1

30th September 2020

Faculty of Health, Psychology and

Social Care

Teaching Care Homes

Programme Evaluation

Professor Kirsten Jack and Dr Annamari Ylonen

2

Contents

Summary ........................................................................................................................ 3

Introduction .................................................................................................................... 5

Part One ......................................................................................................................... 6

Aim .............................................................................................................................. 6

The Homes .................................................................................................................... 6

Background .................................................................................................................... 6

Kineton Manor Nursing Home ................................................................................... 7

Priscilla Wakefield House .......................................................................................... 7

The FED ..................................................................................................................... 8

Methods ......................................................................................................................... 8

Data Analysis ................................................................................................................. 9

Practice Development .............................................................................................. 10

Networking................................................................................................................ 12

Impact on Workforce ................................................................................................ 14

Impact on Residents ................................................................................................ 16

Summary of Impact ..................................................................................................... 17

Resident Care .......................................................................................................... 17

Staff Development .................................................................................................... 18

Image ........................................................................................................................ 19

Part Two ....................................................................................................................... 20

Support with Academic Writing ................................................................................ 20

Involvement in Research ......................................................................................... 20

Positive Risk Taking, General Nursing Council Trust ............................................. 20

Abstract .................................................................................................................... 21

Outcome ................................................................................................................... 22

The Health Foundation, Building Resilience in Social Care ................................... 22

Abstract .................................................................................................................... 22

Outcome ................................................................................................................... 23

Recommendations ....................................................................................................... 24

Appendix One .............................................................................................................. 25

Appendix Two .............................................................................................................. 26

3

Summary

This report provides an evaluation of Year Three of the Foundation of Nursing

Studies (FoNS) Teaching Care Homes Programme (2019/2020 Cohort) and outlines

the ongoing collaborative work between Care England, FoNS, key members of the

care teams and Manchester Metropolitan University.

Part One provides analysis of a qualitative dataset, which explored the experiences

thoughts and feelings of the 2019/20 care home participants. It also summarises the

ongoing good practice to support effective resident care provision and care home

workforce development. Part Two provides an update of the collaborative work being

undertaken with current and past Teaching Care Home participants, supported by

FoNS and working in collaboration with Manchester Metropolitan University. This

includes the submission of an article to a peer reviewed journal and collaboration on

two research project proposals.

Enabling networking, sharing effective practice, facilitating workforce empowerment

and developing communication are the key themes set out in this report and can be

seen as successful outcomes of the Teaching Care Home programme. Projects

delivering on these themes can all help build a more confident workforce and

contribute to ongoing improvement in resident care provision. Through the Teaching

Care Home programme, care home teams have been able to raise their profile both

within their own community and nationally, for example, through conferences, blogs

and by being associated with the programme.

The key recommendations from this evaluation, to promote practice development,

maintain the benefits of collaborative working and raise the profile of care homes for

older people are to:

• Promote the sharing of good practice and learning gained from the current

Teaching Care Home projects on diabetes and dementia care across the care

home sector.

• Publish the findings from the current Teaching Care Home projects e.g.

through relevant social care journals.

• Identify opportunities to promote the FoNS Teaching Care Home model.

4

• Identify funding streams to enable continuation of the Teaching Care Home

programme.

• Continue to collaborate with the existing care home community of practice to

promote opportunities for practice development.

• Maintain partnerships with academic colleagues to enable the development of

research opportunities.

5

Introduction

The Teaching Care Homes Pilot Programme commenced in 2016, initiated by Care

England and funded by the Department of Health and Social Care (ILC-UK 2017).

The overarching aim was to develop person centred care provision in the five

participating homes and support communities of practice, aimed at learning and

development, within and between homes. The Foundation of Nursing Studies

(FoNS) have continued to develop the programme, working with Care England as

lead partner and supported by the Burdett Trust. During this period, FoNS has

supported a further ten care homes (2018/2020) to develop good practice and

innovation in the care home setting. The FoNS Teaching Care Home model is one

which demonstrates an ongoing commitment to person-centred care and ways of

working, which are centred on three main areas:

• Research and practice development

• Education and learning for staff and students

• Community Engagement

Teaching Care Homes are described as homes that work across sectors and

systems and act as a resource for others to support them to develop good care

experiences for residents and their families, staff, and all who visit the home.

