Taking part in care home research

My name is Carinna Lumayno and I work as a staff nurse at Kineton Manor, an independent nursing home in Warwick. At Kineton Manor we offer residential and nursing care to 53 residents. We are proud to have been rated outstanding by the CQC since 2016 and we hold an accredited gold standard framework to provide End of Life care to our residents.

In 2016 we were invited to take part in a research project being conducted at Warwick University.  The project was titled: REACH (REducing Antimicrobial in Care Homes) and ran from September 2016 – November 2017.  Although I am always interested in how we can increase knowledge and improve the caring experience I will admit to feeling reluctant to take part in the project at the beginning.  My reason for hesitancy was that I thought this would only add extra work to my already busy workload, a feeling echoed by my colleagues. However we were reassured by our manager who really encouraged us to try and participate, explaining this would be a good learning experience for all of us.

I am so glad that our manager supported us to take part because she was right, it was a great learning experience and changed my perception of research.  I thought taking part in the project would be a distraction from my day-to-day activities and take a lot of my time away from daily tasks but this was not the case.  What it did was help me improve my practice and made me more confident in my decision-making processes with regards to recognising infection.

Preparing staff to take part in research

From my experience of taking part in this research project I would say it is crucial to prepare staff prior to the research taking place. With the REACH project our manager nominated staff members to join the research programme, we were provided training by Dr Rachel Potter of Warwick University  who gave us some history of the research and how to use the algorithm developed for the research.

During training days all nominated staff were supernumerary to ensure that all day-to-day activities for residents were not disturbed. The proprietor was very supportive with regards to participating in research which was important to us feeling supported in taking part.

Challenges in supporting research

Data collection was confusing at first because the researcher and I were both trying to figure out the necessary data we needed, and it involved a lot of other documents apart from the ones that the research team had given to us. But the more we did it the easier it got. Once I learned the different data we needed I would prepare everything prior to the researchers visit. I found this a very good learning experience because it helped me improve my organisational skills, communication skills, leadership skills.

The nursing team were very much involved because they were mainly the ones who would be required to use the tools for data collecting. The nurses used the algorithm designed for the research as a decision-making tool.  However, as a champion of the research I faced challenges getting nurses to use the algorithm, to complete the forms when they used it, and to tell us why they not had not used the algorithm tool to support decision making.

Tips for researchers wanting to engage with care homes

• It is also important for researchers to understand the complexity of care homes. It is crucial they apply flexibility in their approach as participants may not always be available.  This is important to those taking part as it can remove some of the pressure staff may feel, it is also important not to distract staff from their main tasks of providing care for residents.
• It is important were possible to get buy-in from a champion. Champions of research are able to oversee everything from the inside which makes data collection much easier, it also results in less disturbance to the whole team.
• It is important to develop a professional relationship between the research team and staff as this can result in a positive experience
• Incentives are not essential but they are a good way of showing appreciation for the time spent by staff carrying out tasks outside of their working duties. A voucher is a great incentive, and participants are able to choose how they want to use it.

Why should care homes take part in research?

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. I would encourage anyone working in care homes to take part, it was a good learning experience and it was different from our day-to-day activities.

Long term impact

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 display 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 residents, but for other people living in care homes.