ENRICHEnabling Research in Care Homes
“When making decisions about whether to transfer residents to hospital, care home staff consider the possible benefits and risks of different courses of action. However, to date, an in-depth and theoretically informed engagement with these decision-making processes and their associated behaviours has been lacking. We conducted an ethnographic study of care home staff’s decision-making about resident hospital transfers in England between May 2018 and November 2019. We combined staff interviews at six care home sites, with 30 members of staff, with 113 hours of ethnographic observation at three care homes sites. ‘Risk’ and risk management emerged as important overarching themes. In this article we conceptualise staff decision-making about potential hospital transfers for residents as a form of risk work. In doing so, we identify the different forms of risk knowledge that staff used to conceptualise risk and explore the ways staff navigated tensions between different forms of risk knowledge. We highlight the ways individual understandings of risk were influenced by social interactions with others, both at an interpersonal and organisational level, before identifying strategies that staff use to manage risk. By understanding transfer decisions explicitly in terms of the different forms of risk that care home staff manage, our analysis provides new insights into hospital transfers from care homes and contributes to the wider literature around risk work, demonstrating the utility of this concept in researching organisations that fall under the umbrella of social care, which have been previously neglected in academic research.”
To read this paper in full click here
This research study set out to understand how to progress interoperability in health and care. It combined a literature review with interviews and workshops. The workshops helped to test a methodology around how to build and strengthen relationships to help improve interoperability. Drawing on the experience of two ICSs – Cambridgeshire and Peterborough ICS and Humber and North Yorkshire Health and Care Partnership – case studies are used to share how practical solutions can address the challenges ICSs face.
Overview of the report:
- “Digital technologies can enable better collaboration and joined-up services between health and care partners in integrated care systems (ICSs) and provider collaboratives.
- We explored what is needed for interoperability to progress in an ICS setting using existing literature and a combination of interviews and workshops with staff in the health and care system and national bodies. Through our workshops we trialled a method for creating a shared space to build trust and relationships while tackling tricky topics.
- Interoperability has three equally important aspects that are vital for success: good co-working relationships between staff; technology that makes co-working as easy as possible; and an enabling environment (in which funding, capacity, skills, education and governance are aligned).
- Relationships need to be continually developed and strengthened across organisations and professions for interoperability to progress.
- There need to be improvements in how technology functions, in particular the use of, and adherence to, data and digital standards and addressing the fragmentation of technologies.
- Leaders need to work collectively to minimise power dynamics; staff need to be supported to lead change projects; and communications are an important tool to reinforce a collaborative working culture.”
To download the full report click here
Care home staff play a crucial role in managing residents’ health and responding to deteriorations. When deciding whether to transfer a resident to hospital, a careful consideration of the potential benefits and risks is required. Previous studies have identified factors that influence staff decision-making, yet few have moved beyond description to produce a conceptual model of the decision-making process.
To develop a conceptual model to describe care home staff’s decision-making when faced with a resident who potentially requires a transfer to the hospital.
Data collection occurred in England between May 2018 and November 2019, consisting of 28 semi-structured interviews with 30 members of care home staff across six care home sites and 113 hours of ethnographic observations, documentary analysis and informal conversations (with staff, residents, visiting families, friends and healthcare professionals) at three of these sites.
A conceptual model of care home staff’s decision-making is presented. Except in situations that staff perceived to be urgent enough to require an immediate transfer, resident transfers tended to occur following a series of escalations. Care home staff made complex decisions in which they sought to balance a number of potential benefits and risks to: residents; staff (as decision-makers); social relationships; care home organisations and wider health and social care services.
During transfer decisions, care home staff make complex decisions in which they weigh up several forms of risk. The model presented offers a theoretical basis for interventions to support deteriorating care home residents and the staff responsible for their care.
If you would like to read this paper in its entirety please click here for free access
A study funded by the Science Foundation Ireland (SFI) focused on the design of residential long-term care (RLTC) and the role of the built environment, in terms of creating a balanced approach to COVID-19 infection control and quality of life.
A report providing the key findings and recommendations are set out that apply both to the retrofit of existing settings and the design of new-build settings. The research largely shows how well-designed environments create a convergence between good infection control and a higher quality of life, while also contributing to greater resilience for residents and staff.
