Context: Emergency care treatment planning is increasingly required in care homes for residents living with frailty and/or ill-health. ReSPECT (the Recommended Summary Plan for Emergency Care and Treatment) is a type of emergency care treatment plan used widely in UK care homes to guide treatment decisions in medical emergencies when residents are unable to speak for themselves. Objective: To understand care home staff experiences of implementing ReSPECT with residents in their care, and the implications for their role and practice. Methods: Semi-structured interviews were conducted with 31 care home staff from 12 care homes (seven residential, two nursing and three dual-registered) and one care provider group across three diverse areas of England between 2022 and 2023. Interview data were analysed thematically, drawing on Normalisation Process Theory (NPT) constructs. Findings: Care home staff facilitated and coordinated conversations with residents, their families, and health professionals to complete ReSPECT plans, and supported conversations to elicit resident wishes and reach a shared understanding of treatment scenarios. However, care home staff found interpreting ReSPECT recommendations in an emergency challenging and had mixed experiences of implementing recommendations with attending health professionals. Limitations: Self-selecting bias may have influenced findings. Implications: Current ReSPECT guidance for its use in care homes is limited to the role of care home staff in supporting conversations and does not reflect findings regarding their role in actively using plans in an emergency. There is a need for guidance for care home staff to support them in making informed decisions when interpreting ReSPECT plans in an emergency.
Harlock et al. (Thu,) studied this question.