scholarly journals Using advance and emergency care plans during transfer decisions: A grounded theory interview study with care home staff

2021 ◽  
pp. 026921632110593
Author(s):  
Fawn Harrad-Hyde ◽  
Natalie Armstrong ◽  
Chris Williams
Keyword(s):  
Grounded Theory ◽  
Care Home ◽  
Care Homes ◽  
Structured Interviews ◽  
Care Home Staff ◽  
Care Plans ◽  
Modifiable Factors ◽  
Advance Care ◽  
The Moment ◽  
Staff Experiences

Background: Advance care planning has been identified as one of few modifiable factors that could reduce hospital transfers from care homes. Several types of documents may be used by patients and clinicians to record these plans. However, little is known about how plans are perceived and used by care home staff at the time of deterioration. Aim: To describe care home staff experiences and perceptions of using written plans during in-the-moment decision-making about potential resident hospital transfers. Design: Qualitative semi-structured interviews analysed using the Straussian approach to grounded theory. Setting/participants: Thirty staff across six care homes (with and without nursing) in the East and West Midlands of England. Results: Staff preferred (in principle) to keep deteriorating residents in the care home but feared that doing so could lead to negative repercussions for them as individuals, especially when there was perceived discordance with family carers’ wishes. They felt that clinicians should be responsible for these plans but were happy to take a supporting role. At the time of deterioration, written plans legitimised the decision to care for the resident within the home; however, staff were wary of interpreting broad statements and wanted plans to be detailed, specific, unambiguous, technically ‘correct’, understood by families and regularly updated. Conclusions: Written plans provide reassurance for care home staff, reducing concerns about personal and professional risk. However, care home staff have limited discretion to interpret plans and transfers may occur if plans are not specific enough for care home staff to use confidently.

scholarly journals Process evaluation for the Care Homes Independent Pharmacist Prescriber Study (CHIPPS)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Linda Birt ◽  
Lindsay Dalgarno ◽  
David J Wright ◽  
Mohammed Alharthi ◽  
Jackie Inch ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Qualitative Data ◽  
Controlled Trial ◽  
Care Home ◽  
Cluster Randomised Controlled Trial ◽  
Care Homes ◽  
Structured Interviews ◽  
Medicines Management ◽  
Care Home Staff ◽  
Care Plans

Abstract Background Medicines management in care homes requires significant improvement. CHIPPS was a cluster randomised controlled trial to determine the effectiveness of integrating pharmacist independent prescribers into care homes to assume central responsibility for medicines management. This paper reports the parallel mixed-methods process evaluation. Method Intervention arm consisted of 25 triads: Care homes (staff and up to 24 residents), General Practitioner (GP) and Pharmacist Independent Prescriber (PIP). Data sources were pharmaceutical care plans (PCPs), pharmacist activity logs, online questionnaires and semi-structured interviews. Quantitative data were analysed descriptively. Qualitative data were analysed thematically. Results were mapped to the process evaluation objectives following the Medical Research Council framework. Results PCPs and activity logs were available from 22 PIPs. Questionnaires were returned by 16 PIPs, eight GPs, and two care home managers. Interviews were completed with 14 PIPs, eight GPs, nine care home managers, six care home staff, and one resident. All stakeholders reported some benefits from PIPs having responsibility for medicine management and identified no safety concerns. PIPs reported an increase in their knowledge and identified the value of having time to engage with care home staff and residents during reviews. The research paperwork was identified as least useful by many PIPs. PIPs conducted medication reviews on residents, recording 566 clinical interventions, many involving deprescribing; 93.8% of changes were sustained at 6 months. For 284 (50.2%) residents a medicine was stopped, and for a quarter of residents, changes involved a medicine linked to increased falls risk. Qualitative data indicated participants noted increased medication safety and improved resident quality of life. Contextual barriers to implementation were apparent in the few triads where PIP was not known previously to the GP and care home before the trial. In three triads, PIPs did not deliver the intervention. Conclusions The intervention was generally implemented as intended, and well-received by most stakeholders. Whilst there was widespread deprescribing, contextual factors effected opportunity for PIP engagement in care homes. Implementation was most effective when communication pathways between PIP and GP had been previously well-established. Trial registration The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17847169).

