Sykepleier og stipendiat på Senter for medisinsk etikk, Universitetet i Oslo,
Trygve Johannes Lereim Sævareid
disputerte mandag 7. Oktober med avhandlingen “Advance care planning in nursing homes – A mixed methods study of a complex intervention using a whole-ward approach”. Hovedveileder var Reidar Pedersen, Senter for Medisinsk Etikk, UiO, og Lisbeth Thoresen, UiO.
Første opponent var Professor Chris Gastmans, KU Leuven og dr. PhD. Anette Fosse, Øvermo legesenter andre opponent. Tredje komitémedlem var Adjunct Professor, Director Arild Bjørndal, University of Oslo.
Prøveforelesningen hadde som tema: "Relational autonomy in the ethical literature on end-of-life practices and how it can be applied to advance care planning in nursing homes".
Trygve Sævareid klarte seg flott både i prøveforelesning og på disputas, og Professor Emeritus Per Hjortdahl, UiO, loset oss fint gjennom det hele.
Advance care planning assists people to share their personal values, life goals, and preferences for future medical care before it is too late. When in need of end-of-life decisions in nursing homes, the patient is often no longer capable of participating in any meaningful communication. Thus, advance care planning is essential to secure patient participation in the decision-making processes at the end of their life. One aim of this project was to improve patient participation in the decision-making processes at end of life in nursing homes.
The mixed methods research design included chart reviews, qualitative interviews, and observation of advance care planning. We did a cluster-randomized trial in eight nursing home wards. Advance care planning was the clinical intervention and we used a whole-ward approach in implementing it. Included in the whole-ward approach was involving patients as much as possible, also those with cognitive impairment, and involving next-of-kin as support for the patients.
We found improved nursing home patient participation in advance care planning, patients with cognitive impairment participated actively and relayed relevant information, and participants and observations found conversations as patient-focused. Cognitive impairment represented a challenge and indicate that advance care planning may profit from commencing before nursing home admission. However, the patients received support from their next-of-kin, which enabled them to participate in the discussions. This thesis indicates that advance care planning may lay an important foundation for person-centered care and for respecting patient autonomy, which extends to the nursing home context.