal of Clinical Nursing (2010); 19:389–397

DOI: 10.1111/j.1365-2702.2009.03001.x

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✅ PICO Analysis

Type of Study:

Single-site case study using multiple qualitative data sources (participant observation, field notes, semi-structured interviews, document analysis)

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P – Population

• Setting:Three residential aged care facilities (RACFs) in a regional health service area of New South Wales, Australia
• Participants:
  • Older residents receiving high-level residential care
  • Their family members
  • Registered nurses (RNs)
  • One Clinical Nurse Consultant (CNC) as program facilitator
• Context:
  • Residents often had complex chronic illnesses and were approaching end of life
  • ACP programme was part of a state-supported Chronic and Complex Care Program

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I – Intervention

• Advance Care Planning (ACP) ProgrammeFacilitated by an experienced Clinical Nurse Consultant (CNC), focused on increasing ACP and Advance Care Directive (ACD) uptake through a structured, multidisciplinary model
• Key Components (Based on a service model framework):
  • Input:
    • Organisational policy/manuals
    • Department of Health guidelines
    • Psychological and medical catalysts
    • Leadership by an expert CNC
  • Throughput:
    • Case conferences
    • Education sessions
    • Use of standardised forms and assessment tools
    • Communication with families, GPs, and health professionals
    • Ethical/legal considerations and multidisciplinary team involvement
  • Output:
    • Completion of ACDs
    • Improved autonomy and person-centred care
    • Dying with dignity
    • Cultural change in attitudes toward death and dying
  • Feedback:
    • Ongoing process evaluation and adjustment based on staff input

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C – Comparison

• No formal control or comparison groupThe study focused on capturing real-world implementation in depth through qualitative description and observation

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O – Outcomes

Person-Centred Outcomes:

• Enhanced autonomy for residents in expressing care preferences
• Increased resident and family satisfaction through meaningful involvement in care planning
• Greater alignment of care with residents’ wishes
• Promotion of dignity and improved dying experiences

Process Outcomes:

• Clear documentation of Advance Care Directives and Plans of Treatment
• Increased RN and staff understanding of ACP
• Increased nurse-initiated discussions about end-of-life care
• Multidisciplinary team collaboration and GP involvement
• Use of critical incident and thematic analysis for continuous reflection and system learning

Health System Outcomes (inferred):

• Anticipated reduction in inappropriate hospital transfers and interventions
• Reduction in moral distress among nurses due to clear direction from ACDs
• Organisational shift toward more formalised, values-driven end-of-life care practices

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Summary Conclusion:

This case study provided a comprehensive, systems-level look at the implementation of ACP in Australian RACFs. Successful outcomes were attributed to four essential factors: expert nursing leadership, structured discussions, staff education, and multidisciplinary involvement. The study’s findings support ACP as a person-centred, empowering process that contributes to improved clinical clarity and resident wellbeing, with ripple effects on family members and staff culture .

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