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Recognition of the complexity facing residential care homes: a practitioner inquiry

  • Jenny Dudman (a1), Julienne Meyer (a2) (a3), Cheryl Holman (a4) and Wendy Moyle (a5)
Abstract
Aim

To explore the experiences and challenges for residential care home staff when managing the healthcare needs of their residents, in particular those living with dementia.

Background

Increasing number of older people, with complex health and social care needs are living in residential care homes. Yet there is limited appreciation of why staff sometimes struggle to manage residents’ healthcare needs, or understanding of their working relationship with district nurses (DNs), whose responsibility it is to provide nursing support.

Methods

This PhD study, in a metropolitan area in the United Kingdom, was conducted by an experienced DN and involved three phases. This paper focuses on the first two phases. Phase 1 data included: semi-structured interviews (n=8), reflective field notes based on non-participant observation, documentary analysis of policies, procedures and assessment tools and other contextual data from one care home (case study site). The practitioner researcher reflected on the findings from the case study, in relation to her own knowledge and experience as a DN, focusing in particular on findings that were familiar, or which surprised. In Phase 2 she fed these findings back to other care homes (n=11) to check whether the findings from the single case study were unique or resonated with others. She gathered their feedback through semi-structured interviews with senior care staff (n=14). Data were analysed using thematic data analysis.

Findings

Findings highlight the complexity facing residential care homes: high levels of healthcare needs amongst residents, the demands of caring for residents living with dementia, variations in the knowledge and skill set of care staff, inequity in the level of healthcare support, the challenges of building a good relationship with DNs, and funding pressures facing care homes.

Implications

Any, or all of these factors can prevent care home staff from managing the healthcare needs of their residents.

