Staff become co-researchers

Professors Jan Dewing and Brendan McCormack have conducted a two-year study that involved implementing a person-centred model of care by training care home staff to become co-researchers. The results of the study show that involving staff in research improves staff morale, confidence and their general opinion of how the care home operates and delivers care.

Background

The Older Persons Services National Practice Development Programme was undertaken across 20 Care homes in Ireland. Its aim was to implement person-centred practice across care homes and to evaluate the process.

Person-centred approach: Based on mutual respect and understanding, the resident and others significant to them are at the centre of decision making. Care is focused on discovering and acting on what is important to the resident and considering what affect it will have on their life. In addition, a key consideration in achieving person-centred care with residents is that of creating a culture that supports and enables staff to experience person-centred facilitation, leadership and management processes.

Approach

As the research programme was rather complex and resource intensive it was important that homes didn’t feel overwhelmed by it. To overcome this and maintain a high level of commitment and morale, Brendan and Jan drip fed participants with information on a need-to-know basis.

Jan and Brendan describe the approach as: “Working with staff, allowing them to own the research, and on a day-to-day basis. It’s very much around trying to facilitate people to work with us and do the research themselves. The collection of data and evaluation largely gets done by the participants. It’s a way of working that helps people to find their own solutions. Researchers very much co-ordinate and facilitate the approach and the staff owns the research.”

Jan and Brendan developed a structured work programme for each of the care homes involved as well as having the following layers of support underneath:

Regional facilitators: Individuals, usually nurses, were identified in each region to act as the lead for that area. Their main responsibility was to lead the training sessions in care homes in their allocated areas. Posts were funded by Irish Nursing and Midwifery Planning and Development Units (NMPDUs). In England a similar service can be found across Trusts, Royal Colleges and universities.

Practice development programme groups were set up in each care home as a forum for participants to discuss project working and develop action plans. The group also received skills development days every six weeks that covered:

1. Understanding what practice development involves and developing the skills to role model the processes

2. Using a person-centred framework and practice development models to establish a shared vision

3. Involving residents, relatives and all staff to facilitate an understanding of workplace culture and change processes

4. Holding awareness-raising activities for different staff groups, older people and families

5. Participating in active learning in the workplace

6. Using structured reflection

7. Developing greater appreciation skills for effective group work

8. Evaluation methods

Internal facilitators: Championing the programme on the ground, internal facilitators led training sessions, implemented active learning approaches and built working relationships to enable the practice development programme group to find solutions.

Participants: Any staff within the care home, including health care assistants, housekeeping, administration, catering, maintenance, clinical nurse managers and staff nurses. Staff were eager to be involved and learn the methods for conducting the research, data collection and interviewing techniques to collect resident and staff narratives.

Outcomes

It was evident the research programme impacted considerably upon the personal and professional growth for individuals. Participants particularly found active learning activities to be beneficial and have continued to utilise them.

Evidence from the study reveals that care home staff have benefited from the study in the following ways:

• better knowledge of treatment decisions

• career development opportunities

• improved role satisfaction

• improved workload

• increased staff retention

• improved communication and support channels

• continued support

The study also found a change in nurses’ perceptions of caring. Views shifted from one of seeing the technical aspects of nursing as caring to that of recognising the non-technical aspects of caring as being even more important. In year one there were as many poor practice examples as there were good practices. By year two considerably fewer examples of poor practice existed; demonstrating a change in culture.

Lessons learned

Brendan and Jan would like to provide the following advice to others completing research in this field:

• Try to demystify the concept of research. Introduce what your programme is and what it will involve right from the start. It’s important to involve everyone, including residents and their families. Getting buy-in from senior staff for your approach is important.

• Maximise any opportunities to enhance the leadership capability of the staff at all levels. It doesn’t matter what their role is – if they are interested in learning, involve them.

• Integrate research practices into staff’s daily workload and equip them with the tools to observe practice as a part of everyday work.

• Involve staff from across the home in all aspects of the research. They really value being involved in activities as it provides them with the knowledge and power to raise questions, improve relationships, develop their career and provide them with role satisfaction.

• Use active learning strategies to engage staff with learning and changing practice.

• Consider developing a partnership with a professional development association to aid you to complete participatory work.

• Make sure you consider older people and their families as active participants in your research.

Professor Brendan McCormack said: “The achievements made across each care home were impressive; staff were enthusiastic, worked very hard, engaged with the whole programme and subsequently saw major improvements across their home.”

Case Study Lead

Professor Brendan McCormack, Director of the Institute of Nursing Research

Email: bg.mccormack@ulster.ac.uk