scholarly journals Uptake and use of a minimum data set (MDS) for older people living and dying in care homes in England: a realist review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040397
Author(s):  
Massirfufulay Kpehe Musa ◽  
Gizdem Akdur ◽  
Barbara Hanratty ◽  
Sarah Kelly ◽  
Adam Gordon ◽  
...  
Keyword(s):  
Older People ◽  
Care Home ◽  
Realist Review ◽  
Care Homes ◽  
Term Care ◽  
Data Set ◽  
Care Home Staff ◽  
Services Delivery ◽  
Minimum Data ◽  
Review Protocol

IntroductionCare homes provide nursing and social care for older people who can no longer live independently at home. In the UK, there is no consistent approach to how information about residents’ medical history, care needs and preferences are collected and shared. This limits opportunities to understand the care home population, have a systematic approach to assessment and documentation of care, identifiy care home residents at risk of deterioration and review care. Countries with standardised approaches to residents’ assessment, care planning and review (eg, minimum data sets (MDS)) use the data to understand the care home population, guide resource allocation, monitor services delivery and for research. The aim of this realist review is to develop a theory-driven understanding of how care home staff implement and use MDS to plan and deliver care of individual residents.Methods and analysisA realist review will be conducted in three research stages.Stage 1 will scope the literature and develop candidate programme theories of what ensures effective uptake and sustained implementation of an MDS.Stage2 will test and refine these theories through further iterative searches of the evidence from the literature to establish how effective uptake of an MDS can be achieved.Stage 3 will consult with relevant stakeholders to test or refine the programme theory (theories) of how an MDS works at the resident level of care for different stakeholders and in what circumstances. Data synthesis will use realist logic to align data from each eligible article with possible context–mechanism–outcome configurations or specific elements that answer the research questions.Ethics and disseminationThe University of Hertfordshire Ethics Committee has approved this study (HSK/SF/UH/04169). Findings will be disseminated through briefings with stakeholders, conference presentations, a national consultation on the use of an MDS in UK long-term care settings, publications in peer-reviewed journals and in print and social media publications accessible to residents, relatives and care home staff.PROSPERO registration numberCRD42020171323; this review protocol is registered on the International Prospective Register of Systematic Reviews.

scholarly journals The uptake and use of a minimum data set (MDS) for older people living and dying in care homes: a realist review

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Massirfufulay Kpehe Musa ◽  
Gizdem Akdur ◽  
Sarah Brand ◽  
Anne Killett ◽  
Karen Spilsbury ◽  
...  
Keyword(s):  
Older People ◽  
Care Home ◽  
Realist Review ◽  
Care Homes ◽  
Minimum Data Set ◽  
Data Sets ◽  
Term Care ◽  
Data Set ◽  
Care Home Staff ◽  
Minimum Data

Abstract Background Care homes provide long term care for older people. Countries with standardised approaches to residents’ assessment, care planning and review (known as minimum data sets (MDS)) use the aggregate data to guide resource allocation, monitor quality, and for research. Less is known about how an MDS affects how staff assess, provide and review residents’ everyday care. The review aimed to develop a theory-driven understanding of how care home staff can effectively implement and use MDS to plan and deliver care for residents. Methods The realist review was organised according to RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines. There were three overlapping stages: 1) defining the scope of the review and theory development on the use of minimum data set 2) testing and refining candidate programme theories through iterative literature searches and stakeholders’ consultations as well as discussion among the research team; and 3) data synthesis from stages 1 and 2. The following databases were used MEDLINE via OVID, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ASSIA [Applied Social Sciences Citation Index and Abstracts]) and sources of grey literature. Results Fifty-one papers informed the development of three key interlinked theoretical propositions: motivation (mandates and incentives for Minimum Data Set completion); frontline staff monitoring (when Minimum Data Set completion is built into the working practices of the care home); and embedded recording systems (Minimum Data Set recording system is integral to collecting residents’ data). By valuing the contributions of staff and building on existing ways of working, the uptake and use of an MDS could enable all staff to learn with and from each other about what is important for residents’ care Conclusions Minimum Data Sets provides commissioners service providers and researchers with standardised information useful for commissioning planning and analysis. For it to be equally useful for care home staff it requires key activities that address the staff experiences of care, their work with others and the use of digital technology. Registration PROSPERO registration number CRD42020171323.

