ENRICHEnabling Research in Care Homes
My experience of Research and the REACH Study
Carinna Uy, Staff Nurse, Kineton Manor Nursing Home
In this blog post, Carinna UY, Senior Nurse from Kineton Manor Nursing Home in Warwick, speaks with ENRICH West Midlands Facilitator Fawn Harrad about her experience of taking part in a local study
With a growing interest in carrying out research in the care home setting, many researchers and care home managers are eager to learn more about this emerging field of study. The number of research studies taking place in care homes is growing and in turn more people are curious to hear from those taking part.
In this blog post, Carinna UY, Senior Nurse from Kineton Manor Nursing Home in Warwick, speaks with ENRICH West Midlands Facilitator Fawn Harrad about her experience of taking part in a local study.
Fawn : You were recently involved in the REACH study. Can you tell me a little bit about the aims of the study and what the study means to you?
Carinna: The REACH study – Reducing Antimicrobials in Care Homes – is being delivered by Queen’s University in Belfast and the University of Warwick in the West Midlands. Across the country, and internationally, concerns have been raised about the number of antimicrobials, such as antibiotics and antifungals, that are prescribed in care homes. High levels of prescribing can lead to some residents becoming resistant to antimicrobials, so the more antibiotics they receive, the less likely they will be effective for that person in the future.
The team is adapting an existing intervention carried out in Canada that was shown to be effective in reducing the number of antimicrobials prescribed in care homes.We are currently involved in the feasibility study – a bit like a mini trial-run to test if this approach could reduce the prescribing of antimicrobials in the U.K. There are six care homes in the UK taking part; three of these are in Warwickshire. If the pilot successfully shows that this approach could work, then a larger trial, which will involve many more care homes, may take place.
Fawn: What has the study involved?
Carinna: Our local ENRICH Facilitator contacted the home and discussed the study with our manager. The study involves training staff about signs and symptoms of infection and encouraging staff to use a decision-making tool. We were interested in taking part so allowed the ENRICH team to pass on our contact details to the researchers and arranged a time to meet.
The Warwick study team visited the the home and spoke about the study. Once we agreed we would take part, the team came back and delivered a training session on how to use the decision-making tool and training was also given on the main signs and symptoms of chest infections, skin infections and urinary tract infections. We discussed different scenarios that could take place in the home and considered which ones would be an emergency and which we could manage in the home without the need for antibiotics.
Fawn: What is your role in the study?
Carinna: I am the designated study champion within our home. The majority of the nursing team have undertaken the training but my role is to oversee and compile all the paperwork completed by staff. Once I have checked the paperwork I then hand this over to the research team when they come to visit – usually every two or three weeks.
Fawn: What have you found interesting whilst being involved in this research?
Carinna: It has been fascinating to learn more about research and the way a project is carried out in a care home. Using the decision-making tool has been beneficial for the whole team. I feel many of us were already working in the way the decision-making tool outlines – looking at the severity and number of symptoms a resident displays and discussing whether we could manage them without antibiotics or if we needed to call the doctor. However, the decision-making tool has formalised this so that we now all work in a consistent manner.
The training we received has allowed us to be more proactive and has changed our practices with regards to antibiotic use. We now look more carefully at each resident’s needs to decide if we can manage their symptoms at home or if antibiotics are necessary. This will reduce the likelihood that our residents will become resistant to antibiotics in the future.
The unnecessary prescribing of antibiotics is a global health concern and we feel very privileged to be a part of the REACH study as it has allowed us to contribute toward a project that will be beneficial, not just for our patients, but for other people living in care homes.
Fawn: Were there any challenges / difficulties to taking part?
Carinna: At times it was difficult to motivate staff to complete the necessary forms. Care homes are busy working environments and some members of staff felt that they were too busy and that completing the forms would take a long time. However once the staff became more familiar with the forms we found that they did not add to our workload and were simple and straightforward.
Fawn: Would you recommend taking part in research to other care homes?
Carinna: Yes, definitely! Taking part in the REACH study gave us the opportunity to evaluate the way that we work, specifically around the way we manage residents with suspected infections. Different care homes will have different practices, but participating in research can help care homes to learn from each other’s effective practices and develop new ways of working.
Taking part in research also empowers staff and gives them opportunities to learn, such as the free training we received as part of the project. We are also very pleased to be able to contribute towards knowledge that will help improve practices in other care homes in the future.
Fawn: What advice could you offer to researchers that are looking to carry out research in care homes?
Carinna: The research team have been great, they have approached staff respectfully and have worked with us to collect data in a way that meets their needs but avoids creating extra work in the home. I would recommend that other teams looking to work with care homes in the future also take this approach.
I am fortunate because my manager has given me protected time to work on this study and to look at the data collection forms. However in other care homes the team may not have time to do this, so the researchers would have to work with the care home staff to find ways of working that does not add to their workload or take staff away from patient care.
My advice for other researchers would be to recognise that taking part in a research project can be time consuming and on occasion has required that we bring in an extra member of staff, which in turn has implications for staffing budgets. However, the research team thanked staff by providing them with a small gift voucher for taking part in the training and the project, which showed appreciation for the time and effort that staff had put into the research.