City Research Online

Abstract

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.

Publication Type:	Article
Additional Information:	© The Author(s) 2021. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Publisher Keywords:	Advance care planning, care homes, nursing homes, patient transfer, qualitative
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RT Nursing
Departments:	Presidents's Portfolio
SWORD Depositor:	Symplectic Administrator

Export

Downloads