scholarly journals Older care home residents’ and their relatives’ knowledge, understanding and views of shift handovers: an exploratory, focused-ethnographic qualitative study using interviews and observations

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032189
Author(s):  
Katharine Orellana ◽  
Valerie Lipman ◽  
Jill Manthorpe ◽  
Jo Moriarty ◽  
Caroline Norrie ◽  
...  
Keyword(s):  
Older People ◽  
Care Home ◽  
Care Homes ◽  
Clinical Settings ◽  
Study Participation ◽  
Underlying Assumption ◽  
Home Setting ◽  
Evidence Review ◽  
Administrative Procedures ◽  
South East England

ObjectivesTo investigate residents’ and relatives’ views and experiences of handovers in care homes. This paper reports residents’ and relatives’ awareness of handovers, knowledge of and views on handover practices and purpose, and views on handover effectiveness. Outcomes, safety and satisfaction in clinical settings are influenced by shift handovers. Despite this link with quality, residents’ increasing support needs and the provision of 24 hours care in care homes for older people, little is known about handovers in these settings from a resident and visiting relative perspective.SettingFive purposively sampled care homes for older people in South East England.ParticipantsHome managers (n=5), residents (n=16) relatives of residents (n=10) were interviewed; residents (n=15) and their interactions with staff were observed during handover periods. Participation was voluntary and subject to consent. Residents were identified by managers as having mental capacity to take a decision about participation which was then assessed. An ethnographic approach to data collection was taken, preceded by an evidence review.ResultsShift handovers were largely invisible processes to participating residents and relatives, many of whom had given little thought to handover practice, logistics or effectiveness prior to study participation. Their awareness and understanding of handovers, handover practices, and handover purpose and effectiveness varied. There appeared to be an underlying assumption that administrative procedures in care homes would operate without input from residents or relatives. A small number of residents, however, were highly aware of the routine of handovers and the implications of this for the timing of and response to their requests for care or support.ConclusionsThe care home setting and perspectives of the effectiveness of handovers may influence awareness of, knowledge of and levels of interest in involvement in handovers.

scholarly journals Rhetoric and reality of daily life in English care homes: the role of organised activities

2012 ◽  
Vol 7 (1) ◽  
pp. 53-78 ◽  
Author(s):  
Ingrid Eyers ◽  
Sara Arber ◽  
Rebekah Luff ◽  
Emma Young ◽  
Theresa Ellmers
Keyword(s):  
Older People ◽  
Government Policy ◽  
Care Home ◽  
Care Homes ◽  
Active Ageing ◽  
Delivery Of Care ◽  
Home Life ◽  
Provision Of Services ◽  
South East England

In divergent ways, both government policy and care home practices influence the everyday life of older people living in English care homes. The rhetoric of choice for care home residents may be in conflict with the reality of government policy-driven service delivery. The aim of the article is to examine the role of organised activities in facilitating choice and active ageing among care home residents. Findings from a study of ten care homes in South East England exemplify the conflict between government policy rhetoric and the reality of care home life. The indication is that the formality of the ’’activities of daily living’’ support procedures restricts residents’ involvement in the organised social activities.Within the general provision of services, the organised ’’social activities’’ offered failed to meet the interest, cognitive and physical abilities of residents. The reality of ’’choice’’ is therefore questionable. Policy needs to support a transformation in the delivery of care to ensure it addresses the actual needs and expectations of older people experiencing care home life.

scholarly journals Using comprehensive geriatric assessment for quality improvements in healthcare of older people in UK care homes: protocol for realist review within Proactive Healthcare of Older People in Care Homes (PEACH) study

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017270 ◽  
Author(s):  
Maria Zubair ◽  
Neil H Chadborn ◽  
John R F Gladman ◽  
Tom Dening ◽  
Adam L Gordon ◽  
...  
Keyword(s):  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Care Home ◽  
Realist Review ◽  
Community Dwelling ◽  
Systematic Search ◽  
Care Homes ◽  
British Society ◽  
Home Setting