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Copyright
Corresponding author
Author for correspondence: Dr Jenny Dudman, North East London Foundation Trust, 69 Albert Road, Ilford, London, IG1 1HP, UK. E-mail: Jennifer.Dudman.1@city.ac.uk
References
Hide All
Alzheimer’s Society (2014) Dementia 2014: opportunity for change. London: Alzheimer’s Society.
Alzheimer’s Society (2016) Fix dementia care NHS and care homes. London: Alzheimer’s Society.
Barley, R (2011) Why familiarise? Social Research Update, 201, 1–4. Retrieved 24 September 2014 from http://sru.soc.surrey.ac.uk/SRU62.pdf http://shura.shu.ac.uk/4924/ http://shura.shu.ac.uk/4924/1/SRU62.pdf.
Blythe, S, Wilkes, L, Jackson, D Halcomb, E (2013) The challenges of being an insider in storytelling research. Nurse Researcher 21, 813.
Bowman, C (2009) Are care homes the community hospitals of the future? Journal of Care Services Management 3, 375379.
Braun, V Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77101.
British Geriatrics Society (2011) Quest for Quality: British Geriatric Society Joint Working Party into the quality of healthcare support for older people in care homes: a call for leadership, partnership and quality improvement. London: British Geriatrics Society.
BUPA (2011) Funding adult social care over the next decade: who cares? London: BUPA.
Care Quality Commission (2016) The state of health care and adult social care in England. London: Care Quality Commission.
Cavendish, C (2013) The Cavendish review: an independent review into healthcare assistants and support workers in the NHS and social care settings. Retrieved 6 February 2014 from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/236212/Cavendish_Review.pdf
Cilliers, P (2000) What can we learn from a theory of complexity? Emergence 2, 2333.
Dobie, J (2010) Palliative care provision for older people in care homes. British Journal of Community Nursing 15, 170176.
Dudman, J (2007) Ch 1: Context. In Owen T and The National Care Home Research and Development Forum, editors. My Home Life: quality of life in care homes – review of the literature. London: Help the Aged, 11–23.
Dudman, J (2014) Not just a simple dressing: a practitioner inquiry exploring the complexity within residential care homes and the district nursing response. Ph.D. Thesis. London: City, University of London.
Eborall, C, Fenton, W Woodrow, S (2010) The state of the adult social care workforce in England, 2010. Retrieved 11 August 2010 from http://www.skillsforcare.org.uk/Document-library/NMDS-SC,-workforce-intelligence-and-innovation/Research/Research-Reports/social-care-workforce-report/SOASC-2010-exec-summary-for-web.pdf
Evans, C (2007) The analysis of experiences and representations of older people’s health in care homes to develop primary care nursing practice. Ph.D. Thesis. London: King’s College.
Goddard, C, Stewart, F, Thompson, G Hall, S (2011) Providing end-of-life care in care homes for older people: a qualitative study of the views of care home staff and community nurses. Journal of Applied Gerontology 32, 7695.
Goodman, C, Robb, N, Drennan, V Woolley, R (2005) Partnership working by default: district nurses and care home staff providing care for older people. Health and Social Care in the Community 13, 553562.
Goodman, C, Woolley, R Knight, D (2003a) District nurse involvement in providing palliative care to older people in residential care homes. International Journal of Palliative Nursing 9, 521527.
Goodman, C, Woolley, R Knight, D (2003b) District nurses’ experiences of providing care in residential care home settings. Journal of Clinical Nursing 12, 6776.
Gordon, A, Goodman, C, Dening, T, Davies, S, Gladman, J, Bell, B, Zubair, M, Handley, M, Meyer, J, Bowman, C, Gage, H, Iliffe, S, Martin, F, Schneider, J Victor, C (2014) The optimal study: describing the key components of optimal health care delivery to UK care home residents: a research protocol. Journal of the American Medical Directors Association 15, 681686.
Handley, M, Goodman, C, Froggatt, K, Mathie, E, Gage, H, Manthorpe, J, Barclay, S, Crang, C Iliffe, S (2014) Living and dying: responsibility for end-of-life care in care homes without on-site nursing provision – a prospective study. Health & Social Care in the Community 22, 2229.
Heath, H (2007) Ch 8: Health and healthcare services. In Owen T and The National Care Home Research and Development Forum, editors. My home life: quality of life in care homes – review of the literature. London: Help the Aged, 96–117.
Heath, H (2010) Outcomes from the work of registered nurses working with older people in UK care homes. International Journal of Older People Nursing 5, 116127.
Heath, H (2012) How to optimise the registered nurse contribution in care homes. Nursing Older People 24, 2328.
Iliffe, S, Davies, S, Gordon, A, Schneider, J, Dening, T, Bowman, C, Gage, H, Martin, F, Gladman, J, Victor, C, Meyer, J Goodman, C (2016) Provision of NHS generalist and specialist services to care homes in England: review of surveys. Primary Health Care Research and Development 17, 122137.
Jones, TS, Matias, M, Powell, J, Jones, E, Fishburn, J Looi, J (2007) Who cares for older people with mental illness? A survey of residential aged care facilities in the Australian Capital Territory: implications for mental health nursing. International Journal of Mental Health Nursing 16, 327337.
Lindberg, C Lindberg, C (2008) Ch 2: Nurses take note: a primer on complexity science. In Lindberg C, Nash S and Lindberg C, editors. On the edge: nursing in the age of complexity. Bordentown, NJ: Plexus Institute Press, 2247.
Luff, R, Ferreira, Z Meyer, J (2011) Methods Review 8: Care Homes. Retrieved 25 February 2011 from http://eprints.lse.ac.uk/41191/1/SSCR_Methods_Review_8_web.pdf
McMillan, E (2004) Complexity, organizations and change: an essential introduction. London: Routledge.
Meyer, J, Ashburner, C Holman, C (2006) Becoming connected, being caring. Educational Action Research 14, 477496.
Meyer, J, Noble, H, Kilbride, C, Holman, C Bridges, J (2009) Doing qualitative research as a practitioner: processes, issues and understandings. The Malaysian Journal of Qualitative Research 2, 3551.
Mulholland, J (2007) Ch 5: Understanding the self as instrument. In Taylor J and Wallace P, editors. Contemporary qualitative research: exemplars for science and mathematics educators. Dordrecht, The Netherlands: Springer, 4557.
National Institute for Health Research (2017) Advancing care: research with care homes. Retrieved 2 November 2017 from http://www.dc.nihr.ac.uk/themed-reviews/advancing-care.htm?utm_campaign=Research+and+Innovation+bulletin+Vol+8+Issue+17&utm_source=emailCampaign&utm_medium=email&utm_content=
NHS England (2016) New care model: Vanguards – developing a blueprint for the future of NHS and care services. Retrieved 27 April 2016 from https://www.england.nhs.uk/wp-content/uploads/2015/11/new_care_models.pdf
Owen, T, Meyer, J, Cornell, M, Dudman, P, Ferreira, Z, Hamilton, S, Moore, J Wallis, J (2012) My home life: improving quality of life in care homes. London: Joseph Rowntree Foundation.
Prince, M, Prina, M Guerchet, M (2013) World Alzheimer report 2013 – journey of caring: an analysis of long-term care for dementia. London: Alzheimer’s Disease International.
Royal College of Nursing (2010) Care homes under pressure – an England report. London: RCN.
Sandvoll, AM, Kristoffersen, K Hauge, S (2013) The double embarrassment: understanding the actions of nursing staff in an unexpected situation. International Journal of Nursing Practice 19, 368373.
Skills for Care (2015) The size and structure of the adult social care sector and workforce in England in 2015. Leeds: Skills for Care.
Tracy, S (2010) Qualitative quality: eight “big-tent” criteria for excellent qualitative research. Qualitative Inquiry 16, 837851.
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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
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