scholarly journals Residents transitioning between hospital and care homes: protocol for codesigning a systems-level response to safety issues (SafeST study)

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e050665
Author(s):  
Jason Scott ◽  
Katie Brittain ◽  
Kate Byrnes ◽  
Pam Dawson ◽  
Stephanie Mulrine ◽  
...  
Keyword(s):  
Data Extraction ◽  
Care Home ◽  
Incident Reporting ◽  
Care Homes ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Safety Issues ◽  
Care Home Staff ◽  
Service Specification ◽  
The Impact

IntroductionThe aim of this study is to develop a better understanding of incident reporting in relation to transitions in care between hospital and care home, and to codesign a systems-level response to safety issues for patients transitioning between hospital and care home.Methods and analysisTwo workstreams (W) will run in parallel. W1 will aim to develop a taxonomy of incident reporting in care homes, underpinned by structured interviews (N=150) with care home representatives, scoping review of care home incident reporting systems, and a review of incident reporting policy related to care homes. The taxonomy will be developed using a standardised approach to taxonomy development. W2 will be structured in three phases (P). P1a will consist of ≤40 interviews with care home staff to develop a better understanding of their specific internal systems for reporting incidents, and P1b will include ≤30 interviews with others involved in transitions between hospital and care home. P1a and P1b will also examine the impact of the SARS-CoV-2 pandemic on safe transitions. P2 will consist of a retrospective documentary analysis of care home data relating to resident transitions, with data size and sampling determined based on data sources identified in P1a. A validated data extraction form will be adapted before use. P3 will consist of four validation and codesign workshops to develop a service specification using National Health Service Improvement’s service specification framework, which will then be mapped against existing systems and recommendations produced. Framework analysis informed by the heuristic of systemic risk factors will be the primary mode of analysis, with content analysis used for analysing incident reports.Ethics and disseminationThe study has received university ethical approval and Health Research Authority approval. Findings will be disseminated to commissioners, providers and regulators who will be able to use the codesigned service specification to improve integrated care.

scholarly journals 25 A Pilot Implementation of Providing Enhanced Support to Care Homes within A Primary Care Network

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
R Didehvar ◽  
G Ehtheshamirad ◽  
G Batty ◽  
S Sage ◽  
S Mullins ◽  
...  
Keyword(s):  
Primary Care ◽  
Planning Process ◽  
Care Home ◽  
Care Homes ◽  
Care Planning ◽  
Care Network ◽  
Care Home Staff ◽  
Care Plans ◽  
Pilot Implementation ◽  
The Impact

Abstract Introduction People living with severe frailty in care homes are vulnerable to frequent non-elective hospital attendances. However provision of enhanced healthcare support to care home residents can reduce this risk and increase quality of life for residents.1 The framework for enhanced health in care homes (EHCH) summarises best practice in this area and provides guidance for implementing services.2 Methods This study was a pilot implementation of the EHCH framework based on a Primary Care and Specialist Frailty Multidisciplinary Team (MDT) and delivered on a Primary Care Network (PCN) footprint. The MDT targeted five care homes in a PCN area with historically high levels of non-elective attendances. The model of care was based on the principle of anticipatory care planning, training and support for care home staff to understand and implement plans. Results Over the pilot period of 9 months, non-elective attendances from the 5 homes reduced by 27% compared to the previous year, which was a significant reduction (p<0.042). There was variation between the homes in the reduction in non-elective attendances with the greatest impact seen in the homes that had the highest level of attendance at training and engagement in the care planning process. Feedback received from the care home staff indicated that they felt more confident to refer to the care plans and had alternative options to calling 999. A quality audit of the care plans completed as part of the pilot revealed a number of additional training needs for clinicians completing the plans to ensure consistency of recoding. This training was delivered following the pilot period. Conclusions The pilot demonstrated that the EHCH framework could be successfully implemented on a PCN footprint. Analysis shows this implementation coincided with a reduction in non-elective attendances from the targeted homes. Further analysis is required to compare the impact in different homes and to understand contributing factors. The pilot implementation provides helpful information to inform PCN development. References 1. Lloyd T, Wolters A and Steveton A (2014) The impact of providing enhanced support for care home residents in Rushcliffe: Health Foundation consideration of findings from the Improvement Analytics Unit. The Health Foundation. 2. NHS England (2016) The framework for enhanced health in care homes.

