A critical realist evaluation of advance care planning in care homes

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

A critical realist evaluation of advance care planning in care homes

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

Megarhizoliths in Pleistocene aeolian deposits from Gran Canaria (Spain): Ichnological and palaeoenvironmental significance

The Pleistocene dune field of Tufia, located on the east of Gran Canaria (Spain), contains different stratigraphic levels of indurated pillar-like structures that are interpreted as megarhizoliths. The megarhizoliths occur at the top of different aeolian sets and reach 31.5 cm in diameter and over 1 m in height. These scattered, free-standing, vertical, cylindrical-to-slightly conical columns usually appear as hollow cylinders, displaying elliptical cross-sections aligned with the prevailing wind. On the leeward side of some specimens the external wall shows a tail of rock matrix resembling a sort of “wind shadow”. These tails and other remains of the associated rock matrix show a texture composed of long, horizontal, parallel cylinders orientated with the wind. Internally the most complete structures show five concentrically arranged zones: Zone (a), is a central pore corresponding to the cavity originally occupied by the root; Zones (b) and (c), which include alveolar and laminated carbonate textures indicating that carbonate precipitation was mostly induced by the roots and their associated microorganisms; and Zones (d) and (e), consisting mostly of aeolian sands. In (d) the sand grains show thin micritic coatings whereas in (e) vadose aragonite cements can be seen on the grain surface suggesting a less biogenic influence in their formation. The degree of cementation and the time of the precipitation of carbonate around the roots controlled the preservation of these zones. Thus, in some cases, Zones b, c and/or d are not preserved. Cylinders are up to 30× the diameter of the root that nucleated them. The presence of the megarhizoliths at the top of the aeolianite beds indicates that aeolian sedimentation halted several times, allowing soil formation and plant colonisation during slightly more humid periods. The occurrence of megarhizoliths is further proof of the alternation of arid and slightly more humid climates in the north Atlantic during the last glacial period. It is also noted that they may be misinterpreted as animal trace fossils or tree trunk casts, resulting in incorrect ichnological or palaeoenvironmental interpretations