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 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.

scholarly journals Understanding Stakeholders’ Perspectives on Implementing Deprescribing for Older People Living in Long-term Residential Care Homes: The STOPPING Study Protocol

2020 ◽  
Author(s):  
Krystal Warmoth ◽  
Jo Day ◽  
Emma Cockcroft ◽  
Donald Nigel Reed ◽  
Lucy Pollock ◽  
...  
Keyword(s):  
Older People ◽  
Healthcare Professionals ◽  
Care Home ◽  
Family Members ◽  
Care Homes ◽  
Health Economy ◽  
The Public ◽  
Individual Interviews ◽  
Care Home Staff ◽  
Qualitative Approaches

Abstract Background: Older people with multimorbidity often experience polypharmacy. Taking multiple medicines can be beneficial; however, some older adults are prescribed multiple medicines when they are unlikely to improve clinical outcomes and may lead to harm. Deprescribing means reducing or stopping prescription medicines which may no longer be providing benefit. While appropriate deprescribing may usually be safely undertaken, there is a lack of guidance about how to implement it in practice settings such as care homes. Implementing deprescribing in care homes is often challenging, due to differing concerns of residents, staff, clinicians, friends/family members and carers along with differences in care home structures. The STOPPING study will support the development of better deprescribing practice in care homes, considering different views and environments. This paper aims to introduce the research protocol. Methods: We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid analysis. To understand the barriers, facilitators and contextual factors influencing deprescribing in care homes, we will employ individual interviews with care home residents and family members, focus groups with care home staff and healthcare professionals, and observations from care homes. Then, we will examine acceptability, feasibility, and suitability of existing deprescribing approaches using cognitive interviews with care home staff and healthcare professionals. Lastly, we will use narrative synthesis to integrate findings and develop guidance for implementing a deprescribing approach for care homes.Discussion: This research will support the development of implementable approaches to deprescribing in care homes. The insights from this project will be shared with various stakeholders: care home residents, staff, pharmacists, general practitioners, nurses, and other health professionals, carers, researchers, and the public. This work will support deprescribing to be implemented effectively in care homes to benefit residents and the wider health economy.

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 ◽  
Best Practice ◽  
Vision Loss ◽  
Care Home ◽  
Care Homes ◽  
Eye Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Home Staff ◽  
Vision Care

Abstract Background: Hearing and vision loss in older people has been proven to affect physical and mental health and increase the speed of cognitive decline. Studies have demonstrated that certain practices and improved staff knowledge increase the effective care of residents’ ears and eyes, yet it is not known which practices are being implemented in care homes. This study aimed to identify the gaps in staff knowledge regarding hearing and vision difficulties in older residents, and which practices known to improve ear and eye care in older care home residents are not commonly implemented in care homes in England.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. A convenience sample of care home staff were recruited from care homes across England between November 2018 and February 2019 via email and in paper format. Descriptive statistics and Chi-Square analysis were applied to identify the factors influencing the care being provided to care home residents. Results: A total of 400 care home staff responded from 74 care homes. The results revealed that less than half of staff respondents reported to use screening tools to identify hearing (46%) and vision impairments (43.8%); that care homes rarely have limited access to other assistive devices for hearing (16%) and vision loss (23.8%), and that audiology services do not regularly assess care home residents (46.8%). A majority of staff who responded were not confident in ear and eye care. Responses were found to be influenced by the respondents’ job role, length of time working in care homes and also the care home type and care home size. Findings confirmed a lack of standardised practice and the importance of shared communication for promulgation of best practice.Conclusion: This study has identified that some practices known to facilitate ear and eye care are not commonly applied in a sample of English care homes. It has also shown that care home staff knowledge of ear and eye care is inconsistent. The information derived from this survey can be used to inform guidelines for best practice and inform needs for future research.

scholarly journals Questionable practices despite good intentions: coping with risk and impact from dementia-related behaviours in care homes

2017 ◽  
Vol 38 (9) ◽  
pp. 1933-1958 ◽  
Author(s):  
TAMARA BACKHOUSE ◽  
BRIDGET PENHALE ◽  
RICHARD GRAY ◽  
ANNE KILLETT
Keyword(s):  
Human Rights ◽  
Psychological Symptoms ◽  
Participant Observation ◽  
Care Home ◽  
Care Homes ◽  
Service Development ◽  
Ageing Population ◽  
Term Care ◽  
Staff Members ◽  
Care Home Staff