462 COUNSELLING IN CARE HOMES

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii1-ii4
Author(s):  
J Pybis ◽  
N Chigariro ◽  
J Bacon
Keyword(s):  
Mental Health ◽  
Service Delivery ◽  
Care Home ◽  
Poor Mental Health ◽  
Care Homes ◽  
Structured Interviews ◽  
Home Setting ◽  
Care Home Staff ◽  
People With Dementia ◽  
Mental Health Foundation

Abstract Introduction Although many people live well within care homes, it is estimated that 60% of those living in residential care have poor mental health (Age Concern & Mental Health Foundation, 2006) and 40% suffer from depression (The Royal College of General Practitioners, 2014). Antidepressant prescribing has been reported to be nearly four times greater in care homes than for older people living in the community (Harris, Carey, Shah, Dewilde & Cook, 2012). However, antidepressants have been found to be ineffective for people with dementia (Dudas, Malouf, McCleery & Dening, 2018). With two-thirds of care home residents having some form of dementia, there is a need to find alternative interventions. Talking therapies, such as counselling, may be a useful alternative. Method Adopting a qualitative approach using semi-structured interviews and focus groups with counsellors (N = 12) who have experience of working in this context and with care home managers (N = 3) and care teams (N = 6), this study aimed to explore the feasibility of implementing counselling in a care home setting. We explored the views of care home staff towards counselling and identify barriers to service implementation, alongside the experience of counsellors who have delivered counselling in care homes to understand what service delivery models are currently adopted. Data were analysed thematically. Results Findings fell under the following key themes: The funding and referral process for counselling in a care home; skills and competences required; training needs; adaptations to practice; barriers to implementing counselling in a care home. Conclusions It is timely to consider the role of psychological therapy in supporting the mental health of care home residents. There is a need for further research to explore a service delivery model of counselling in care homes.

scholarly journals P-198 Care home staff experiences of palliative and end-of-life care in care homes during COVID-19

2021 ◽  
Author(s):  
Izabele Batkovskyte ◽  
Lori Bourke ◽  
Clare Ellis-Smith ◽  
Anna Bone ◽  
Claire Goodman ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Home ◽  
Care Homes ◽  
Life Care ◽  
Care Home Staff ◽  
Staff Experiences

scholarly journals ‘Waiting and Wanting’: older peoples’ initial experiences of adapting to life in a care home: a grounded theory study

2020 ◽  
pp. 1-25 ◽  
Author(s):  
Marie O'Neill ◽  
Assumpta Ryan ◽  
Anne Tracey ◽  
Liz Laird
Keyword(s):  
Grounded Theory ◽  
Data Analysis ◽  
Social Care ◽  
Care Home ◽  
Theory Approach ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Senior Member ◽  
Care Home Staff ◽  
Health And Social Care

