Mrs Gabrielle Raikiwasa1
1Eldercare Australia Ltd, Eastwood, Australia
Biography:
Gabrielle is a Nurse Practitioner Candidate and passionate advocate for evidence-based palliative care, focusing specifically on palliative care in residential aged care settings. Her work, an intensive integrative literature review, examines the systemic and professional impact of Advance Care Planning (ACP) on the nursing workforce. Gabrielle’s research identifies key organisational, emotional, and educational barriers, underscoring the necessity of culturally competent and structured ACP initiatives. She is committed to translating these findings into practical, sustainable workforce education and policy reforms that empower nurses and ensure equitable, preference-aligned end-of-life care for all RACF residents.
Abstract:
Background:
The redesign of end-of-life care in the community requires innovative approaches, positioning residential aged care facilities (RACFs) as central hubs for palliative support. Inconsistent Advance Care Planning (ACP) is a key barrier, leaving nurses without clear guidance, contributing to avoidable hospital transfers, and increasing professional distress. This integrative review examines nurses lived experiences to demonstrate how a proactive ACP culture acts as a practical, system-level innovation for optimal, person-centred care.
Aims:
This review aimed to evaluate aged care nurses’ perceptions and experiences of end-of-life care for residents with and without a completed ACP. The purpose was to identify key barriers and enablers to effective ACP implementation to inform evidence-based strategies for improving practice and policy in the aged care sector.
Methods:
An integrative review of qualitative and mixed-methods studies, focusing on nurses’ first-hand experiences in RACFs, was conducted. A systematic search of PubMed, CINAHL, and AgeLine (2014–2025) identified 14 peer-reviewed studies. Synthesis and critical appraisal followed the Joanna Briggs Institute’s (JBI) Feasibility, Appropriateness, Meaningfulness, and Effectiveness (FAME) framework.
Results:
The presence of a clear ACP significantly enhanced nurses’ professional confidence and reduced moral distress, guiding timely, preference-aligned interventions. Conversely, the absence of an ACP created clinical uncertainty, ethical burden, and frequently resulted in reactive hospitalisations. Key barriers included insufficient training, organisational time constraints, and a lack of culturally competent tools. Enablers were strong interdisciplinary communication and targeted education on ethical and emotional complexities.
Conclusions:
ACP is a core, practical innovation critical for redesigning end-of-life care and achieving equity in RACFs. Embedding ACP as routine practice empowers the nursing workforce with a clear, ethical guide, establishing RACFs as primary settings for delivering compassionate, efficient, and preference-aligned palliative support.