Online Supportive Conversations and Reflection Sessions (OSCaRS): A Feasibility Pilot with Care Home Staff during the Pandemic

Care homes care for people with complex needs, supporting them to the end of life and are now being seen as the ‘de facto’ hospice. Reflective debriefing for care home staff has been found to help support staff and provide an educative and communicative function when a resident dies. Pre-COVID-19, one of the authors had been conducting reflective debriefings face-to-face with care home staff but when COVID-19 struck, face-to-face sessions were impossible. An online format was developed with the aim of providing emotional support and practice-based learning in relation to death and dying through reflection. This study assessed the acceptability and feasibility of delivering online supportive conversations and reflective sessions (OSCaRS) on palliative and end of life care to care home staff during the pandemic. A mixed methods study design was undertaken in April to September 2020. Qualitative data comprised of digital recordings of sessions and semi-structured interviews with OSCaRS participants, managers and session facilitators. An online survey was sent to all staff and had a response rate of 12%.  Eleven OSCaRS were conducted over ten weeks. Thirty-four staff members attended one or more sessions. Three overarching themes were identified from the data: pressures of working in a pandemic, practicalities of delivering online support and, practice development opportunities. Engaging care home staff in online structured supportive conversations and reflections in relation to death and dying is acceptable, feasible and valuable for providing support with the pressures of working in a pandemic.  There is value for OSCaRS to continue as online sessions as they provide care home staff access to practice-based learning and support from professionals and allows specialists based in a range of settings to in-reach into care homes in an efficient way. Future implementation must consider the availability of sufficient devices with cameras to aid participation, timing and frequency of sessions to accommodate staff workflows, the engagement and support of managers and post-session support.  

Long term cognitive outcomes of early term (37-38 weeks) and late preterm (34-36 weeks) births: a systematic review

Background: There is a paucity of evidence regarding long-term outcomes of late preterm (34-36 weeks) and early term (37-38 weeks) delivery.  The objective of this systematic review was to assess long-term cognitive outcomes of children born at these gestations. Methods: Four electronic databases (Medline, Embase, clinicaltrials.gov and PsycINFO) were searched.  Last search was 5 th August 2016.  Studies were included if they reported gestational age, IQ measure and the ages assessed.  The protocol was registered with the International prospective register of systematic reviews (PROSPERO Record CRD42015015472).  Two independent reviewers assessed the studies.  Data were abstracted and critical appraisal performed of eligible papers. Results: Of 11,905 potential articles, seven studies reporting on 41,344 children were included.  For early term births, four studies (n = 35,711) consistently showed an increase in cognitive scores for infants born at full term (39-41 weeks) compared to those born at early term (37-38 weeks) with increases for each week of term (difference between 37 and 40 weeks of around 3 IQ points), despite differences in age of testing and method of IQ/cognitive testing.  Four studies (n = 5644) reporting childhood cognitive outcomes of late preterm births (34 - 36 weeks) also differed in study design (cohort and case control); age of testing; and method of IQ testing, and found no differences in outcomes between late preterm and term births, although risk of bias was high in included studies. Conclusion:  Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks).  This should be considered when discussing timing of delivery.  For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores

Online Supportive Conversations and Reflection Sessions (OSCaRS): A Feasibility Study with Care Home Staff during the Pandemic

Care homes care for people with complex needs, supporting them to the end of life and are now being seen as the ‘de facto’ hospice. Reflective debriefing for care home staff has been found to help support staff and provide an educative and communicative function when a resident dies. Pre-COVID-19, one of the authors had been conducting reflective debriefings face to face with care home staff but when COVID-19 struck, face-to-face sessions were impossible. An online format was developed with the aim of providing emotional support and practice-based learning in relation to death and dying through reflection. This study assessed the acceptability and feasibility of delivering online supportive conversations and reflective sessions (OSCaRS) on palliative and end of life care to care home staff during the pandemic. A mixed methods study design was undertaken (April to September 2020). Qualitative data - digital recordings of sessions and semi-structured interviews with OSCaRS participants, managers and session facilitators. An online survey sent to all staff, had a response rate of 12%. Eleven OSCaRS were conducted over ten weeks. Thirty-four staff members attended one or more sessions. Three overarching themes were identified from the qualitative data: pressures of working in a pandemic: practicalities of delivering online support and, practice development opportunities. Engaging care home staff in online structured supportive conversations and reflections in relation to death and dying is acceptable, feasible and valuable for providing support with the pressures of working in a pandemic. There is value in them continuing as online sessions as OSCaRS provides care home staff access to practice-based learning and support from professionals and allows specialists based in a range of settings to in-reach into care homes in an efficient way. Future implementation must consider the availability of sufficient devices with cameras to aid participation, timing and frequency of sessions to accommodate staff workflows, the engagement and support of managers and post-session support

