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‘Getting Everyone on the Same Page’: Long‐Term‐Care Nurses' Experiences With Advance Care Planning
Preetha Krishnan, Susan McClement, Genevieve N. Thompson, Marie Edwards, Philip St. John. International Journal of Older People Nursing, 2025-02-13
Topic: Risk, prevention and care in population studies
The basic social process that emerged from the data was that of nurses trying to identify an ACP level and craft a corresponding care plan that they believed would optimise residents' comfort in LTC during both acute medical events and at the end-of-life (EOL). The empirically derived theoretical model that captured the experiences, processes and strategies of nurses to address the identified social process was orchestrating comfort: getting everyone on the same page. This model encompassed two main processes, downgrading and upgrading ACP levels, and two preconditions, piecing together the big picture and selling the big picture. Ensuring comfort for LTC residents at the end-of-life or during acute events by getting everyone on the same page is a complex process. The ability of nurses to downgrade or upgrade the ACP level to orchestrate comfort for LTC residents involves many factors related to the resident, family, healthcare providers and the context in which the ACP discussions take place. IMPLICATIONS OF PRACTICE: Providing ACP/dementia information in LTC admission packages and through informational sessions can raise family awareness of these topics and dementia's complications. Clinical rotations in LTC facilities for medical, nursing, and paramedic students could also improve their understanding of the sector's complexities.
Key findings
- The basic social process that emerged from the data was that of nurses trying to identify an ACP level and craft a corresponding care plan that they believed would optimise residents' comfort in LTC during both acute medical events and at the end-of-life (EOL).
- The empirically derived theoretical model that captured the experiences, processes and strategies of nurses to address the identified social process was orchestrating comfort: getting everyone on the same page.
- This model encompassed two main processes, downgrading and upgrading ACP levels, and two preconditions, piecing together the big picture and selling the big picture.
- Ensuring comfort for LTC residents at the end-of-life or during acute events by getting everyone on the same page is a complex process.
- The ability of nurses to downgrade or upgrade the ACP level to orchestrate comfort for LTC residents involves many factors related to the resident, family, healthcare providers and the context in which the ACP discussions take place.
Why it matters
This study describes long-term-care nurses' experiences of trying to identify an advance care planning level and craft a care plan to optimise residents' comfort. It offers a theoretical model of this process rather than testing whether any intervention changes outcomes.
Study details
- Evidence strengthLow
How this study scored 30/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (International Journal of Older People Nursing) |
| Journal's citation record | 0 / 4 | International Journal of Older People Nursing: journal h-index 61 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 2 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Philip St. John: h-index 23 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | University of Manitoba: institution h-index 666 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39945484) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 30 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Krishnan, P., McClement, S., Thompson, G. N., Edwards, M., & John, P. S. (2025). ‘Getting Everyone on the Same Page’: Long‐Term‐Care Nurses' Experiences With Advance Care Planning. International Journal of Older People Nursing. https://doi.org/10.1111/opn.70013
Vancouver
Krishnan P, McClement S, Thompson GN, Edwards M, John PS. ‘Getting Everyone on the Same Page’: Long‐Term‐Care Nurses' Experiences With Advance Care Planning. International Journal of Older People Nursing. 2025. doi:10.1111/opn.70013. PMID: 39945484.
BibTeX
@article{krishnan2025-39945484,
author = {Krishnan, Preetha and McClement, Susan and Thompson, Genevieve N. and Edwards, Marie and John, Philip St.},
title = {{‘Getting Everyone on the Same Page’: Long‐Term‐Care Nurses' Experiences With Advance Care Planning}},
journal = {International Journal of Older People Nursing},
year = {2025},
doi = {10.1111/opn.70013},
pmid = {39945484},
url = {https://doi.org/10.1111/opn.70013}
}
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