Manchester Metropolitan University was invited to evaluate Year Three of this work.

Part One of this report provides an evaluation of Year Three of the Teaching Care

Homes Programme (2019/2020 Cohort). Part Two provides an update of the work

being undertaken with several members of the previous cohorts from Years One and

Two (2017 – 2019), supported by FoNS in collaboration with Manchester

Metropolitan University.

6

Part One

Aim

The aim of this evaluation was to capture the experiences of the care home teams

involved in the Teaching Care Homes programme and explore the impact of the

work undertaken, on residents and the workforce. Information from this evaluation

can be used to inform the future development of the programme.

The Homes

Care teams from the following homes took part in the 2019/20 programme:

Kineton Manor Nursing Home, Kineton Manor, Manor Lane, Kineton, Warwick CV35

0JT

Priscilla Wakefield House, Rangemoor Road, London N15 4NA

The FED, Heathlands Village, Prestwich, Manchester M25 9SB

Coloma Court Care Home, Layhams Road, West Wickham, Kent BR4 9QJ

(participants from this home had to withdraw due to unforeseen circumstances and

are not included in this evaluation)

Riversway Nursing Home, Crews Hole Road, Bristol BS5 8GG (participants from this

home had to withdraw due to unforeseen circumstances and are not included in this

evaluation)

Background

Year Three of the Teaching Care Homes programme commenced in April 2019,

following a competitive application process. Building on learning from previous years,

the applicants were asked to identify a focussed cross-sector collaboration that they

would lead throughout the duration of the programme. This focus is commensurate

with the integrated care agenda and would enable the homes to raise their profiles

as innovators and leaders of care planning and delivery. Further, this call responded

to the Year Two evaluation in which the participants suggested the need for the

programme to have a more clearly defined focus. Each home identified an aim,

related to cross-sector working and their own priorities. For Kineton Manor and

7

Priscilla Wakefield House, these priorities related to improvements in the areas of

Diabetes and Dementia care. The FED had an educational priority, to develop inter-

professional learning and practice in the home.

Kineton Manor Nursing Home

Located in Kineton, Warwickshire, Kineton Manor is a 51-bed home, offering a wide

range of care, with an ethos to provide the quality of care that the owners would wish

for their own parents.

Aim: To make Kineton Manor Nursing Home dementia-friendly and to ‘Improve the

experience of living well with dementia for residents, staff, families and the wider

community.’ The three main objectives were to 1. Introduce Namaste Care; 2. To

identify ways in which the local community could become more involved in life at the

home and in doing so, learn about dementia and 3. To improve dementia care

provision by promoting teamwork in the home. Residents living with dementia can

have complex caring needs and support for the workforce is essential for effective

care provision.

Priscilla Wakefield House

Located in Haringey, North London, Priscilla Wakefield House is a specialist

dementia care home, committed to developing a comfortable and stimulating

environment that meets the individual needs of all the residents.

Aim: To become a centre of excellence for good diabetes care for residents living in

care homes in North Central London, working in collaboration with Haringey Clinical

Commissioning Group. The three main project objectives described by the care team

were to 1. Create educational resources and raise awareness of diabetes in the

home; 2. Develop protocols to assist staff in decision making about escalation

around hypo/hyperglycaemic attacks and 3. To develop a system for regular resident

diabetic reviews. The incidence of diabetes increases with age with an estimation of

23.8% in the over 75 age group. Diabetes often has greater health implications in

older people, who are more likely to be suffering from other diseases, such as

cardiovascular disease.

8

The FED

Located in Greater Manchester, The FED, Heathlands Village, offers a wide range of

care, which is flexible to accommodate residents changing needs.

