Today’s guest blog comes from Sarah Penney @SarahPenney9 at Ulster University @UlsterINHR on the day of the “Improving Quality of Life in Nursing and Residential Homes”. To follow live updates from the event, follow #QCH on Twitter.
As a student nurse I always enjoyed my care of older people placements and always felt I would eventually end up that that area. Although when I qualified I worked in surgical care for many years and I always enjoyed project work. When living in Guernsey I managed several health & social care projects such as implementing care pathways, patient dependency framework, and the knowledge & Skills (KSF) framework implementation. When I returned to Northern Ireland I took up post as manager in a residential care home. This was a great experience as the home was owned by a non-profit organisation and the emphasis was always on the resident experience.
Early last year I obtained the post of Research Fellow in Ulster University to manage a project Improving Quality of Care in Nursing & Residential care homes in Northern Ireland. This was ideal for me, linking my love for older peoples nursing and managing a project. This post was part time so I was also able to accept the role of Dementia Lead two days a week for Belfast Central mission.
This project was a knowledge transfer initiative and was led by Dr Assumpta Ryan. It was delivered around four themes of best practice identified from research carried out in local care homes. These themes provide a focus to improve the quality of life through evidenced based practice. The themes are summarised as follows:
- Facilitating a positive transition for residents and relatives: Supporting residents, relatives and staff to manage the loss and upheaval associated with moving into a nursing or residential home and to view the move in a more positive light.
- Maintaining dignity and identity: Using person-centred care to meet the needs of residents and relatives by respecting values, beliefs, preferences, rituals and routines.
- Sharing decision making: Involving residents, relatives and staff as partners in decision-making on all aspects of life in the nursing or residential home and working in partnership to improve communication and clarify roles.
- Creating and maintaining community links: Optimising relationships between and across residents, relatives and staff and integrating the home within the local community.
These themes are entirely consistent with those identified in the ‘My Home Life’ (MHL) @MyHomeLifeUK programme in the UK. ‘My Home Life’ is an initiative aimed at giving older people in care homes more control over their lives.
The project completed over one year in 15 care homes in the western health and social care trust and care home managers had to commit to quite a demanding schedule.
There were two strands;
- Practice development – An important and innovative element of this project was that the managers were involved in parallel sub-groups which focused the 4 themes. Each sub-group met with the Project Manager to identify research, develop and implement a project within their care home which related to Maintaining Identity, Sharing Decision Making, Creating Community or Managing Transitions theme. This was an additional meeting as well as the ALS.
- The My Home Life Leadership Support programme consists of each participant attending a 4 day workshop followed by a cycle of 8 monthly action learning sessions (ALS) to support their leadership development and to subsequently take forward quality improvement in their respective care homes. The four workshop’s days introduced participant’s to various concepts, approaches and tools to aid their development exploring the meaning of Relationship-Centred Care (RCC) which ‘provides a complementary philosophy of care where all participants appreciate the importance of their relationships with each other (Beach et al. 2006), and the associated Six Senses Framework (SSF) security, significance, continuity, belonging, purpose, achievement Nolan et al. (2006) The action learning within the Leadership Support programme is ‘critical reflection’ (O’Neill and Marsick 2007) and follows closely the model as described by McGill & Brockbank (2004). In the spirit of experiential learning, action learning is a continuous process of learning through guided reflection (active listening and open questioning), action and feedback which is undertaken within a confidential, supportive and safe environment
At the moment I am also completing the final part of my MSc dissertation for which I evaluated this project, whilst the MSc is not quite complete the findings are very positive, with managers seeing a real shift in their own approach and becoming more leaders not managers. They now listen and involve their staff, resident and relatives in a more inclusive way. Within the practice development work some exemplary work was produces with new tools and resources developed. These included:
Within group 1, a new preadmission paperwork and approach to collecting this information was developed. This focused on a normal day at home collecting specific information about how the resident likes to spend their time and things that are important to them. Managers reported that staff felt they had more meaningful information about residents and were therefore better equipped to support them when they moved in. This included knowing their specific likes or dislikes and making sure preferences were communicated and demonstrates staff recognising the findings of Ryan & McKenna (2014) that it is the ‘little things that count’
In group 2, a ‘This is Me Now’ document was devised which is a narrative approach to detailing the specific things residents with limited communication and or advanced dementia needed to have in place. This included things like reassuring photos or approaches to daily tasks as well as involvement and interaction with relatives.
In group 3 a decision tree was the centre of their initiative and represented a change in approach which was introduced to promote shared decisions. The decision tree is a physical tree where over a set period of time answers to specific questions can be written on tags and hung on the tree allowing a more open response to questions.
Finally, in group 4 community links were established using an intergenerational approach with many youth groups, organisations and schools. Managers were enthusiastic about the dramatic increase in activities these links had provided for the residents.
Sarah Penney, BSc(Hons) RGN, is in her final year of her Masters degree in Dementia Studies. She currently works as a Research Fellow at Ulster University and is a project Manager for Ulster University project – Improving Quality of Life in Nursing and Residential Homes in Northern Ireland.
Sarah has a background in surgical nursing before managing several health & Social care projects and then worked as manager in a care home for older people before moving to Ulster University to manage a project to develop practice in care homes. Specific interests are supporting staff to develop practice in dementia care and dementia design. She sits on the Northern Ireland expert panel to assist with the development of a national learning & development framework. She is also Dementia Lead for a Belfast Charity.