ABSTRACTCare-home residents with dementia can experience behavioural and psychological symptoms such as aggression, agitation, anxiety, wandering, calling out and sexual disinhibition. Care-home staff have a duty to keep residents safe. However, residents with dementia can pose particular challenges in this area. In this paper, we draw on a study which explored how care-home staff manage dementia-related behaviours. In-depth ethnographic case studies at four separate care homes were conducted in England. These involved interviews with 40 care-home staff and 384 hours of participant observation. Our analysis showed that some residents with dementia experience behaviours which can either create risks for, or negatively impact on, themselves and/or other residents or staff members. It emerged that the consequences of the behaviours, rather than the behaviours themselves, created difficulties for staff. To cope with the risk and impact of behaviours, staff employed multiple strategies such as surveillance, resident placement, restrictions and forced care. Using the data, we explore how actions taken by staff to manage the risk and impact of behaviours in these communal settings relate to residents’ human rights. Our findings have particular relevance for care-home staff who need support and guidance in this area, for service development worldwide and for the global ageing population whose valued human rights may become under threat, if they require long-term care.

scholarly journals Protocol for a realist review of General Practitioners’ Role in Advancing Practice in Care Homes (GRAPE study)

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036221 ◽  
Author(s):  
Adam L Gordon ◽  
Reena Devi ◽  
Christopher Williams ◽  
Claire Goodman ◽  
Kathleen Sartain ◽  
...  
Keyword(s):  
General Practitioners ◽  
Care Home ◽  
Realist Review ◽  
Healthcare Services ◽  
Care Homes ◽  
Healthcare Provision ◽  
Care Home Staff ◽  
Research Journal ◽  
Experience Of Care ◽  
Literature Searches

IntroductionOlder people who live in care homes have a high level of need with complex health conditions. In addition to providing medical care to residents, general practitioners (GPs) play a role as gatekeeper for access to services, as well as leadership within healthcare provision. This review will describe how GPs were involved in initiatives to change arrangements of healthcare services in order to improve quality and experience of care.Methods and analysisFollowing RAMESES quality and publication guidelines standards, we will proceed with realist review to develop theories of how GPs work with care home staff to bring about improvements. We identify when improvement in outcomes does not occur and why this may be the case. The first stage will include interviews with GPs to ask their views on improvement in care homes. These interviews will enable development of initial theories and give direction for the literature searches. In the second stage, we will use iterative literature searches to add depth and context to the early theories; databases will include Medline, Embase, CINAHL, PsycINFO and ASSIA. In stage 3, evidence that is judged as rigorous and relevant will be used to test the initial theories, and through the process, refine the theory statements. In the final stage, we will synthesise findings and provide recommendations for practice and policy-making.During the review, we will invite a context expert group to reflect on our findings. This group will have expertise in current trends in primary care and the care home sector both in UK and internationally.Ethics and disseminationThe study was approved by University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee: 354-1907. Findings will be shared through stakeholder networks, published in National Institute for Health Research journal and submitted for peer-reviewed journal publication.

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 ◽  
Best Practice ◽  
Vision Loss ◽  
Care Home ◽  
Care Homes ◽  
Eye Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Home Staff ◽  
Vision Care

Abstract Background: Hearing and vision loss in older people has been proven to affect physical and mental health and increase the speed of cognitive decline. Studies have demonstrated that certain practices and improved staff knowledge increase the effective care of residents’ ears and eyes, yet it is not known which practices are being implemented in care homes. This study aimed to identify the gaps in staff knowledge regarding hearing and vision difficulties in older residents, and which practices known to improve ear and eye care in older care home residents are not commonly implemented in care homes in England.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 via email and in paper format for care home staff to complete. Descriptive statistics and Chi-Square analysis were applied to identify the factors influencing the 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; that care homes have limited access to other assistive devices for hearing and vision loss, and that audiology services do not regularly assess care home residents. A majority of staff who responded were not confident in ear and eye care. Responses were found to be influenced by the respondents’ job role, length of time working in care homes and also the care home type and care home size. Findings confirmed a lack of standardised practice and the importance of shared communication for promulgation of best practice.Conclusion: This study has identified that some practices known to facilitate ear and eye care are not commonly applied in a sample of English care homes. It has also shown that care home staff knowledge of ear and eye care is inconsistent. The information derived from this survey can be used to inform guidelines for best practice and inform needs for future research.

scholarly journals National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

2014 ◽  
Vol 2 (4) ◽  
pp. 1-480 ◽  
Author(s):  
David Challis ◽  
Sue Tucker ◽  
Mark Wilberforce ◽  
Christian Brand ◽  
Michele Abendstern ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Older People ◽  
Mental Health Problems ◽  
Care Home ◽  
Research Programme ◽  
Community Services ◽  
Care Homes ◽  
Care Home Staff ◽  
Mental Health Outreach

BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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