IntroductionCare home residents are relatively high users of healthcare resources and may have complex needs. Comprehensive geriatric assessment (CGA) may benefit care home residents and improve efficiency of care delivery. This is an approach to care in which there is a thorough multidisciplinary assessment (physical and mental health, functioning and physical and social environments) and a care plan based on this assessment, usually delivered by a multidisciplinary team. The CGA process is known to improve outcomes for community-dwelling older people and those in receipt of hospital care, but less is known about its efficacy in care home residents.Methods and analysisRealist review was selected as the most appropriate method to explore the complex nature of the care home setting and multidisciplinary delivery of care. The aim of the realist review is to identify and characterise a programme theory that underpins the CGA intervention. The realist review will extract data from research articles which describe the causal mechanisms through which the practice of CGA generates outcomes. The focus of the intervention is care homes, and the outcomes of interest are health-related quality of life and satisfaction with services; for both residents and staff. Further outcomes may include appropriate use of National Health Service services and resources of older care home residents. The review will proceed through three stages: (1) identifying the candidate programme theories that underpin CGA through interviews with key stakeholders, systematic search of the peer-reviewed and non-peer-reviewed evidence, (2) identifying the evidence relevant to CGA in UK care homes and refining the programme theories through refining and iterating the systematic search, lateral searches and seeking further information from study authors and (3) analysis and synthesis of evidence, involving the testing of the programme theories.Ethics and disseminationThe PEACH project was identified as service development following submission to the UK Health Research Authority and subsequent review by the University of Nottingham Research Ethics Committee. The study protocols have been reviewed as part of good governance by the Nottinghamshire Healthcare Foundation Trust. We aim to publish this realist review in a peer-reviewed journal with international readership. We will disseminate findings to public and stakeholders using knowledge mobilisation techniques. Stakeholders will include the Quality Improvement Collaboratives within PEACH study. National networks, such as British Society of Gerontology and National Care Association will be approached for wider dissemination.Trial registration numberThe realist review has been registered on International Prospective Register of Systematic Reviews (PROSPERO 2017: CRD42017062601).

scholarly journals Protocol for A randomised feasibility trial comparing fluoride interventions to prevent dental decay in older people in care homes (FInCH trial)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rakhee Patel ◽  
Iftekhar Khan ◽  
Mark Pennington ◽  
Nigel B. Pitts ◽  
Claire Robertson ◽  
...  
Keyword(s):  
Older People ◽  
Dental Care ◽  
Care Home ◽  
Community Dwelling ◽  
Care Homes ◽  
Feasibility Trial ◽  
Search Query ◽  
Dental Decay ◽  
Home Setting ◽  
Cochrane Reviews

Abstract Background The number and proportion of older people globally is growing faster than that of any other age group. At the same time the number of people retaining some of their own teeth is rising. There significant differences between those living in care and their community dwelling peers, with evidence showing those in care having fewer teeth and significantly higher levels of dental decay. There are numerous Cochrane reviews linking the use of fluoride to a reduction in dental decay, however, the majority of research on effectiveness has been conducted on children and consequently, children and adolescents tend to be the main recipients of fluoride interventions. There are to date no studies comparing the effectiveness of fluoride interventions in older people in care homes in the UK. However, prior to developing an appropriate protocol for full-scale trial comparing clinical effectiveness of fluoride interventions, there are a number of trial feasibility and statistical parameters that need to be clarified. Methods This trial is a single centre, multi-site randomised controlled assessor blind parallel group (three groups) trial, with the primary objective of establishing the feasibility, practicability and compliance of fluoride interventions to prevent dental decay in care homes. Secondary and tertiary objectives will aim to explore the acceptability of the interventions from resident, care home and dental services perspectives, and estimate the efficacy of the three different fluoride treatments. Discussion This feasibility trial will produce new knowledge and add value to a landscape that is under researched. Although the efficacy of fluoride interventions is proven, the feasibility of dental research and prevention in this vulnerable group and in the complex care home setting is novel. This work will not only add to our understanding of the interface of dental care and social care but will also contribute to our broader understanding on undertaking research in care home settings. Dental care for older people has been a longstanding issue, and the events of this past year has shone a light on the vulnerabilities of those residing in care homes and so this research is landing at a pivotal time. Trial registration EudraCT Registration 2017-002248-34. Registered 20th February 2018 https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-002248-34.

Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff

2006 ◽  
Vol 62 (1) ◽  
pp. 29-36 ◽  
Author(s):  
C.A.M. McNulty ◽  
J. Bowen ◽  
C. Foy ◽  
K. Gunn ◽  
E. Freeman ◽  
...  
Keyword(s):  
Older People ◽  
Care Home ◽  
Care Homes ◽  
Urinary Catheterization ◽  
Care Home Staff

scholarly journals Quality improvement collaborative aiming for Proactive HEAlthcare of Older People in Care Homes (PEACH): a realist evaluation protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023287 ◽  
Author(s):  
Reena Devi ◽  
Julienne Meyer ◽  
Jay Banerjee ◽  
Claire Goodman ◽  
John Raymond Fletcher Gladman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Older People ◽  
Care Home ◽  
Realist Evaluation ◽  
Evaluation Framework ◽  
Care Homes ◽  
Quality Improvement Initiative ◽  
Quality Improvement Collaborative ◽  
Programme Theory ◽  
Health And Social Care

IntroductionThis protocol describes a study of a quality improvement collaborative (QIC) to support implementation and delivery of comprehensive geriatric assessment (CGA) in UK care homes. The QIC will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching and assistance with project evaluation.Methods and analysisThe QIC will be delivered across a range of partnering organisations which plan, deliver and evaluate health services for care home residents in four local areas of one geographical region. A realist evaluation framework will be used to develop a programme theory informing how QICs are thought to work, for whom and in what ways when used to implement and deliver CGA in care homes. Data collection will involve participant observations of the QIC over 18 months, and interviews/focus groups with QIC participants to iteratively define, refine, test or refute the programme theory. Two researchers will analyse field notes, and interview/focus group transcripts, coding data using inductive and deductive analysis. The key findings and linked programme theory will be summarised as context-mechanism-outcome configurations describing what needs to be in place to use QICs to implement service improvements in care homes.Ethics and disseminationThe study protocol was reviewed by the National Health Service Health Research Authority (London Bromley research ethics committee reference: 205840) and the University of Nottingham (reference: LT07092016) ethics committees. Both determined that the Proactive HEAlthcare of Older People in Care Homes study was a service and quality improvement initiative. Findings will be shared nationally and internationally through conference presentations, publication in peer-reviewed journals, a graphical illustration and a dissemination video.

scholarly journals An exploration of hydration practices in Maltese residential care homes for older people

2021 ◽  
Vol 23 (11) ◽  
pp. 1-12
Author(s):  
Francesca Micallef ◽  
Marisa Vella ◽  
Alan Sciberras Narmaniya ◽  
Glenda Cook ◽  
Juliana Thompson
Keyword(s):  
Older People ◽  
Residential Care ◽  
Care Home ◽  
Good Health ◽  
Care Homes ◽  
Complex Needs ◽  
Increased Risk ◽  
Adequate Hydration ◽  
Axial Coding ◽  
Sugary Beverages

Background/aims The integral relationship between adequate hydration and good health is widely recognised. Older people with complex needs and frailty can struggle to maintain adequate hydration, with residents in care home settings being at an increased risk of dehydration. The aim of this study was to explore current hydration practices in residential care homes in Malta. Methods An exploratory qualitative approach was adopted to explore staff's views and approaches in supporting residents' hydration. Data was collected via semi-structured, individual and small group interviews with staff from two care homes from the central and southern region of Malta. A process of open coding, followed by axial coding, was used to analyse the data. Peer debriefing was performed throughout, until agreement was reached among the research team about the final themes and sub-themes. Results Three themes emerged from the data: culture of promoting fluid intake; challenges in supporting older people to achieve optimum hydration; hydration practices and approaches. Conclusions A hydration promotion culture was demonstrated through various practices adopted in the care homes. The strong focus on water intake, in response to concerns about consuming sugary beverages, has implications for the promotion of a person-centred approach to hydration care. Inconsistencies in monitoring of fluids and daily recommended targets highlights the importance of policies or guidelines to guide hydration practice. Challenges related to refusal of fluids and language barriers among non-native staff were evident and justify further research is this area.

scholarly journals Hearing and vision care provided to older people residing in care homes: a cross-sectional survey of care home staff

2020 ◽  
Author(s):  
Wendy Andrusjak ◽  
Ana Barbosa ◽  
Gail Mountain
Keyword(s):  
Older People ◽  
Vision Loss ◽  
Care Home ◽  
Care Homes ◽  
Eye Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Home Staff ◽  
Chi Square Analysis ◽  
Vision Care

