Working in the field – lessons for care home researchers

Background

Julie’s PhD project aimed to understand the relationships between people with advanced dementia and staff providing palliative care in care homes, to see how these relationships support the delivery of care. Care home staff need to find ways to relate to the person receiving care, however limited their interaction, in order to respond with empathy and compassion. Julie also wanted to find out whether people with advanced dementia simply become passive recipients of care or whether they continue to play an active role in the caring relationship.

The research mostly involved observation in the care home as well as interviews and group discussions with staff. Julie has a background in palliative care nursing, so was able to take on the role of participant observer. She provided hands-on care with the staff, at the same time as observing everyday life in the home. This case study describes some of the lessons Julie learnt in both preparing for and carrying out the field work.

Gaining ethical approval

Julie initially thought her observation study was low risk, as she explained,

“I didn’t think I would need written consent from residents for general observation in communal areas – I’d developed a way of gaining verbal consent – but the ethics committee said written consent was required. It was a complex task, because every resident lacked capacity, so I then had to consult all the relatives. On reflection, I think that was right, because the care home is a private space, as well as a work place – it’s where people live, and you’re working with a very vulnerable population.”

Recruiting a care home

Julie used her professional networks to recruit a care home, as she described,

“A colleague of mine met a service manager at an event and talked to her about my research. She said she’d be interested in one of her homes taking part. One of the homes was near me and fitted my criteria, so I ended up recruiting the only care home I spoke to!”

Establishing relationships with staff

Before starting the fieldwork, Julie invested a lot of time in establishing relationships with staff as she explained,

“The managers were very supportive and happy for me to be there, but some of the front line staff seemed a bit suspicious of being observed. So I put a lot of effort into explaining the research… I visited the home about ten times before starting data collection to make sure everybody was clear about what I was doing.”

Keeping people informed

It’s also important to keep everyone informed as the project progresses to maintain their interest and keep them on board. Julie did this by:

• Holding regular meetings with managers
• Using a white board in the staff room, to let staff know what she had done and what she planned to do next
• Writing articles for the care home newsletter to keep relatives informed

Maintaining boundaries

Only half of the families of residents responded, and provided written consent for their loved-one to be included in the project. However, no one objected to Julie being there. This posed some challenges as Julie described, “I sometimes had a dilemma around whether to respond to residents’ requests for help, when I didn’t have permission to involve them in the research. I didn’t want to ignore them, but I had to be careful not to cross a line.

Emotional support

Julie made sure she was prepared to provide emotional support to staff if they became upset during interviews or group discussions. She also put support structures in place for herself, as
she explained,

“As well as having an academic supervisor, I had access to another nurse for emotional support. It was agreed I could go to her if I witnessed any poor practice, but it’s always very helpful to have someone to talk to when you’re a lone researcher… This work is very intense – you have to be aware of the impact and have a strategy for taking care of yourself.”

Giving something back

Julie wants to ensure that the care home staff benefit in some way from their participation, although this is challenging with an academic study of this kind. She therefore plans to return to the care home to discuss her conclusions,

“They might have expected to hear about the results immediately, but the analysis takes time… another important aspect of the communication with staff is about managing their expectations.”

Key messages for care home researchers

• Don’t underestimate the time it takes to set up the project and obtain consent
• Make use of professional networks for care home recruitment
• Be prepared to invest a lot of time in building relationships with care home staff and keeping them informed during the field work
• Be prepared to provide emotional support to the people who take part in research and ensure you have that support for yourself
• Think about how you can share your findings with all stakeholders – not only other researchers.