Dataset Information

Using the recommended summary plan for emergency care and treatment (ReSPECT) in care homes: a qualitative interview study.

ABSTRACT:

Background

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an advance care planning process designed to facilitate discussion and documentation of preferences for care in a medical emergency. Advance care planning is important in residential and nursing homes.

Aim

To explore the views and experiences of GPs and care home staff of the role of ReSPECT in: (i) supporting, and documenting, conversations about care home residents' preferences for emergency care situations, and (ii) supporting decision-making in clinical emergencies.

Setting/participants

Sixteen GPs providing clinical care for care home residents and 11 care home staff in the West of England.

Methods

A qualitative research design using semi-structured interviews.

Results

Participants' accounts described the ReSPECT process as facilitating person-centred conversations about residents' preferences for care in emergency situations. The creation of personalised scenarios supported residents to consider their preferences. However, using ReSPECT was complex, requiring interactional work to identify and incorporate resident or relative preferences. Subsequent translation of preferences into action during emergency situations also proved difficult in some cases. Care staff played an important role in facilitating and supporting ReSPECT conversations and in translating it into action.

Conclusions

The ReSPECT process in care homes was positive for GPs and care home staff. We highlight challenges with the process, communication of preferences in emergency situations and the importance of balancing detail with clarity. This study highlights the potential for a multi-disciplinary approach engaging care staff more in the process.

SUBMITTER: Kesten JM

PROVIDER: S-EPMC9588387 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Publications

Using the recommended summary plan for emergency care and treatment (ReSPECT) in care homes: a qualitative interview study.

Kesten Joanna May JM Redwood Sabi S Pullyblank Anne A Tavare Alison A Pocock Lucy L Brant Heather H Hill Elizabeth M EM Tutaev Mary M Shum Rui Zhi RZ Banks Jon J

Age and ageing 20221001 10

<h4>Background</h4>The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an advance care planning process designed to facilitate discussion and documentation of preferences for care in a medical emergency. Advance care planning is important in residential and nursing homes.<h4>Aim</h4>To explore the views and experiences of GPs and care home staff of the role of ReSPECT in: (i) supporting, and documenting, conversations about care home residents' preferences for emergency ca ...[more]

PMID: 36273344

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Project description:BackgroundEarly in the COVID-19 pandemic, care homes (long-term care facilities) globally were severely impacted in many ways, including end-of-life care and death of residents. They experienced significantly elevated mortality rates amongst residents, compounded by restrictions on support from external healthcare and specialist palliative care providers. Family access to dying residents was often severely restricted. This paper explores experiences of deaths, dying and end-of-life care in care homes during the first year of the pandemic (Spring 2020-2021).MethodsAs part of a wider study of experiences in care homes in Northern England during the early pandemic, we conducted semi-structured interviews with care home staff (16), residents (3), family members (5) and health service staff (10). Interviews were analysed using reflexive thematic analysis, this secondary analysis focusing on experiences of death and dying over the period.ResultsThematic analysis generated three key themes: (1) Preparing for large scale deaths: Care home staff reported a sense of foreboding at requirements to prepare for large scale resident deaths, sometimes feeling left with minimal external support to manage this, and uneasy about the rapid roll-out of emergency care planning to residents; (2) Balancing support and policing visiting during the terminal phase: The requirement to restrict access for family members when their relatives were dying was experienced as distressing for both family members and care home staff; and, (3) Distress surrounding deaths for staff and families: Care home staff were distressed by the frequency and speed of deaths that they witnessed when their care home had a COVID-19 outbreak. Family separation near time of death was a source of distress for everyone involved, with suggestions that this led to regrets in bereavement for family members, and moral distress in staff.ConclusionsThe experience of death and dying in care homes in the early waves of the COVID-19 pandemic was extremely challenging for care home staff and family members. Our analysis suggests that the ramifications of stringent visitation policies and the consequent distress may shape experiences in bereavement. Monitoring for longer term consequences, such as prolonged grief and moral injury, should be a priority.

Project description:BackgroundImproving quality of palliative and end of life care in older people's care homes is essential. Increasing numbers of people die in these settings, yet access to high quality palliative care is not routinely provided. While evidence for models of care are growing, there remains little insight regarding how to translate evidence-based models into practice. Palliative Care Needs Rounds (hereafter Needs Rounds) have a robust evidence base, for providing palliative care in care homes, reducing resident hospitalisations, improving residents' quality of death, and increasing staff confidence in caring for dying residents. This study aimed to identify and describe the context and mechanisms of change that facilitate implementation of Needs Rounds in care homes, and enable other services to reap the benefits of the Needs Rounds approach to care provision.MethodsQualitative interviews, embedded within a large randomised control trial, were conducted with a purposive sample of 21 staff from 11 care homes using Needs Rounds. The sample included managers, nurses, and care assistants. Staff participated in individual or dyadic semi-structured interviews. Implementation science frameworks and thematic analysis were used to interpret and analyse the data.ResultsContextual factors affecting implementation included facility preparedness for change, leadership, staff knowledge and skills, and organisational policies. Mechanisms of change that facilitated implementation included staff as facilitators, identifying and triaging residents, strategizing knowledge exchange, and changing clinical approaches to care. Care home staff also identified planning and documentation, and shifts in communication. The outcomes reported by staff suggest reductions in hospitalisations and problematic symptoms for residents, improved staff skills and confidence in caring for residents in their last months, weeks and days of life.ConclusionsThe significance of this paper is in offering care homes detailed insights into service contexts and mechanisms of change that will enable them to reap the benefits of Needs Rounds in their own services. The paper thus will support the implementation of an approach to care that has a robust evidence base, for a population under-served by specialist palliative care.Trial registrationACTRN12617000080325 .

Project description:ObjectivesTo explore the emergency medical dispatchers (EMDs) experiences of managing emergency medical calls.DesignA qualitative interview study with an inductive approach. EMDs were interviewed individually using a semistructured interview guide. The verbatim transcripts were analysed using a qualitative content analysis.SettingEMDs, without a professional background as registered nurses, were recruited from emergency medical communication centers (EMCCs) within Sweden.ParticipantsTo achieve a varied description of EMDs' experiences, participants were included from several EMCCs nationally, using a convenience sampling. Interviews were performed up until saturation of data, resulting in 13 EMDs from 7 EMCCs being interviewed. All the EMDs were women, ranging in age from 28 to 61 years (mean 42 years), and had worked in emergency medical dispatching between 1 and 13.5 years (mean 6.5 years).ResultsThe analysis revealed the main category-to attentively manage a multifaceted, interactive task-made up of three categories: utilize creativity to gather information, continuously process and assess complex information, and engage in the professional role. The content of each category was reflected in several subcategories further described and illustrated with representative quotes.ConclusionsManaging emergency medical calls was experienced by EMDs to attentively manage a multifaceted interactive task. Core parts were described as: the ability to utilize creativity to gather information, continuously process and asses complex information, and engage in the professional role. Our results could be beneficial for emergency care managers when designing training programmes and organising EMD work and the EMD work environment, including further development of dispatch protocols and implementation of regular feedback sessions. Moreover, the results indicate that aspects such as self-awareness and emotional challenges encountered during EMD work could be important matters to discuss during staff evaluations.

Dataset Information

Using the recommended summary plan for emergency care and treatment (ReSPECT) in care homes: a qualitative interview study.

Background

Aim

Setting/participants

Methods

Results

Conclusions

Publications

Using the recommended summary plan for emergency care and treatment (ReSPECT) in care homes: a qualitative interview study.

Similar Datasets

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