19.03.19 - 2nd quarterly blog update
Realistic rehabilitation for Outdoor
Activities and Mobility in care homes is an exciting new research study Sponsored by Nottinghamshire
Healthcare NHS Foundation Trust and funded by the Abbeyfield Research
Foundation. In the first blog, we said
that the aim of the study is to increase
residents’ opportunities to use care home gardens and outdoor spaces. Whilst
this is still true to some extent, the study scope, aims and objective have evolved,
which is entirely in keeping with our research approach – Appreciative Action Research (AAR). Action research seeks to describe, interpret and explain social phenomena in the setting of interest whilst operationalising a change intervention aimed at improvement and involvement. Often, the process is framed in terms of addressing organisational or staff team problems or deficits. Conversely, the starting point for AAR is a focus on what is working well and positive experiences. Appreciative Inquiry (AI) is an internationally recognised asset-based organisational approach to quality improvement. It has been tailored for use in UK care home research by leaders and researchers affiliated to My Home Life, a UK social movement whose stated aim is to challenge the negative stereotypes and widespread fear experienced by the care home sector. By focusing on and celebrating positive elements of services in the context of developing respectful and collaborative research partnerships, AAR offers the potential to minimise and/or overcome workforce-related barriers to research in care homes.
What’s happened since November 2018?
In December,
I visited Professor Julienne Meyer (Managing Director of My Home Life) at City College London for advice about conducting
Appreciative Action Research (AAR) in care homes. It was a fantastic
learning opportunity which gave the study team much food for thought about how
much we are able and also prepared to work in true collaboration with our care
home partners. For more local support and advice, Julienne advised me to speak
to Anita Astle MBE, Managing Director of Wren Hall, a nursing home in
Nottinghamshire rated as ‘Outstanding’ by the Care Quality Commission. Anita
was so enthused about the premise of the study and had such great ideas about how
it might work best, that she agreed to provide ongoing stakeholder consultation
alongside the households at Wren Hall. Pending ethical approval, it is hoped
that she will also become a co-researcher.
Following introductions
from Anita, Landermeads and Skylarks in Nottinghamshire have also been
providing consultation on the research protocol. This has involved a number of
visits to each care home to meet the people who live and work there, plus
relatives and friends. The level of interest and engagement has been fantastic
and the research protocol now feels like a much more collaborative endeavour. A brief
overview is provided by below:
Main research question
Can
an outdoor programme to improve the quality of
resident outdoor engagement be co-produced with staff, residents and
relatives in UK care homes?
Recruitment / Participants
Eligible care homes are those within Nottinghamshire that are dementia
registered and considered by the study team to: have accessible outdoor spaces,
some scope for quality improvement regarding outdoor engagement and be
'research ready' in terms of the approach and the topic. Three care homes will
be recruited. The total sample size is 224: 90 residents, 28 relatives and 106
care staff.
Phase 1: Preparation - Can we get to
know you? (5 weeks)
The primary
outcome measure is resident outdoor engagement (measure to be agreed). The secondary
outcome measures are resident social care-related quality of life (using ASCOT
CH3 tool) and care staff perceptions of quality of care (using a sub-scale of Work-Stress-Competence
questionnaire).
Questionnaires
will be used to collect descriptive data from each care home to describe the
study context, determine current levels of residents' outdoor use and to
understand some of the factors that might impact on this. For residents who
demonstrate difficulty in answering the questions, or those without mental
capacity, Talking Mats may be used, plus a nominated care home employee will be
asked to clarify information.
Phase 2: Discover - What is working
well? (3 weeks)
The data
collected in Phase 2 will explore what is working well in relation to outdoor
use, including phenomena or practices that potentially facilitate tailored and
meaningful outdoor activity engagement.
Observations
Observations
of care staff, residents and relatives will be conducted by the study team in
the indoor and outdoor communal areas of each care home. Observations will take place when
residents are most likely to go outside. A combination of non-participant and
participant observation will be used depending on the ability of residents to
participate.
Informal
discussions, interviews and focus groups
Care staff, residents
and relatives from each participating household will be invited to take part in
mixed focus groups to further explore positive experiences of outdoor use and
what is working well. The findings from the observations will be used as a
starting point for discussions. During the consultation period, care staff and
residents suggested that participants should be offered a choice of method as
some people might not be comfortable with talking in groups or on a one-to-one
basis. For residents with additional communication needs who may not be able to
engage in participant observations, informal discussions, focus groups and
interviews, there will be an option to use Talking Mats and Dementia Care Mapping.
Talking
Mats.
Talking Mats
is an evidenced-based resource that uses paper or digital symbols to support
communication for people with communication difficulties, including those with
dementia. For residents who respond well to this tool, there is an option for
this to be used to support their engagement throughout the study. Field notes
will be made directly after each session and each Talking Mat will be
photographed.
Dementia
Care Mapping (DCM)
DCM is a
recognised, evidence-based observational tool that seeks to understand the
experience of people living with dementia from their viewpoint. DCM will focus
on transitions to the outdoor space from indoors, plus outdoor activities. Field
notes will be used to collect qualitative data and structured, quantitative
data will be collected about what residents are doing and their levels of mood
and engagement. This combined approach may provide some indication of what is
working well from the residents perspective.
At the end
of Phase 2, a proportion of care staff, residents and relatives from each house
will be invited to join a core group who will take a lead on Phase 3 and 4
activities.
Core
Group Activities
In Phase 3,
the findings from Phase 2 will be fed back to the core groups who will begin to
identify a household vision for how they would like things to be in terms of
outdoor engagement. The medium for this
is to be agreed with each core group but it is anticipated that workshops
and/or action learning sets will be used. A minimum of two sessions will be
required. Phase 3 will also incorporate
discussion about how Phase 4 might work best.
Phase 4: Co-create - how can we work
together to make it happen and evaluate it? (12 weeks)
Core
Group Activities
In Phase 4,
each core group will work together to agree an initial vision for outdoor
engagement and then design, implement and evaluate a house-specific outdoor
programme which supports the achievement of this vision. A researcher will be available for a day a week
in each house to provide support with implementation and evaluation activities,
as appropriate. Participant and non-participant observations (as appropriate)
will be conducted for two hours per week during the co-create phase to provide insight
into how the co-produced outdoor programme is working in practice.
Phase 5: Embed - What can we do to
make it happen more of the time? (4 weeks)
In part one
of Phase 5, each core group will be supported to explore the process and
outcome data collected so far and to discuss future development and
sustainability of the outdoor programme.
In part two,
managers, care staff, resident and relative participants will be invited to
share their experiences of taking part in the research and to discuss the
co-produced outdoor programme in terms of what worked, under what
circumstances, how, why and to what extent. Given that these experiences and
views may be personal in nature, participants will decide how they would like
to share this information, for instance, informal discussions, individual
interviews or focus groups.
What’s happening next?
Nottinghamshire
Healthcare NHS Foundation Trust have recently agreed to Sponsor the study on
and this will be reviewed by a Research Ethics Committee soon. We are hoping to
start recruiting participants from three care homes in Nottinghamshire in early
May.
The next quarterly
blog update will be posted sometime in June 2019, when we hope to have recruited
the majority of participants.
Whatever
your role, please join in the discussion about working with UK care homes to
improve the quality of resident outdoor engagement via our twitter feed: @ROAM IIStudy
Contact details:
Lead
Investigator: Amanda King
(Research
Occupational Therapist)
Email:
Amanda.king@nottshc.nhs.uk
Telephone:
07769366313
Co-applicants: Professor Pip Logan, Professor Adam Gordon and Dr Neil Chadborn (University of Nottingham)
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