Abstract A grounded theory approach, consistent with the work of Strauss and Corbin, was used to undertake semi-structured interviews with 17 older people, to explore their experiences of living in a care home, during the four- to six-week period following the move. Purposive sampling was initially adopted, thereafter, theoretical sampling was employed to recruit individuals identified by care managers within older peoples’ community teams and care home managers within a large Health and Social Care Trust in the United Kingdom. Consistent with grounded theory methodology, data collection and analysis occurred simultaneously. Constant comparative analysis underpinned data analysis and data management techniques. Data analysis revealed five distinct categories that captured these experiences. These were: (a) wanting to connect – ‘I am so lost here’, (b) wanting to adapt – ‘Well mentally you have to make the best of it’, (c) waiting for assistance – ‘it's a frustration for me’, (d) ‘waiting on the end’ – I am making no plans’ and (e) wanting to re-establish links with family and home – ‘I love getting home and I like getting out to the town’. Together these five categories formed the basis of the core category, ‘Waiting and Wanting’, which encapsulates the initial adaptation experiences of the men and women in the study. Findings indicate that individuals were dependent on others to create a sense of belonging, independence and wellbeing. Moreover, risk aversive practices were perceived as a threat to individuals’ independence and autonomy. Recommendations include the need to amend policy and practice for the development of a bespoke induction programme for each resident facilitated by a senior member of the care home staff working in partnership with individuals and families, in addition to the health and social care team, to support a more positive transition for new residents, relatives and care home staff.

scholarly journals Recognition of the complexity facing residential care homes: a practitioner inquiry

2018 ◽  
Vol 19 (6) ◽  
pp. 584-590 ◽  
Author(s):  
Jenny Dudman ◽  
Julienne Meyer ◽  
Cheryl Holman ◽  
Wendy Moyle
Keyword(s):  
Residential Care ◽  
Care Home ◽  
Assessment Tools ◽  
Care Staff ◽  
Care Homes ◽  
Structured Interviews ◽  
Care Home Staff ◽  
Healthcare Needs ◽  
Health And Social Care

AbstractAimTo explore the experiences and challenges for residential care home staff when managing the healthcare needs of their residents, in particular those living with dementia.BackgroundIncreasing number of older people, with complex health and social care needs are living in residential care homes. Yet there is limited appreciation of why staff sometimes struggle to manage residents’ healthcare needs, or understanding of their working relationship with district nurses (DNs), whose responsibility it is to provide nursing support.MethodsThis PhD study, in a metropolitan area in the United Kingdom, was conducted by an experienced DN and involved three phases. This paper focuses on the first two phases. Phase 1 data included: semi-structured interviews (n=8), reflective field notes based on non-participant observation, documentary analysis of policies, procedures and assessment tools and other contextual data from one care home (case study site). The practitioner researcher reflected on the findings from the case study, in relation to her own knowledge and experience as a DN, focusing in particular on findings that were familiar, or which surprised. In Phase 2 she fed these findings back to other care homes (n=11) to check whether the findings from the single case study were unique or resonated with others. She gathered their feedback through semi-structured interviews with senior care staff (n=14). Data were analysed using thematic data analysis.FindingsFindings highlight the complexity facing residential care homes: high levels of healthcare needs amongst residents, the demands of caring for residents living with dementia, variations in the knowledge and skill set of care staff, inequity in the level of healthcare support, the challenges of building a good relationship with DNs, and funding pressures facing care homes.ImplicationsAny, or all of these factors can prevent care home staff from managing the healthcare needs of their residents.

New relationships and intimacy in long-term care: The views of relatives of residents with dementia and care home staff

Dementia ◽  
2016 ◽  
Vol 17 (4) ◽  
pp. 405-422 ◽  
Author(s):  
Esther Wiskerke ◽  
Jill Manthorpe
Keyword(s):  
Qualitative Interviews ◽  
Care Home ◽  
Care Homes ◽  
Sexual Intimacy ◽  
Term Care ◽  
Care Home Staff ◽  
General Terms ◽  
People With Dementia ◽  
The Moment ◽  
Person With Dementia

Background There is limited research on what family members and frontline care home staff consider to be the best responses to the sexual expression of a person with dementia, whilst at the same time respecting relatives’ feelings, managing their possible distress and conflict. Methods This exploratory study investigated the views of relatives and care workers of new relationships or sexual intimacy between care home residents with dementia, whilst still married to another person. It reports the themes that emerged in qualitative interviews with eight relatives of people with dementia and with 12 frontline care home staff working in two English care homes. Interviews took place in 2015 using a hypothetical vignette that unfolded in four stages. Thematic analysis was used to analyse the data. Findings The views of care home staff and relatives had similarities in general terms regarding the problems arising around expressions of sexuality in care homes: indicting that a light-hearted or non-physical connection between residents is deemed acceptable, but the moment it becomes a sexual relationship then decision making becomes more complicated. Staff were inclined to turn to managers for advice and to consider separating residents. They expressed familiarity with distracting residents from situations that were of concern. Relatives were considerate of the difficulties and dilemmas faced by care home staff. Conclusion The use of a vignette facilitated discussion of a potentially sensitive topic. Areas for further research are identified.