For access to this report click here
Continence, dementia, and care that preserves dignity
“Dementia is a growing, global challenge. As populations age, it has become one of the most important issues facing health and care systems around the world. People living with dementia often have problems going to the toilet (continence problems) which can have a profound impact on their lives and on their carers’. There is a misconception that nothing can be done if a person living with dementia experiences episodes of incontinence of urine or faeces or both. In fact, continence can be promoted through activities and care practices, including a balanced diet, exercise, and a clear routine. Encouragement and help to use the toilet may involve ‘signposting’ the toilet and mobility aids. A growing range of products, including assistive technology, can help some people at some times. Even so, the progressive nature of dementia means that there will come a point where containment might be the best approach. In which case, carers and practitioners need support and advice to provide this intimate care in the best way possible.”
“This themed review, featuring NIHR-funded research, identifies the impact of continence problems on people living with dementia and their carers, as well as ways to improve continence care at home, in care homes and in hospitals.”
“Inspiring different teams to work together is key to the successful leadership of any integrated health and social care system (ICS). However, little is known about how effective leadership can be supported and improved.
In England, ICSs are bringing together local NHS services and working with social care systems, local authorities, communities, and other groups, each with their own motivations. Leaders of ICSs therefore may be managing several professional teams with different goals and accountabilities. The challenges are not the same as in managing a team of professionals working towards a single goal.
ICSs are being rolled out across the UK and will soon be the new model of healthcare delivery. They are designed to put the person at the centre of their care. But there is little research on how leadership works (the mechanisms of leadership), and what makes it successful.
Research into successful leadership in health and social care mostly focuses on single teams and their tasks. This new study explored leadership of complex integrated teams and systems across health and social care. Working with a range of service providers and users, carers and researchers, the team reviewed the published evidence. They identified 10 mechanisms (such as balancing different perspectives, or working appropriately with power) which could influence the success of ICS leadership.
The researchers then searched for papers which either did or did not support the importance of these mechanisms. This allowed them to describe the influence of these mechanisms on ICS leadership.
Overall, the researchers said there was a lack of evidence on ICS leadership. Most studies referred to simple models of leadership and did not explore more complex teams and systems. They generally assumed the necessary skills for leadership are the same. The researchers argue that this assumption is not valid and that more research is needed to understand how to successfully lead ICSs.”
To read more on this topic click here
In the report you’ll find our learning about what works to support people with long term conditions to be active, what some of the barriers are, and how we went about collaborating to deliver greater impact. There are a number of different recommendations for anyone funding, developing, delivering, and evaluating physical activity behaviour change projects for people with long term conditions.
We’ve also developed a suite of Physical Activity and Long Term Conditions Resource Packs aimed at:
- the health and care workforce
- health and care organisations
- and the sports and physical activity sector
The packs include:
- four ways to make a difference and help people with long term health conditions be more active
- a summary of useful statistics and essential information about physical activity and long term health conditions including why it’s important to engage with this issue and how supporting people to be active can help organisations
- tailored resources and case studies that give examples of how to act upon the information in practice.
For more information on the report click here
“Last autumn HSR UK, the Nuffield Trust, the King’s Fund, the Health Foundation and PPI representatives from the Health Foundation Inclusion Panel co-developed a series of events to address improving inclusion in health and care research. An inclusive research system is essential for the delivery of effective, appropriate and respectful health and care services for all, and for understanding and reducing health inequalities. Everyone involved in commissioning, funding, designing and conducting research has a part to play in eliminating discrimination and ensuring that health and care research genuinely serves all patients and communities.
Each of the three online events aimed to showcase people, projects and organisations approaching research in inclusive and innovative ways, and to discuss how we can move existing practice forward. We also used the events to scrutinise the deeply embedded barriers to inclusion and consider how they might be tackled, at the research project, system and funding level. In this co-authored report, we share insights from the expert speakers who participated in the series, as well as our personal and practical reflections and learnings from running the series. The report also reaffirms our commitment to tackling these issues in health and care services research and outlines next steps from each of the organisations involved.”
If you are interested in this and would like to read more on this topic please click here
“A booklet has been created for carers who assist a person with dementia with their personal care. This booklet was developed as part of the Alzheimer’s Society funded Pro-CARE study, which was undertaken at the University of East Anglia. The booklet is available on the link below, please do share with any family carers, care-home staff or dementia support organisations you feel may benefit from the resource.”
This guidance is based on regularly reviewed clinical advice.
This guidance covers:
- visits that should happen in all circumstances
- safe visiting practices
- when different visiting arrangements are needed
- sources of information and support