Practicalities of promoting practice-based learning in end of life care for care home staff: Lessons from “online” supportive conversations and reflection sessions

IntroductionDeaths in care homes and “at home” are anticipated to account for a third of UK deaths by 2040. Currently, palliative and end of life care are not part of statutory training in care homes. Reflective practice is a tool that can facilitate practice-based learning and support. Following a feasibly study to test “online” supportive conversations and reflection sessions (OSCaRS) to support care home staff in relation to death/dying during the first months of the COVID pandemic, a one-year practice development follow-up project was undertaken with the aim to create a team of NHS/specialist palliative care (SPC)-based facilitators to lead and support OSCaRS provision in up to 50 care homes in one region in Scotland—the focus of this paper.MethodsForty care home managers attended an on-line session explaining the project, with a similar session held for 19 NHS/SPC-based nurses external to care homes. Those interested in facilitating OSCaRS then attended three education sessions. Data collected: records of all activities; reflective notes on OSCaRS organised/delivered; a summary of each OSCaRS reflection/learning points; final interviews with NHS/SPC trainee facilitators.ResultsA total of 19 NHS/SPC facilitators delivered one or more OSCaRS in 22 participating care homes. However, as of January 2022 only six trained facilitators remained active. Out of the 158 OSCaRS arranged, 96 took place with a total of 262 staff attending. There were three important aspects that emerged: the role, remit, and resources of NHS/SPC supporting OSCaRS; requirements within care homes for establishing OSCaRS; and, the practice-based learning topics discussed at each OSCaRS.ConclusionAttempts to establish a team of NHS/SPC facilitators to lead OSCaRS highlights that end of life care education in care homes does not clearly fall within the contractual remit of either group or risks being missed due to more pressing priorities

Who lives in Scotland’s care homes? Descriptive analysis using routinely collected social care data 2012–16

Background: Adults living in long-term care are a significant and complex population who are under-represented in research using traditional methodologies. Methods: The aim of this study was to provide the first description of the adult care home population and their homes, using routinely collected data. A retrospective descriptive analysis was performed using the Scottish Care Home Census (SCHC) between 1 April 2012 and 31 March 2016. Results: Data are from 1,299 care home services (79.3–89.7% completeness), including 34,399–39,311 residents per year across all regions of Scotland. A total of 68% of residents are female, with median age 84 years. 27% fund their own care. Over 85% of self-funded residents receive free personal care allowance. Around 60% require care from a registered nurse and 49% have a formal diagnosis of dementia. The majority of admissions come from hospital (46%). Between 13 and 17% of residents die annually, with a median time to death of 596–653 days. Conclusions: This study provides the most comprehensive descriptive data of UK care home residents available. There is scope to enhance the information available through linkage to other routine sources

Indentifying published studies of care home research: an international survey of researchers

Collating the published research around institutional, long term care is confounded by the differing terminologies used to describe this health-care setting. We aimed to collate the descriptors used by researchers to inform the future development of a ‘search filter’ (a collection of search terms to help identify relevant records from electronic literature databases). We surveyed international researchers via the Nursing Home Research International Working Group, European Geriatric Medicine Society and published reviewers, achieving at 38% response rate across 21 countries. Our findings identified variation in terminology used by researchers to describe long-term care settings in their country of practice. Nursing home was the most accepted term (96%). ‘Homes for the Aged’ was selected by 48% of respondents. A range of terms are likely to be necessary to identify all relevant research and these may not be intuitive. We will use these data to help inform development of a search filter