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The Role of Advance Care Planning on Community Dwelling Adults' Coping Abilities and Death Attitudes: A Sequential Mixed‐Methods Study

ABSTRACT

Aim

To (1) examine the attitudes of community-dwelling adults towards death and their ability to cope with death, as well as (2) understand the influence of advance care planning on community-dwelling adults' death attitudes and coping with death.

Design

A sequential explanatory mixed-methods study was conducted in Singapore.

Methods

In Phase I, a case–control study was conducted to examine the differences in death attitudes and coping with death ability between community-dwelling adults who have completed advance care planning and those who have not. A univariate general linear model was used to compute the mean difference in death attitudes and coping with death scores. In Phase II, a descriptive qualitative study was conducted to provide an in-depth understanding of the influence of advance care planning among community-dwelling adults. Thematic analysis was used for qualitative analysis. Mixed-methods analysis was conducted to integrate the quantitative and qualitative data.

Results

In Phase I, 80 community-dwelling adults who had completed advance care planning and 81 community-dwelling adults who did not have advance care planning were included. Adults who had completed advance care planning had significantly higher coping with death scores (t = 4.14, p < 0.01). In Phase II, a purposive sample of 24 adults who had completed advance care planning was selected for individual semi-structured interviews. From the thematic analysis, three themes were developed: (1) Advance care planning enables coping with death, (2) overcoming fear of death with advance care planning and (3) confronting death with advance care planning.

Conclusion

Advance care planning may influence death attitudes and coping with death. Further work on longitudinal designs and among individuals from different age groups should be used to gain further in-depth understanding of the impacts of advance care planning.

Implications for the Profession and/or Patient Care

Strategies to enhance one's coping abilities with death and death attitudes should be developed to stimulate the uptake of advance care planning.

Reporting Method

This paper was reported according to the Good Reporting of A Mixed Methods Study framework.

Patient or Public Contribution

Community-dwelling adults participated in the survey and interviews.

Advanced Practice Nurses' Evidence‐Based Healthcare Competence and Associated Factors in Finland and Singapore—A Cross‐Sectional Study

ABSTRACT

Aim

To describe and compare the Evidence-Based HealthCare (EBHC) competence of Advanced Practice Nurses (APNs), and the factors associated with it in Finland and Singapore.

Design

A descriptive and analytical cross-sectional study.

Methods

Data were collected from APNs working in healthcare in Finland (n = 157) or Singapore (n = 99) between May 2023 and October 2023 using a self-assessment instrument to measure EBHC competence (EBHC-Comp-APN) and an EBHC knowledge test. The data were analysed using descriptive statistics, analysis of variance, K-mean cluster and multivariate analyses.

Results

The self-assessments of APNs working in Finland and Singapore regarding their EBHC competence level varied and three distinct profiles of APNs' EBHC competence were identified in both countries. The strongest EBHC competence was in ‘The Knowledge Needs Related to Global Health’, while the weakest in ‘Evidence Synthesis and Transfer’. The country-specific differences were identified in factors associated with EBHC competence.

Conclusion

The EBHC competencies of APNs vary widely and require planned and needs-driven development. In connection with the development of EBHC competence, the factors related to competence should be considered country-by-country.

Implications for the Profession

The APN's EBHC competence should be systematically developed considering the factors associated with and the current level of EBHC competence.

Impact

The level of EBHC competence of APNs and associated factors should be identified when developing their competence and role in collaboration with APNs, leaders of healthcare and education organisations and policy makers. In addition, research into APNs' EBHC competence should continue.

Reporting Method

The STROBE checklist was used in the reporting of the study.

Patient or Public Contribution

No patient or public contribution.

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