Laying the foundations – what helps research in care homes to work well?

We spoke to Cathryn Hart (Head of Research & Development), Saba Alam (Senior Research Assistant) and Katie Gibson (Research Assistant) at Humber NHS Foundation Trust about their work on the MARQUE Project. The MARQUE project is a five-year study led by a team at University College London, involving care homes throughout England. The researchers describe the groundwork that’s essential to establishing good relationships with care home managers and staff, and the importance of being flexible and responsive to different stakeholders’ needs.

Background

The MARQUE Project is aiming to find better ways to manage agitation and improve the quality of life of people with dementia. Agitation (restlessness, pacing, shouting and verbal or physical aggression) is very common in people with dementia, causing distress for everyone involved. Ultimately, the Project will develop and assess a new approach to agitation management, but first the researchers need to develop an in-depth understanding of the problem. During the first two years, the researchers are therefore observing current practice in care homes, assessing the cost and impact of agitation on staff, relatives, and residents. The lessons from this work will be used to develop a new approach to agitation management, which will then be evaluated through a randomised controlled trial.

Katie and Saba are working on the early observational study, which will last for 16 months. They will be going into care homes within their region, visiting each home five times. This will give them an in-depth view of people’s experience of agitation and its management. The research started in February 2015 and will finish in the summer of 2016.

The team have invested a lot of time in establishing good working relationships with care home staff and managers. This ground work is essential to help the research run smoothly and to ensure participation is a positive experience. In this case study, we draw out the lessons that may be useful to other researchers.

Building relationships with managers

Care home managers are central to bringing everyone else into the project. Their support gives others confidence that the research is worthwhile and the researchers can be trusted. It’s essential to invest time in developing good relationships with managers (or their deputy) right from the start, as Cathryn described, “One of the most important We spoke to Cathryn Hart (Head of Research & Development), Saba Alam (Senior Research Assistant) and Katie Gibson (Research Assistant) at Humber NHS Foundation Trust about their work on the MARQUE Project. The MARQUE project is a five-year study led by a team at University College London, involving care homes throughout England. The researchers describe the groundwork that’s essential to establishing good relationships with care home managers and staff, and the importance of being flexible and responsive to different stakeholders’ needs. things is having the manager on board and enthusiastic. If the manager is there when you go into the home, even if it’s just for 5 minutes, then staff realise it’s OK to contribute.”

It can be challenging and time consuming to work with care home managers because they are so busy and often have competing demands on their time, but once they understand the aims of the research, they are usually very supportive.

Building relationships with staff

Staff are often very co-operative once they understand the aims of research. They may need briefing to be clear about how it works, as Katie explained, “The staff may not be used to interviews and questionnaires, so you need to prepare them. You also need to reassure them they are not being assessed. Make it clear you’re not auditors. If you come in with a big bag and lots of paperwork, it can be alarming.”

Saba also added, “It’s important to make staff feel you’re approachable and respectful of their work. Their priority is providing care, so you need to avoid disturbing them when they are busy.”

Taking part in research can be a positive experience for staff. It provides an opportunity to reflect on practice and get their views heard. As Katie explained, “Staff like to contribute because there’s mostly bad press about care homes, so it’s a chance to show some of the good that they do.”

Responding to residents’ needs

Residents need to be interviewed at the right time to avoid causing disturbance or distress. Working with staff can help as Katie described, “If you speak to the staff who know a resident well, they can tell you when that person may be more approachable.” Saba also explained, “There are times when the staff won’t want us to do interviews, such as mealtimes, and other times staff may want to be there to support me, because they know the resident has challenging behaviour.”

Responding to relatives’ needs

The researchers have learnt they need to be flexible about arranging to speak with relatives, as often people are working all day and want to prioritise visiting their loved one at other times. This means being prepared to meet people in the evenings, either at the care home or in their own home.

Some relatives also want to be present when their loved one is interviewed, as Katie experienced, “One relative wanted to be there because she said she could sense when the person was going to become agitated or upset.”

Responding to the needs of care home

If staff are unexpectedly busy, or off-sick, then even the best laid plans for research are disrupted, as Cathryn explained, “You can turn up at the home for a day of interviews and find you’re not allowed in because of a bug, or that staff aren’t available. So then you have to be prepared to come back another time. The more flexible you can be, the more likely your research will be a success.”

Key messages for care home researchers

• Don’t underestimate the time needed for doing the groundwork with care homes as well as collecting data

• Invest time in building relationships with staff and managers – be approachable and show respect

• Be flexible in arranging times for interviews with residents and relatives

• Always be prepared to change your plans at short notice

March 2015

For more information contact:

Cathryn Hart: Cathryn.Hart@humber.nhs.uk