A critical realist evaluation of advance care planning in care homes

Spacey, A; Scammell, J; Board, M; Porter, S

Abstract

Aims
To evaluate care planning in advance of end‐of‐life care in care homes.

Design
A qualitative study.

Methods
Qualitative data were collected from January 2018–July 2019 (using focus groups and semi‐structured interviews) from three care homes in the South West of England. The data were analysed using thematic analysis followed by Critical Realist Evaluation.

Results
Participants comprised of registered nurses (N = 4), care assistants (N = 8), bereaved relatives (N = 7), and domiciliary staff (N = 3). Although the importance of advance care planning was well recognized, the emotional labour of frequently engaging in discussions about death and dying was highlighted as a problem by some care home staff. It was evident that in some cases care home staff's unmet emotional needs led them to rushing and avoiding discussions about death and dying with residents and relatives. A sparsity of mechanisms to support care home staff's emotional needs was noted across all three care homes. Furthermore, a lack of training and knowledge appeared to inhibit care home staff's ability to engage in meaningful care planning conversations with specific groups of residents such as those living with dementia. The lack of training was principally evident amongst non‐registered care home staff and those with non‐formal caring roles such as housekeeping.

Conclusion
There is a need for more focused education to support registered and non‐registered care home staff to effectively engage in sensitive discussions about death and dying with residents. Furthermore, greater emotional support is necessary to help build workforce resilience and sustain change.

Impact
Knowledge generated from this study can be used to inform the design and development of future advance care planning interventions capable of supporting the delivery of high‐quality end‐of‐life care in care homes.

Citation

Spacey, A., Scammell, J., Board, M., & Porter, S. (2021). A critical realist evaluation of advance care planning in care homes. Journal of Advanced Nursing, 77(6), 2774-2784. https://doi.org/10.1111/jan.14822

• Journal Article Type: Article
• Acceptance Date: Feb 23, 2021
• Online Publication Date: Mar 10, 2021
• Publication Date: Jun 1, 2021
• Deposit Date: Mar 10, 2021
• Publicly Available Date: Mar 10, 2021
• Journal: Journal of Advanced Nursing
• Print ISSN: 0309-2402
• Electronic ISSN: 1365-2648
• Publisher: Wiley
• Volume: 77
• Issue: 6
• Pages: 2774-2784
• DOI: https://doi.org/10.1111/jan.14822
• Publisher URL: https://doi.org/10.1111/jan.14822
• Related Public URLs: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2648