Implementing advance care planning in palliative and end of life care: a scoping review of community nursing perspectives.

BACKGROUND: Advance care planninganning (ACP) is a priority within palliative care service provision. Nurses working in the community occupy an opportune role to engage with families and patients in ACP. Carers and family members of palliative patients often find ACP discussions difficult to initiate. However, community nurses caring for palliative patients can encourage these discussions, utilising the rapport and relationships they have already built with patients and families. Despite this potential, implementation barriers and facilitators continue to exist. To date, no research synthesis has captured the challenges community nurses face when implementing ACP, nor the facilitators of community nurse-led ACP. Considering this, the review question of: 'What factors contribute to or hinder ACP discussion for nurses when providing care to palliative patients?' was explored. METHOD: To capture challenges and facilitators, a global qualitative scoping review was undertaken in June 2023. The Arksey and O'Malley framework for scoping reviews guided the review methodology. Six databases were searched identifying 333 records: CINAHL (16), MEDLINE (45), PUBMED (195), EMBASE (30), BJOCN (15), IJOPN (32). After de-duplication and title and abstract screening, 108 records remained. These were downloaded, hand searched (adding 5 articles) and subject to a full read. 98 were rejected, leaving a selected dataset of 15 articles. Data extracted into a data extraction chart were thematically analysed. RESULTS: Three key themes were generated: 'Barriers to ACP', 'Facilitators of ACP' and 'Understanding of professional role and duty'. Key barriers were - lack of confidence, competence, role ambiguity and prognostic uncertainty. Key facilitators concerned the pertinence of the patient-practitioner relationship enabling ACP amongst nurses who had both competence and experience in ACP and/or palliative care (e.g., palliative care training). Lastly, nurses understood ACP to be part of their role, however, met challenges understanding the law surrounding this and its application processes. CONCLUSIONS: This review suggests that community nurses' experience and competence are associated with the effective implementation of ACP with palliative patients. Future research is needed to develop interventions to promote ACP uptake in community settings, enable confidence building for community nurses and support higher standards of palliative care via the implementation of ACP.

Justice for whom, exactly? Beliefs in justice for the self and various others.

The present studies examine why people think the world is more just to themselves than to others generally. Beliefs in justice for the self were uniquely associated with psychological adjustment, consistent with the theoretical motive to believe in justice for the self (Studies 1 and 2). However, this "justice motive" did not appear to affect the relative strength of justice beliefs. Instead, self-other differences in justice beliefs appeared to reflect objective assessments of the justice received by various demographics. Undergraduates believed the world to be more just to themselves than to others but not their undergraduate peers specifically (Study 1). Participants of both genders believed the world to be more just to men, and to themselves, than to women (Study 2). Women did not exempt themselves individually from injustice but believed, similar to men, that undergraduate women receive as much justice as men (Study 3).

A dual-process account of digit invariance learning.

Performance in the McGeorge and Burton (1990) digit invariance task was originally thought to be mediated by unconscious abstraction of a "rule" that identified the invariant feature across all study items. Subsequent explanations have suggested explicit strategy use or similarity-to-exemplar matching rather than abstraction. This paper presents data that suggest that both similarity and abstraction can be used under different task demands. Delay between study and test afforded abstraction of the invariant knowledge whereas reducing the pool of study exemplars enhanced responding based on specific similarity. These results parallel effects found in the categorization literature. Rule abstraction in this sense may be due to statistical learning of feature frequency rather than abstraction of a central tendency or a complex/conceptual rule. Categorizing responses into subjective memory states (remember/know/guess) demonstrates that neither the similarity matching nor the abstraction mechanism uses information from episodic memory. Confidence measures show that participants are more confident of responses when the prototypical representation is used but not specific similarity. Taken together, these data suggest that abstracted knowledge is not held consciously but that participants have meta-awareness of when they are using the abstracted representation.