ENRICHEnabling Research in Care Homes
How to make friends and influence people…in care homes.
Victoria Simmons, Research Assistant, Oxford Health NHS Foundation Trust
Upon your arrival at a care home the last thing you want to see as a researcher is the care staff cowering away in the kitchen and the face drop of a visiting relative.
. But, let’s be honest, regardless of how enticing a friendly face and smile may be, would you too not flee from the suited and booted researcher who has come to interrogate you for the next half an hour? This blog reflects on the skills needed to build relationships in care homes, especially during data collection, and how we can inspire staff and relatives to come out from behind the couch.
When you are working a long shift, with someone else’s hardened porridge stuck to your tunic, the last thing on your list of priorities is participating in a trial to enhance the evidence base of dementia research to inform these so-called “NICE guidelines”. As a care assistant I found it tricky manoeuvring a pair of latex gloves through tired eyes let alone finding time to sit down with a researcher to answer a stack load of questions. Care homes are often very busy places, and both direct care staff and managers can be stretched for time, so it is important not to take a “sorry not now, maybe later” so personally. Being approachable (a smile often helps with this!) and asking staff how they are or how did that porridge ended up on their tunic not only shows you are interested but it also acts as the first step to building a good working relationship. As researchers, we can cement these foundations through showing compassion and demonstrating genuine empathy. If you can relate to what they are saying then tell them! There is nothing better than finding that mutual ground.
How wonderful would it be to have some uninterrupted and reflective time in a confidential space with staff? Sometimes this is just wishful thinking and during these times we will need to get our head out of the clouds and think “How can we make this more realistic?” Usually collaborating with staff on this will help you reach your answer, they are the experts on their care home and residents after all. And this is where being flexible comes into it as the more flexible we can be the more chances we create for data collection and valuable interviewing time. It will also show staff that you meant it when you said “I completely understand where you’re coming from”.
Now this is not to say that as researchers we should become professional eggshell-walkers, we have a job to do at the end of the day, it is about establishing mutual respect for each other’s roles. As a researcher on the DCM-EPIC trial getting this balance was paramount during data collection, especially when care staff shortages meant you relied more heavily on the same staff members to fill in yet another five booklets. So, if thus far you have been avoided like a bad smell, it’s time to bring out those assertiveness skills you have picked up along the way. Establish convenient times for you to meet with staff and ask [cue wise motivational voice of John Lewis] ‘if not now, when?’ ‘If not us, who?’ Liaise with management or senior staff to ensure there are staff available and that they know they can take time away from the floor to answer your questions. If all else fails be resourceful. Whether that’s finding out what staff are free during the upcoming choir event, whether there is someone else you could ask those questions to, finding a different place to carry out your observational assessment or if you could be getting on with another piece of work while you wait for staff to become available. We need to change the way we work to establish these working relationships, thus enabling us to conduct data collection more efficiently.
As Mr Edison once said ‘Opportunity is missed by most people because it is dressed in overalls and looks like work’. Perhaps the ‘overalls bit’ is not relevant here but the perception of opportunity being mistaken for work definitely is. If we can provide staff with protected time during interviews to reflect on their residents and their role in delivering care this can only seek to enhance practice. Care staff are such a wealth of knowledge when it comes to the people with dementia that they care for, and this can be especially useful for us when assessing capacity. As researchers we can empower staff by seeking out this knowledge, asking for their opinions, actively listening to their responses and utilising their skills to facilitate our work. Collaborating with staff on research can inspire confidence in many ways, including confidence in their own skills, your working relationship and the impact of care home research. There is learning to be gained on both sides from this exchange of knowledge. Staff are given the opportunity to make connections between their resident’s behaviour and can experience epiphany-like moments when answering questions. Merely asking questions can have an impact on care as staff reflect on their answer and become aware of their practice. Whilst as researchers we can learn a lot more about the clinical population we are researching, highlighting the unique experiences of people diagnosed with dementia and the people who help care for them. Through imparting this knowledge we are both equipped with new information and skills to enhance our practice.
It can be difficult watching a loved one with dementia experience challenging times, especially when you cannot be with them as often as you would like. Relative responses to research can vary significantly so don’t take the “well it won’t help my Margret so what’s the point?” to heart, instead highlight the benefits of the research. Regardless of their perspective this should be respected and interactions should be handled with sensitivity. When engaging relatives in research we should provide them with all the information necessary for gaining consent, including describing the aim of the research, explaining what would be required of both them and their loved one and any impact it may have. This in itself can empower relatives to make a decision on their role and the role of their loved one in research. Additionally, keeping them regularly updated on the progress of the research trial and informing them of the results once it has finished also encourages confidence in the part they have played. Be careful here though as you wouldn’t want your passion for research and charming eagerness to be mistaken for harassment. Throughout your contact with relatives it is important to highlight your experiences of their loved ones strengths and emphasise that people can live well with dementia. Utilising family liaison officers or seeking an invite to the next relative meetings can also provide opportunities to collaborate with relatives and explain the impact their participation in research will have on care.
As you can see, inspiring absolute confidence in research amongst care home staff and relatives is no easy feat. It takes time and skill to build effective working relationships but once you have built these relationships it will provide you with the platform to empower people and promote dementia research.
So the next time you pull up at a new care home, take a moment, prepare and think: “what do I want people thinking, feeling and doing as a result of me being here?”
Victoria Simmons is a Research Assistant working on the DCM-EPIC Trial at Oxford Health NHS Foundation Trust for more information on the study you can also follow them on twitter by following @EPICTrial
Editor comment – some key words for me here… Approachable, friendly, professional with empathy, and an appreciation of the environment, challenges and opportunities.