Aim: To develop collaborative working between students at the University of Salford,

Greater Manchester, and staff at The FED. The focus of this project was to develop

communities of practice, where students from different disciplines (for example,

Podiatry/Sports Science/Physiotherapy/Nursing) would experience inter-professional

learning and practice at The FED. Effective care provision requires the collaborative

involvement of a range of health and social care professionals. This is recognised by

a variety of health-related regulatory bodies, including the Health and Care

Professions Council and Nursing and Midwifery Council, who require the inclusion of

inter-disciplinary teamwork and collaboration as part of healthcare educational

programmes. Inter-professional education (IPE) experiences, which involve students

from two or more professions learning together to facilitate collaboration, is now

established in various ways in undergraduate health and social care programmes.

Learning with and about other professional groups will ultimately contribute to

improvements in care outcomes and social care environments are ideally suited to

support learning about holistic person-centred care provision.

Methods

An initial email was sent to the care home managers from the participating homes in

November 2019 to enable them to provide information about their project (see

Appendix One). This information was to provide a basis to support subsequent

interviews aimed at exploring the projects undertaken in the homes in more detail. It

was envisaged that further information and a discussion of the evaluation could take

place on March 18th 2020, when the lead researcher was due to meet with the care

home representatives as part of their final workshop day with the FoNS in London.

However, due to the Covid-19 pandemic, this workshop day was cancelled due to

concerns about risks associated with the care teams travelling to London.

9

Due to the ongoing disruption caused by the pandemic, the decision was made to

undertake the qualitative interviews over the telephone. However, this proved

challenging for the research team due to the physical and psychological pressure

staff were under caused by the pandemic at that time. It was difficult for the

participants to engage with the researchers due to commitments in the homes.

Furthermore, the inter-professional education project being undertaken by The FED

had to be postponed as it involved University of Salford students attending their

placement at the home. At the time of writing, students are still unable to attend

these placements. Therefore, this evaluation has focused on two projects (Kineton

Manor and Priscilla Wakefield House) and contains no data from participants at The

FED.

Participants were given time to make an informed choice about taking part in the

evaluation. Participants were informed that they could drop out of the study at any

time without giving a reason, by contacting the lead researcher. To arrange the

interviews each manager was either sent an email or received a telephone call to

arrange mutually convenient dates and times for the telephone interviews. To

support the evaluation data, care home managers shared other information such as

presentations, meeting minutes and action plans. All this information has been used

to inform the evaluation of the projects.

Data Analysis

Data were analysed using Braun and Clarke’s (2014)1 approach to thematic analysis

to report the main themes. Braun and Clarke’s approach involves familiarisation with

the data and then searching for and defining themes. Subsequently themes were

defined and named to capture the essence of the data they reflected.

These data are representative of 5 participants from the 2 homes involved in the

evaluation. Data were collected from 2 Care Home Managers, 1 Deputy Manager, 1

Registered Nurse and 1 Care Support Worker. Pseudonyms have been used to

1 Braun, V. & Clarke, V. (2014). What can thematic analysis offer health and

wellbeing researchers? International Journal of Health and Wellbeing Studies in Qualitative Research DOI: 10.3402/qhw.v9.26152

10

protect the participants’ identities and any information that could lead to recognition

of the participant has been removed from the dataset.

From analysis of this initial dataset the four themes are as follows:

1. Practice Development

2. Networking

3. Impact on the Workforce

4. Impact on the Residents

Practice Development

During the evaluation, all participants reported that they had developed personally

and professionally from being involved in the Teaching Care Homes programme.

