Christine Brown Wilson

Developing personal relationships in care homes: realising the contributions of staff, residents and family members

ABSTRACT Personal relationships are an integral part of living, working and visiting in care homes, but little research has made relationships the main focus of enquiry, and there have been few studies of the perspectives of residents, staff and family members. The study reported here sought to redress this neglect. Using a constructivist approach, the nature and types of relationships between residents, staff and family members were explored in three care homes in England using combined methods including participant observation, interviews and focus groups. The data collection and analysis occurred iteratively over 21 months and three types of relationships were identified: ‘pragmatic relationships’ that primarily focus on the instrumental aspects of care; ‘personal and responsive relationships’ that engage more fully with the particular needs of individual residents; and ‘reciprocal relationships’ that recognise the roles of residents, staff and family members in creating a sense of community within the home. This paper explores the contributions made by staff, residents and family members in the development of these relationships. The findings enhance our understanding of the role of inter-personal relationships in care home settings and of the factors that condition them. The implications for developing improved practice in care homes are also considered.

Developing relationships in long term care environments: the contribution of staff.

AIMS AND OBJECTIVES The aim of this study was to consider how relationships in care homes influence the experience of older people, their families and staff. The main objective reported in this paper considers how these relationships are developed and the contribution that staff make to this process through the routines of care. BACKGROUND Relationships have been found to be integral to experiences of residents, families and staff in care homes but little is known about how these relationships develop. Few studies consider relationships in care homes as their main focus and there is a dearth of studies that consider relationships from the perspective of residents, families and staff within the same care home. DESIGN The study employed a constructivist design where the different perspectives held by participants were explored and shared to develop a joint construction of how relationships influenced their experiences. METHODS Data were collected from three care homes in England over two years between 2003-2005. Participant observation and interviews enabled a hermeneutic circle to be created between residents, families and staff. Data collection and analysis were conducted concurrently using a constant comparative method. RESULTS Staff adopted three approaches to care delivery and these influenced the type of relationships that were developed between residents, families and staff. The three approaches were described as individualised task-centred, resident-centred and relationship-centred. CONCLUSION This study progresses our understanding of the development of relationships between staff, residents and families in care homes by considering how the staff may support or constrain these relationships through their approach to care delivery. RELEVANCE TO CLINICAL PRACTICE These findings have implications for developing practice in care homes to improve the experience of older people and their families by encouraging staff to develop a relationship-based approach to care routines.

Developing community in care homes through a relationship-centred approach

Within the literature, the formation of therapeutic relationships between professionals, older people and others significant to them in their lives has been considered as central to current care philosophies. Furthermore, relationships between staff, residents and their families have emerged within the literature as fundamental to the experiences of life within the community of a care home. This paper reports part of a wider study that explored relationships between residents, families and staff. The aim of this paper is to contribute to an understanding of the factors that may be significant in the formation of relationships in care homes, and how this may support the development of community. Three case studies of care homes were undertaken using a constructivist approach. Constructivist methodology seeks to share multiple perceptions between participants with the aim of creating a joint construction. This process supported the development of shared meanings as views and ideas were shared between participants using interviews, participant observation and focus groups. The key factors influencing relationships that emerged were leadership, continuity of staff, personal philosophy of staff and contribution of residents and families. This paper suggests that considering how the style of leadership influences the organisation of care may be a useful starting point in developing community within care homes.

The senses in practice: Enhancing the quality of care for residents with dementia in care homes

AIM The study aimed to develop, deliver, and evaluate a training programme in care homes to enhance the quality of care for people living with dementia based on the principles of relationship-centred care expressed through the Senses Framework. BACKGROUND There are increasing numbers of people living with dementia worldwide with a growing proportion requiring residential long-term care. This makes the quest for enhancing the quality of care and quality of life for people with dementia ever more pressing. DESIGN A mixed-methods design was used adopting a Practice Development approach. The findings from one care home in the North West of England are reported. METHODS Eight facilitated workshops based on the principles of relationship-centred care were completed and evaluated in 2010, using pre- and postintervention design. A focus group was undertaken with staff on completion of the study to gain a more comprehensive understanding of the practice/training context, augmented by case examples of changes in practice identified from the study workshops. RESULTS Structured questionnaires were used to profile the care home before and after the training. Following the workshops, staff felt more able to collect and use biographical information. In particular, staff reported how this information supported them to initiate meaningful conversations with the person with dementia as part of everyday care routines, thus improving overall feelings of well-being. CONCLUSION Using a biographical approach to care planning structured through the Senses Framework helped staff to develop a greater understanding of the person with dementia.

