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Palliative care
Original research
Implementation and perceived impact of the SWAN model of end-of-life and bereavement care: a realist evaluation
  1. Adele Stewart-Lord1,
  2. Lesley Baillie1,
  3. Laura Green2,
  4. Fiona Murphy3,4,
  5. Alison Leary1
  1. 1Institute of Health and Social Care, London South Bank University, London, UK
  2. 2School of Health Sciences, Divisionof Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
  3. 3Palliative /End of Life /Bereavement, Northern Care Alliance NHS Foundation Trust, Salford, UK
  4. 4Corporate Services, Liverpool Royal Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Adele Stewart-Lord; stewara2{at}lsbu.ac.uk

Abstract

Objectives To evaluate the End-of-Life and Bereavement Care model (SWAN) from conception to current use.

Design A realist evaluation was conducted to understand what works for whom and in what circumstances. The programme theory, derived from a scoping review, comprised: person and family centred care, institutional approaches and infrastructure. Data were collected across three stages (May 2021 to December 2021): semi-structured, online interviews and analysis of routinely collected local and national data.

Setting Stage 1: Greater Manchester area of England where the SWAN model was developed and implemented. Stage 2: Midlands. Stage 3: National data.

Participants Twenty-three participants were interviewed: Trust SWAN leads, end-of-life care nurses, board members, bereavement services, faith leadership, quality improvement, medicine, nursing, patient transport, mortuary, police and coroners.

Results Results from all three stages were integrated within themes, linked to the mechanisms, context and outcomes for the SWAN model. The mechanisms are: SWAN is a values-based model, promoting person/family-centred care and emphasising personhood after death. Key features are: memory-making, normalisation of death and ‘one chance’ to get things right. SWAN is an enablement and empowerment model for all involved. The branding is recognisable and raises the profile of end-of-life and bereavement care. The contextual factors for successful implementation and sustainability include leadership, organisational support, teamwork and integrated working, education and engagement and investment in resources and facilities. The outcomes are perceived to be: a consistent approach to end-of-life and bereavement care; a person/family-centred approach to care; empowered and creative staff; an organisational culture that prioritises end-of-life and bereavement care.

Conclusion The SWAN model is agile and has transferred to different settings and circumstances. This realist evaluation revealed the mechanisms of the SWAN model, the contextual factors supporting implementation and perceived outcomes for patients, families, staff and the organisation.

  • PALLIATIVE CARE
  • Health policy
  • Protocols & guidelines

Data availability statement

Data are available upon reasonable request. Data (interview transcripts) are available upon reasonable request. All request to be directed to the lead author at ORCID identifier 0000-0003-1594-5616.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2022-066832

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    Data availability statement

    Data are available upon reasonable request. Data (interview transcripts) are available upon reasonable request. All request to be directed to the lead author at ORCID identifier 0000-0003-1594-5616.

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    Footnotes

    • Contributors AS-L: Substantial contributions to the design of the work; the acquisition, analysis and interpretation of the data; lead on drafting and revising of work for intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work related to accuracy and integrity. LB: Substantial contributions to the design of the work; the acquisition, analysis and interpretation of the data; drafting and revising of work for intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work related to accuracy and integrity. LG: Substantial contributions to the design of the work; the acquisition, analysis and interpretation of the data; drafting and revising of work for intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work related to accuracy and integrity. FM: Substantial contributions to the design of the work; the acquisition, analysis and interpretation of the data; revising work for intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work related to accuracy and integrity. AL: Substantial contributions to the design of the work; the acquisition, analysis and interpretation of the data; drafted and revised work for intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work related to accuracy and integrity. A-SL takes responsibility as guarantor for the overall. The guarantor accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This work was supported by Burdett Trust for Nursing grant number SB\ZA\101010662\575308.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.