Each participant talked at length about the tangible elements of their development,

and the first two excerpts described the type of learning they experienced:

For me it was an ultimate eye opener… I learned a lot… so when I’m in a

meeting and see what the other care homes do with elderly people, make

them (homes) a happy place to live, a home, make a place a real home for

elderly people, and a place for learning for the students… it’s eye-opening for

me and caused me really to learn more (Joan, Care Support Worker)

First it made us be more proactive with what we are doing … made us think

outside of the box, what else we could do and what else we can provide (Jill,

Deputy Manager)

Well it brought all of us together… it was a rewarding experience and because

our subject was focussed on xxxx, we got to do quite a lot of work on this

topic as in, involve the community with educating them, and finding ways and

means of how to infiltrate the feeling of living well with xxxx as opposed to

thinking, “it is my diagnosis and that’s it”, whereas we were able to educate

the community as well and even the staff who are in that age group (Pauline,

Registered Nurse)

The following excerpts described how the positive facilitation style of the FoNS staff

led to further collaboration and prompted thinking in new ways:

11

… the goals that we had when we started the project, halfway through we met

to look at the challenges and when (FoNS Facilitator) visited our home, they

saw what we were doing… and they guided us saying “So maybe you all need

to do this to meet your goals or liaise with somebody who’s local”. This got us

into some research work (Pauline, Registered Nurse)

She (FoNS Facilitator) asks you certain questions that you never think about

that also helped you, for example, how you evaluate your project and how do

you improve after the evaluation (Fran, Care Home Manager)

It was good in terms of how she (FoNS Facilitator) facilitated. So, it wasn’t like

a ‘talking to’ or ‘at’, it was more like, ‘How do we collaborate?’ ‘How do we put

our heads together?’ ‘How do we look at these key areas and what the

outcome and the impact would be for individuals living in this environment?’

So, I think it’s those sorts of areas … she was really great in how she

managed that (Claire, Care Home Manager)

The next participant described the growth in her confidence since she engaged with

the Teaching Care Homes programme:

Well it has indeed boosted my confidence, so I am more outspoken now …

when I deal with residents … and letting my voice be heard. So, yeah, I feel

I’m more confident now (Pauline, Registered Nurse)

The following participant described how participating in the Teaching Care Homes

programme had led to holistic developments in the home. These developments

included education for several members of staff, system development and

community engagement; all of which are aims of the FoNS Teaching Care Home

Model:

We didn’t have protocols in place, yes, if something did happen then the

registered nurses would be able to deal with the situation but there wouldn’t

be something confirmed in terms of a process for them to follow, so that was

generated as part of the impact of being on FoNS… our care team has never

had training for example… now, every single staff, and that’s just not our

healthcare assistants but also our laundry staff that actually spend quite a lot

of time on the floor speaking to individuals ... the catering teams are now able

12

to look out for things to monitor in terms of what they’re providing and the

impact of that on people’s health needs… So it’s just helped us to broaden

our ideas around how we can support … although we did have a couple of

systems and procedures and things in place it wasn’t as robust as what we’ve

been able to achieve under the FoNS project, it’s given us a focus. It’s helped

us to look at it as an area and explore that. We also do, which we never did

before the FoNS, we also do community related projects, so we actually invite

residents’ relatives and the local community to come in to talk about it (Claire,

Care Home Manager)

Networking

As with previous evaluations all participants valued the opportunity to network with

others, describing it as a positive aspect of the Teaching Care Homes programme.

Having opportunities to discuss and share effective care home practice with peers

from other areas was welcomed. The first participant described taking inspiration

from peers she met during the study days and how listening to their stories helped

her find direction in her own work:

The first time (attendance at the study day) I was like a frog in a well, looking

to the sky from the well and I felt so small… then every time I was there, I

could listen to these highly knowledgeable people, top people in the same

career, they are in a top position to talk about what they can do, how they do it

for the people, make them, you know, at the last stage of their life, make it so

valuable… I was really moved by it, so then I thought about what I could do to

help… That’s why I’m happy to get involved in this programme… I am out of

the well now and I know which direction to go in (Joan, Care Support Worker)

The following participant discussed how she had shared ideas from the study days to

develop interprofessional working in her own setting:

Even though we were all nursing homes, we were very much different… it

gave us an idea to get some dieticians in … we only facilitate nursing

students, so now we are looking into getting some social workers... all these

13

ideas we got when we attended the teaching care home because all the other

homes are doing it (Pauline, Registered Nurse)