scholarly journals Care home residents who die in hospital: exploring factors, processes and experiences

2020 ◽  
Vol 49 (3) ◽  
pp. 468-480
Author(s):  
Gemma Alcorn ◽  
Scott A Murray ◽  
Jo Hockley
Keyword(s):  
Hospital Admission ◽  
Care Home ◽  
External Support ◽  
Care Homes ◽  
Teaching Hospitals ◽  
Structured Interviews ◽  
Care Needs ◽  
Care Home Staff ◽  
Health And Social Care ◽  
Acute Changes

Abstract Background Care home residents are increasingly frail with complex health and social care needs. Their transfer to hospital at the end-of-life can be associated with unwanted interventions and distress. However, hospitals do enable provision of care that some residents wish to receive. We aimed to explore the factors that influence hospital admission of care home residents who then died in hospital. Methods This study combined in-depth case note review of care home residents dying in two Scottish teaching hospitals during a 6-month period and semi-structured interviews with a purposive sample of 26 care home staff and two relatives. Results During the 6-month period, 109 care home residents died in hospital. Most admissions occurred out-of-hours (69%) and most were due to a sudden event or acute change in clinical condition (72%). Length of stay in hospital before death was short, with 42% of deaths occurring within 3 days. Anticipatory Care Planning (ACP) regarding hospital admission was documented in 44%. Care home staff wanted to care for residents who were dying; however, uncertain trajectories of decline, acute events, challenges of ACP, relationship with family and lack of external support impeded this. Conclusions Managing acute changes on the background of uncertain trajectories is challenging in care homes. Enhanced support is required to improve and embed ACP in care homes and to provide rapid, 24 hours-a-day support to manage difficult symptoms and acute changes.

scholarly journals Symposium 9: Competent to care A train-the-trainer method of teaching as a way of implementing the correct use of the ‘Malnutrition Universal Screening Tool’ in Norfolk: is it effective?

2009 ◽  
Vol 68 (3) ◽  
pp. 300-305 ◽  
Author(s):  
Rachel Lee ◽  
Fiona Scott
Keyword(s):  
Universal Screening ◽  
Screening Tool ◽  
Care Home ◽  
Care Homes ◽  
Train The Trainer ◽  
Support Materials ◽  
Training Support ◽  
Care Home Staff ◽  
Care Plans ◽  
Malnutrition Universal Screening Tool

Malnutrition is frequently undetected in care homes. It is recommended that residents are screened on admission and at suitable intervals thereafter. It is aimed to implement the ‘Malnutrition Universal Screening Tool’ (‘MUST’) in all care homes in Norfolk in order to fulfil this recommendation. Following a pilot of successful (but time-consuming) ‘MUST’ training a train-the-trainer package was developed as a practical way of achieving this goal. Courses were held in 2007, each comprising a study day and an assessment of each trainer delivering training. Trainers were provided with a dossier of training support materials. Data were collected at the study day and 3 months after the course to evaluate its effectiveness. Sixty-seven trainers were trained, all of whom rated the course as effective in preparing them to deliver training. At their assessments 96% were able to explain ‘MUST’ accurately. Of the new trainers 44% returned follow-up questionnaires and copies of sample care plans. The majority of care plans showed ‘MUST’ scores had been calculated accurately and appropriate nutrition care plans had been set up and evaluated. The train-the-trainer model is an effective method of training large numbers of care-home staff to use ‘MUST’. One of the unexpected benefits observed was the ownership taken by the trainers, which was demonstrated by the enthusiasm and confidence with which they subsequently trained their colleagues.

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