Involving older people in research: practical considerations when using the authenticity criteria in constructivist inquiry

Aim The purpose of this paper is to identify practical suggestions that could enable other researchers to consider how quality may be evidenced using constructivist principles including the perspectives of older people and their caregivers. Background Constructivism suggests that reality is part of a social construction, which holds different meanings for each person, in which people are active agents, making autonomous decisions. This approach to research has been identified as suitable for health and social care professionals because these underpinning principles reflect the values of these professions, facilitating the involvement of users and carers. The authenticity criteria have been developed to reflect these philosophical principles but have been criticized for their inaccessible language. To incorporate user and carer perspectives, the criteria have been revised into a more accessible model matrix known as the AldreVast Sjuharad criteria. Discussion This paper reports on two constructivist studies that explored relationships between older people, families and staff in different settings – the community and care homes. Examples from both settings demonstrate how the perspectives of users and carers were incorporated throughout the research process. Following the AldreVast Sjuharad model matrix, practical guidance is provided on how the quality of constructivist research may be implemented in nursing research. Conclusions The different settings in this paper influenced how the AldreVast Sjuharad model matrix was applied. Further work is needed in exploring how the perspective of users and carers may be incorporated into the quality process of constructivist research.

Using relationships to develop practice that values the contribution of older people, families and staff

Relationships between staff, residents and their families have emerged within the literature as fundamental to the experiences of life within the community of a care home. While there is consensus in the literature that such relationships are central to caring processes, there is a dearth of studies that have explained how different factors contribute to the formation of relationships. The research reported here aims to describe the nature of relationships and develop an interpretive framework to understand how relationships influence the experience of residents, families and staff in care homes. This paper is based on the findings from a constructivist inquiry. Data were collected in three care homes using participant observation, interviews and focus groups with older people, families and staff. Constructivist methodology seeks to share multiple perceptions between participants with the aim of creating a joint construction. This process, known as the hermeneutic dialectic supported the development of shared meanings as views and ideas were shared between participants. The findings suggested that three types of relationships are developed within care homes: pragmatic; personal and responsive and reciprocal. These relationships are influenced by a range of factors that include leadership, team working and the contributions made by residents, families and staff.

Old(er) care home residents and sexual/intimate citizenship

ABSTRACT Sexuality and intimacy in care homes for older people are overshadowed by concern with prolonging physical and/or psychological autonomy. When sexuality and intimacy have been addressed in scholarship, this can reflect a sexological focus concerned with how to continue sexual activity with reduced capacity. We review the (Anglophone) academic and practitioner literatures bearing on sexuality and intimacy in relation to older care home residents (though much of this applies to older people generally). We highlight how ageism (or ageist erotophobia), which defines older people as post-sexual, restricts opportunities for the expression of sexuality and intimacy. In doing so, we draw attention to more critical writing that recognises constraints on sexuality and intimacy and indicates solutions to some of the problems identified. We also highlight problems faced by lesbian, gay, bisexual and trans (LGB&T) residents who are doubly excluded from sexual/intimate citizenship because of ageism combined with the heterosexual assumption. Older LGB&T residents/individuals can feel obliged to deny or disguise their identity. We conclude by outlining an agenda for research based on more sociologically informed practitioner-led work.

The challenges and opportunities in researching intimacy and sexuality in care homes accommodating older people: a feasibility study.

Abstract Aim To explore the challenges of conducting research on sexuality and intimacy among older care home residents. Background Sexuality and intimacy are neglected in care policies and practices. Design Qualitative analytical study drawing on poststructuralist theorizing. Methods Semi‐structured interviews were conducted with residents and spouses (n = 6) and care staff (n = 16) in two care homes in Northwest England in 2014. The sample was obtained through a network of ‘research‐ready’ care homes. Thematic analysis was used to make sense of narratives with the aid of NVivo10. Results Participant responses highlight the workings of ageist erotophobic discourse that undergirds the assumption of residents (and old people generally) as postsexual. This materialized in reservations about the research ranging from opposition on moral grounds to doubts about its feasibility given the age‐group concerned. However, residents and care home staff can also draw on counter‐discourses that resist/challenge ageist erotophobic thinking, which materialized in methodological and ethical recommendations. Conclusion Participants generally agreed with the principle of the research and made recommendations that could counter/resist ageist erotophobic governance and guide researchers on sampling, style of questioning and communicating with (prospective) study participants on a sensitive subject.

Strategies to increase participant recruitment to research studies by healthcare professionals

Our primary objective is to identify and assess the effect of strategies designed to improve the recruitment of participants to research studies by healthcare professionals.

The value of reflexivity in resolving ethical dilemmas research in care homes

AIM This paper highlights ethical dilemmas experienced by researchers when undertaking qualitative inquiry with vulnerable older people in care homes. Scenarios from research that adopted a constructivist approach illustrate a range of ethical dilemmas and propose practical strategies. BACKGROUND The importance of ethical comportment within qualitative inquiry is uncontested within the literature. Ethical guidelines exist to support qualitative researchers, but there appears limited consensus on how these are applied. Subsequently, ethical conduct in qualitative research relies heavily on researcher reflexivity and the development of positive relationships with participants. Although these aspects are widely recognized, there is limited literature on how this is achieved in the research process. DISCUSSION In-depth analysis of confidentiality, privacy and informed consent supports researchers in navigating these ethical issues in care homes research. Placing the older person at the centre of ethical decisions enables the researcher to consider simultaneously the context and relationships that exist. This promotes a transparent process that demonstrates ethical sensitivity. CONCLUSION When involved in ethical decisions in care homes, researchers are encouraged to consider how each participant may engage in a consultative process, acknowledging that they are a person living in a social world, interacting with both researcher and their environment. This approach promotes the inclusion of older people in decisions affecting the research process.