Lynne Phair

Shifting the focus: outcomes of care for older people

Internationally there is commitment to work towards eradicating the abuse of older people and to develop services that promote their equality, dignity and human rights. The emphasis on service users is gradually increasing and, along with this, the focus within health and social care policy, service provision and professional practice is shifting. In UK health and social care policy the emphasis on service structure and provision is being replaced by a focus on outcomes for service users, including outcomes which patients themselves evaluate. The focus of UK Adult Protection services is also shifting from intervention to prevention through developing greater understanding of the factors which contribute to abuse, changing attitudes towards entrenched poor care, identifying preventative services and safeguarding vulnerable adults. Nursing literature is also beginning to acknowledge the evolution of an outcomes focus. This paper discusses the shifting emphasis in UK health and social care in the safeguarding of vulnerable people and in nursing practice. It offers an overview of literature on outcomes. The paper then describes a research study which sought to identify outcomes of care for older people living in UK care homes. The outcomes framework developed through the research is offered, along with a discussion of the advantages of an outcome-focused approach to care and some of the remaining challenges. A case example is offered to illustrate an outcomes-focused approach. Finally, the paper draws conclusions on how shifting the focus of care delivery from traditional problem-orientated approaches and ritualized practice towards the outcomes of care that individual older people choose and evaluate for themselves offers potential towards eradicating abuse and neglect in formal care settings.

The development of the West Sussex institutional care neglect risk assessment tool: a reflective analysis using Mezirow’s transformative learning framework

The protection of vulnerable people is becoming more understood internationally, and in the UK standards of care for frail older people is now receiving appropriate attention (CSCI 2009, The state of social care in England 2007-2008. Commission for Social Care Inspection, London). Although many people continue to live in their own homes, even when they are very frail, many receive long term care in institutional settings, and are dependent on the standards, practices, belief systems and culture of the staff who care for them. As society becomes more intolerant of sub standard services, more adult protection investigations are being carried out to establish whether frail people are being neglected. Within West Sussex England, the multi agency safeguarding team addressed the dilemma of how to assess the risk to other residents in a formal care setting, when concerns had been raised about a small number of people who are resident in that place. The Consultant Nurse, used intuitive and craft knowledge, including examination of clinical evidence as audit data, collected as part of her practice, to examine how to assess the risk to others in formal care settings where care had been identified as neglectful for some of the residents. This paper uses the reflective framework of Mezirow transformative learning theory (http://en.wikipedia.org/wiki/Transformative_learning) to examine the development of a neglect risk assessment tool and highlight the issues identified by a consultant nurse in examining concerns about poor care and neglect in formal care settings. The final section of the paper describes the new Neglect Risk Assessment Tool developed in West Sussex, England, and offers case examples illustrating its use in practice.

Developing outcome indicators in continuing care: part 1: In the first of two articles, the authors describe the development of outcome measures for nursing older people in a continuing care setting. They describe why such a process was initiated and the framework which guided the project, including current nursing and government policy and theories of knowledge and expert practice. The second article will appear next week

In the first of two articles, the authors describe the development of outcome measures for nursing older people in a continuing care setting. They describe why such a process was initiated and the framework which guided the project, including current nursing and government policy and theories of knowledge and expert practice. The second article will appear next week.

Training Manual for Working with Older People in Residential and Day Care Settings Jackie Pritchard Training Manual for Working with Older People in Residential and Day Care Settings Jessica Kingsley Publishers 399pp £39.95 1 843101238 1843101238

With the requirement for training in care homes now firmly set in legislation, a plethora of resources has started spilling onto the market. This manual is another example of an imaginative approach offering home managers and trainers resources to move staff through the hoops that the induction and foundation standards have rapidly become.

Nursing in care homesNursing in care homes Linda Nazarko Blackwell 391pp £19.99 0632052260 0632052260

This book offers a descriptive account of the role of the nurse in dealing with selected medical conditions. It reinforces the medical model and focuses on traditional nursing tasks and problems within the traditional nursing home model.

The care homes legal handbookThe care homes legal handbook Jeremy Cooper Jessica Kingsley Publishers 171pp £15.95 1843100649 1843100649

There continues to be a barrage of legislative changes and arrangements for everyone working in health and social care. For professionals working in the care home sector major changes are still taking their time to bed down. Many home managers and care home owners have little opportunity to get clear, succinct guidance about how to interpret new rules and regulations and are often lost as to where to find this support.

Is the cooker turned off? caring for an older person with failing memoryIs the cooker turned off? caring for an older person with failing memory Josephine and Michael Woolf £9.99 Gorselands, Oxton 095441280X 095441280X

Learning that a parent is loosing his or her memory and coming to terms with the realisation that you are slowly loosing the person you love can be a very slow, tortuous and emotional journey. Dementia, unlike other conditions, attacks the whole family, and very little can be done to stop its destruction.