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


  • Lucy Johnston Edinburgh Napier University
  • Jo Hockley University of Edinburgh
  • Julie Watson University of Edinburgh
  • Susan D Shenkin University of Edinburgh



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.   


Ahlstrom, G., Nilsen, P., Benzein, E., Behm, L., Wallerstedt, B., Persson, M. & Sandgren, A. (2018). Implementation of knowledge-based palliative care in nursing homes and pre-post post evaluation by cross-over design: a study protocol. BMC Palliative Care 17(52).

Billings, J., Kember, T., Greene, T., Grey, N., El-Leithy, S., Lee, D., Kennerley, H. Albert, I., Robertson, M., Brewin, D. & Bloomfield, M. (2020). COVID Trauma Response Working Group Rapid Guidance. Available from: (Accessed 31.5.2021)

Bone, A. E., Gomes, B., Etkind, S. N., Verne, J., Murtagh, F. E. M., Evans, C. J. & Higginson, I. J. (2018). What is the impact of population ageing on future provision of end-of-life care? Population based projections on place of death. Palliative Medicine, 32(2), 329-336.

Bone, A. E., Finucane, A. M., Leniz, J., Higginson, I. J. & Sleeman K. E. (2020). Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications. Palliative Medicine, 34(9), 1193-1201.

Braun, V. & Clarke, V. (2019) Reflecting on reflexive thematic analysis. Qualitative Research in Sport Exercise and Health 11(4), 589–597.

Braun, K. L & Zir, A. (2005) Using an Interactive Approach to Teach Nursing Home Workers About End-of-Life Care. Journal of Hospice & Palliative Nursing, 7(5), 280-288.

Caper, K & Macdonald, E. (2016). The role of hospice care in Scotland. Hospice UK

Chesney, M. A., Neilands, T. B., Chambers, D. B., Taylor, J. M., & Folkman, S. (2006). A validity and reliability study of the coping self-efficacy scale. British Journal of Health Psychology, 11, 421–437.

Connolly, M. J., Broad, J. B., Boyd, M., Kerse, N. & Gott, M. (2014). Residential aged care: The de facto hospice for New Zealand's older people. Australasian Journal on Ageing, 33(2), 114-120.

Cousins, E., de Vries, K., & Dening K. H. (2021). Ethical care during COVID-19 for care home residents with dementia. Nursing Ethics, 28(1), 46-57.

Deschacht, M., Malfait, S. & Eeckloo, K. (2021). Integrated care for older adults during the COVID-19 pandemic in Belgium: Lessons learned the hard way. International Journal of Older People Nursing, 16(3).

Devi, R., Hinsliff-Smith, K., Goodman, C. & Gordon, A. L. (2020). The Covid-19 pandemic in care homes: revealing the cracks within the system. The Journal of Nursing Home Research, 6, 58-60

Doyle, L., Brady, A. M., & Byrne, G. (2009). An overview of mixed methods research. Journal of Research in Nursing, 14(2), 175-185.

Fallowfield, L . (2004). Communication with the patient and family in palliative medicine. In Doyle, D.,

Hanks, G., Cherny, N. I. & Calman, K., (Eds). Oxford Textbook of Palliative Medicine (3rd ed., 101-106). Oxford University Press.

Gibbs, G. (1988). Learning by Doing: A Guide to Teaching and Learning Methods. Further Education Unit, Oxford Polytechnic, Oxford.

Gordon, A. L., Goodman, C., Achterberg, W., Barker, R. O., Burns, E., Hanratty, B., Martin, F. C.,

Meyer, J., O'Neill, D., Schols, J., & Spilsbury, K. (2020). Commentary: COVID in care homes-challenges and dilemmas in healthcare delivery. Age & Ageing, 49(5), 701-705. doi:

Hanna, J. R., Rapa,, E., Dalton, L. J., Hughes, R., Quarmby, L. M., McGlinchey, T., Donnellan, W. J.,

Bennett, K. M., Mayland, C. R. & Mason, S. R. (2021). Health and social care professionals’ experiences of providing end of life care during the COVID-19 pandemic: A qualitative study. Palliative Medicine, 35(7), 1249-1257.

Hockley, J. (2019). Teaching/research-based Care Home Centre – Lothian care home innovation partnership UPDATE. University of Edinburgh.

Hockley, J. (2014). Learning, support and communication for staff in care homes: outcomes of reflective debriefing groups in two care homes to enhance end-of-life care. International Journal of Older People Nursing, 9(2), 118–130.

Hockley, J. (2017). Hospices and care homes – similarities and differences in relation to palliative care. Annals of Palliative Medicine, 6(4), 396-398.

Information Services Division Scotland (2018). Care Home Census for Adults in Scotland, Figures for 2007-2017.

Lancaster H, Finlay I, Downman M & Dumas J. (2018) Commissioning of specialist palliative care services in England. BMJ Supportive & Palliative Care, 8(1), 93-101.

McGilton, K. S., Escrig-Pinol, A., Gordon, A., Chu, C.H., Zúñiga, F., Sanchez, M. G., Boscart, V., Meyer, J., Corazzini, K. N., Jacinto, A. F., Spilsbury, K., Backman, A., Scales, K., Fagertun, A., Wu, B., Edvardsson, D., Lepore, M. J., Leung, A. Y. M, Siegel, E. O.,…Bowers, B. (2020). Uncovering the Devaluation of Nursing Home Staff During COVID-19: Are We Fuelling the Next Health Care Crisis? Journal of the American Medical Directors Association, 21(7), 962-965.

McNally, R. J., Bryant, R. A. & Ehlers,A. (2003). Does early psychological intervention promote recovery from traumatic stress? Psychological Science in the public interest, 4(2), 45-79.

Mezirow, J. (1991). Transformative Dimensions of Adult Learning. Jossey- Bass.

Nyashanu, M. Pfende, F. & Ekpenyong, M. S. (2021). Triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic in private care homes and domiciliary care agencies: Lived experiences of care workers in the Midlands, UK. Health and Social Care in the Community, 30(2), e370-e376.

Rose, S. C., Bisson, J., Churchill, R. & Wessley, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic reviews.

Towers, A. M., Killett, A., Handley, M., Almack, K., Backhouse, T., Bunn, D., Bunn, F., Dickinson, A., Mathie, E., Mayrhofer, A., Mikelyte, R. and Goodman, C. (2020). Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps. Journal of Long-Term Care, 151–166.

Veronese, N., Trabucchi, M., Vecchiato, C., Demurtas, J. & De Leo, D. (2021). The risk of suicide in healthcare workers in nursing home: An exploratory analysis during COVID‐19 epidemic. International Journal of Geriatric Psychiatry, 36(10), 1588-1589.

Watson, J. (2019). Developing the Senses Framework to support relationship-centred care for people with advanced dementia until the end of life in care homes. Dementia, 18(2), 545-566.




How to Cite

Johnston, L., Hockley, J., Watson, J., & Shenkin, S. D. (2022). Online Supportive Conversations and Reflection Sessions (OSCaRS): A Feasibility Pilot with Care Home Staff during the Pandemic . International Journal of Practice-Based Learning in Health and Social Care, 10(1), 48–58.