Abstract Background: Hearing and vision loss in older people has proven to affect physical and mental health and increase the speed of cognitive decline. Studies have proven certain practices and aspects of staff knowledge increase the effective care of residents’ ears and eyes, yet it is not known which of these are being implemented in care homes. This study aims to identify the gaps in staff knowledge and underused practices evident in long term care homes when identifying and managing hearing and vision difficulties in older residents. Methods: This study used a cross-sectional survey design. Survey questions were informed by the existing literature and were focused on practices, staff knowledge, and other aspects that have shown to affect residents’ hearing and vision care. The survey was sent to care homes across England between November 2018 and February 2019 both via Email and in paper format for care home staff to complete. Descriptive statistics and Chi-Square analysis was used to assess the factors particularly influencing the current care being provided to care home residents. Results: A total of 400 care home staff responded from 74 care homes. The results revealed that screening tools are rarely used by staff to identify hearing and vision impairments, care homes have limited access to other assistive devices, and audiology services do not regularly assess care home residents. A majority of staff were also not entirely confident in their knowledge of ear and eye care. Responses were also affected by the respondents’ job role, length of time working in care homes and also the care home type and care home capacity revealing a lack of standardised practice and shared communication. Conclusion: This study identifies which practices known to facilitate ear and eye care are currently under used in care homes across England and what particularly staff are not knowledgeable on when it comes to ear and eye care. This can now inform future research of the areas requiring improvement to as effectively address to acknowledged slow identification and poor management of hearing and vision loss in older people residing in care homes.

Multifaceted competence requirements in care homes: Ethical and interactional competence emphasized

2017 ◽  
Vol 38 (1) ◽  
pp. 48-58 ◽  
Author(s):  
Outi Kiljunen ◽  
Tarja Välimäki ◽  
Pirjo Partanen ◽  
Päivi Kankkunen
Keyword(s):  
Older People ◽  
Registered Nurses ◽  
Delphi Study ◽  
Care Home ◽  
Care Homes ◽  
Interactional Competence ◽  
Licensed Practical Nurses ◽  
Modified Delphi ◽  
Practical Nurses ◽  
Care For Older People

Nurses need versatile competence to care for older people in care home settings. A modified Delphi study was conducted to identify competencies registered nurses and licensed practical nurses need to care for older people in care homes. A total of 38 panelists consisting of experienced professionals in clinical and managerial roles were recruited to identify types of competencies these nurses require. In total, 80 competencies for licensed practical nurses and 81 competencies for registered nurses were identified as necessary. This study has shown that licensed practical nurses are required to have similar competencies to registered nurses in care homes. Nurse managers, nurse educators, and policy makers should pay more attention, to nurses’ work requirements, especially for licensed practical nurses, and support nurses to meet the needs of older people living in care homes.

Care homes for older people

2020 ◽  
pp. 371-394
Author(s):  
Tom Dening ◽  
Alisoun Milne
Keyword(s):  
Older People ◽  
Late Stage ◽  
Care Home ◽  
Care Homes ◽  
Sensory Impairment ◽  
Comorbid Conditions ◽  
Illness Trajectory ◽  
Home Culture ◽  
Independent Sector

The care home sector has changed significantly in recent years: the vast majority of care homes are now in the independent sector, funding of care is complex, with greater reliance on self-funders to ensure profitability, and regulation has shifted to a more targeted model. In terms of the care home population, as most people are admitted at a late stage of their illness trajectory, many have comorbid conditions and multiple needs. Frailty is a dominant issue, often combined with dementia and other problems, e.g. sensory impairment and incontinence. The dimensions of a positive care home culture include a well-managed transition into the home, a commitment to person-centred care, and a well-trained and supported workforce. Over the last few years there has been a growing interest in care homes as major providers of care to some of the UK’s most vulnerable citizens; this includes welcome attention to research.

Care homes for older people

2013 ◽  
Author(s):  
Tom Dening ◽  
Alisoun Milne
Keyword(s):  
Older People ◽  
Residential Care ◽  
Physical Disability ◽  
Care Home ◽  
Developed Countries ◽  
Care Homes ◽  
Standards Of Care ◽  
Ageing Population ◽  
Behavioural Disturbance ◽  
The Uk

Although only 5% of the total over 65 population in developed countries lives in a care home, the lifetime risk of needing residential care is considerable. In the UK, 418 000 older people occupy nearly 12 000 care homes; the sector has a total value of around £14 billion. Care home residents tend to be very old, most are women, and most have complex co-morbid needs. Most people enter a care home because they can no longer live independently due to ill health, notably dementia. Dementia affects over two thirds of all residents; physical disability and functional impairment are also common. Behavioural disturbance is common as is depression. There are concerns about excessive reliance on medication, and more emphasis recently has been placed on improving standards of care. Evidence suggests that training and good leadership is effective. With the ageing population, the provision and the funding of care home places will come under increasing pressure. The solutions to this are yet to be determined.

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