Department of Health Sciences, University of Leicester, Leicester, UK.
Palliat Med. 2022 Jan;36(1):200-207. doi: 10.1177/02692163211059343. Epub 2021 Dec 6.
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.
To describe care home staff experiences and perceptions of using written plans during in-the-moment decision-making about potential resident hospital transfers.
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.
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.
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.
预先医疗照护计划已被确定为为数不多的可改变因素之一，它可以减少从养老院向医院的转移。患者和临床医生可能会使用多种类型的文件来记录这些计划。然而，对于在患者病情恶化时养老院工作人员如何感知和使用这些计划，我们知之甚少。
描述养老院工作人员在考虑居民是否可能转入医院时，在即时决策中使用书面计划的经验和看法。
采用 Straussian 扎根理论方法对定性半结构式访谈进行分析。
地点/参与者：英格兰东米德兰兹和西米德兰兹的六家养老院（有和没有护理的）的 30 名工作人员。
工作人员原则上更愿意让病情恶化的居民留在养老院，但担心这样做可能会对他们个人产生负面影响，尤其是当他们认为与家属照顾者的意愿存在分歧时。他们认为临床医生应该负责这些计划，但他们愿意扮演支持角色。在病情恶化时，书面计划使在养老院照顾居民的决定合法化；然而，工作人员对解释宽泛的陈述持谨慎态度，并希望计划详细、具体、明确、技术上“正确”，能被家属理解并定期更新。
书面计划为养老院工作人员提供了保证，减轻了他们对个人和职业风险的担忧。然而，养老院工作人员对计划的解释权有限，如果计划不够具体，工作人员无法自信地使用，那么转移仍可能发生。