Listening to good practice from other areas encouraged the next participant to

develop their own practice in creative ways:

It was very stimulating to hear all the objectives of the other projects and it

helps you be creative and to do more that you usually do, that was just …

very stimulating (Fran, Care Home Manager)

The next participant spoke at length about the value of networking with others during

the study days. Having protected time away from the home and hearing how others

had overcome challenges helped her to maintain her focus:

When you’re running a nursing home of this size you’re not always able to

collaborate with others… and that’s just in the nature of the beast, i.e. you

come in and you’re firefighting or you’re dealing with staffing issues. It’s

taking that time away from work to sit with your colleagues and actually

explore what your topic or your area that you’re looking into, just having that

away time helps you to put some perspective into what you’re doing; having

an action plan and then being able to come back and share that means that

you have to keep it as a focus … when you’re coming to these sessions

you’re actually sitting, you’re exploring, you’re listening to other carers that

are, even if they’re not doing a similar project to yourself, how they’re getting

support from different bodies. That could be your health colleagues at the

hospitals, it could be your CCG or your local authority or how other people

outside of your setting is supporting you with your subject matter, and I think

it’s just learning from others assists you in keeping that focus … I think

sometimes the barriers are there and you don’t know how to overcome them

or you might have tried and then failed and you don’t tend to go back into it

because you’ve got so many other things that are happening. But I think

when you sit with others and you hear, ‘Okay, actually, they’ve got similar

challenges, but they’ve overcome those challenges by doing this, this and

this, or these are the resources that have been shared’ (Claire, Care Home

Manager)

14

Impact on Workforce

The participants spoke at length about how taking part in the Teaching Care Homes

programme had impacted on them as individuals and as part of a wider workforce.

The following excerpts described practical knowledge and understanding that was

gained through participation:

Before doing this, before taking part in this activity… I confused… these two

terms. But after I had this experience … I have a better understanding and I

can do it (look after residents) … in a more professional way (Joan Care

Support Worker)

Now, most of the staff know what to look for… so they do understand…

they’re then coming to the nurse and highlighting that maybe we can give this

or maybe we can give that… they are more proactive in going to the nurse

and asking them… so there’s more awareness among the carers as well

(Pauline, Registered Nurse)

… it’s meant that the individual’s health needs have been boosted and we’ve

seen quite a lot of improvement in terms of nutrition and people taking that

baton up in terms of consistently supporting them (residents) throughout the

day (Claire, Care Home Manager)

It was kind of an eye opening when we met…, even for us nurses. We met…

about… what was best choice of food… it was an education for us… (Pauline,

Qualified Staff)

The next participant described how through learning from the project, she had

supported the care support workers to take up some responsibility and lead some

fund-raising activities. Furthermore, the activities had enabled some community

engagement:

I think with carers, we had lots of meetings when we applied to be part of this

project… we really took them on board… they got more training, they were

very involved and we also gave them opportunities to take the initiative. For

example… they formed a little committee and decided what to do… They

15

were very cooperative, all the staff, for example, we had the project for the

community… (Fran, Care Home Manager)

She continued by describing how delegating staff some responsibility had enabled

them to develop in their roles:

When you give people responsibilities and you support them in that

responsibility then they flourish … so all the nurses have specific

responsibilities and most of the carers have specific responsibilities … for

example, a person who’s the xxxx champion, I will not make decisions without

consulting that person… and the person gets acknowledgement for it (Fran,

Care Home Manager)

For the next participant, being part of the Teaching Care Homes programme had

enabled the care support workers to be more fulfilled in their roles and adopt more

caring responsibilities:

It gives the carers a sense of fulfilment as well because they are able to care

for the residents more than what they’re already doing (Jill, Deputy Manager)

The next two participants describe the supportive aspects of the Teaching Care

Homes project and the ways in which participation had reaffirmed their important

roles:

They gave us ideas and they got us thinking that we can make a difference. It

is good… I don’t think homes are well supported, because there is much

difference between what the hospitals think about the care homes and what,

in terms of support, that they get, but we really do quite a lot of work and they

don’t realise that, and projects like this teaching care homes make us realise

that we can make a difference by empowering us to say that, yes, we make a

difference, we do all this work (Pauline, Registered Nurse)

It’s been an absolutely brilliant project. It’s helped open doors where before

we didn’t know what was possible and it’s helped us to get involved with

research … we have got involved with research… so there are now trials

happening within the home… as a result of the teaching care homes support

(Claire, Care Home Manager)

16

The final participant described how taking part in the Teaching Care Homes

programme had informed the development of home guidelines, which in turn had

improved confidence and collaboration with other health care professionals:

A lot more confident, a lot more confident, particularly, I would say, the team

leaders and the registered nurses because, yes, they were quite confident

before we started on FoNS but now that they’ve got guidelines, the team

leaders who were managing our residential floor can actually even now pick

up that document and run with it, so to speak. So, they actually have more

confidence in dealing with what they’re checking, how they’re communicating

that to the GP, how they’re communicating that to other clinicians within the

home… (Claire, Care Home Manager)

Impact on Residents

Participants involved in this evaluation were committed to raising care standards

around either dementia or diabetes care. Exploring any impact on care provision

from the resident perspective was outside the range of this evaluation. However, the

following excerpts described how through the Teaching Care Homes programme,

staff had made changes in the homes, which they perceived had a positive impact

on the residents:

After the training, the resident responded very positively for someone who is

very anxious. They are less anxious … the carers found them more

manageable to care for… so, lots of the things are still on-going and we’re not

finished yet (Jill, Deputy Manager)

Quality improvements in the homes included a more collaborative approach to care,

which led to a reduction in unscheduled hospital admissions. Improvements had

benefitted neighbouring homes who had been able to share the good practice:

So, we have trained most of the staff … and we have a whole spreadsheet on

the company shared drive on what progress we are making … we involved

the neighbouring care homes … so not only benefitting our home but the

neighbouring care homes as well… (Pauline, Registered Nurse)

17

It’s helped us as an organisation to look at the clients we have, to look at the

diverse nature of those individuals … to work with (local colleagues) there to

develop protocols of how to deal with it, to make sure all staff are aware and

trained in terms of spotting signs… and what next steps to take if those were

spotted… So to develop that collaborative communication and learning and

what that’s meant for the clients is that obviously they don’t need to be put on

an ambulance into hospital, they can actually be supported within their home

(Claire, Care Home Manager)

Being part of the Teaching Care Homes programme was perceived to have had a

positive general effect on the residents and relatives and the following participant

suggested that staff were now viewed in a ‘different way’:

Well, the relatives and the residents were really happy and they see us in a

different way in the sense that not all nursing homes are doing this, so it’s kind

of an awareness thing, that it can be done (Pauline, Registered Nurse)

Summary of Impact

Alongside the qualitative data collection, the research team collated minutes of

meetings, presentation slides and action plans, which summarised the ways in which

engagement with the Teaching Care Homes programme had a positive impact on the

participating homes. This impact is summarised below in terms of improvements to

resident care, staff development and the overall image of the home.

Resident Care

Since engaging with the Teaching Care Homes programme, both homes reported

improvements in resident centred care provision. For Kineton Manor, this was

through activities such as the implementation of Namaste Care, which had been

beneficial for residents and staff. The Lead Nurse had also completed a dementia

friendly environment audit and the home had placed ‘Alexa’ in rooms, with a list of

activities to provide different stimulation to the residents in that room. Longer term

plans included changes to the main lounge area and the incorporation of a nursery in

the home to support intergenerational care. Consulting with residents and relatives,

18

they are also introducing new signage within the home and trialling luminous toilet

signs in resident’s rooms, helping residents with dementia to find their personal toilet

at night.

Priscilla Wakefield House reported positive change in the care of residents with

diabetes. Staff were more able to identify when residents were having hyper/hypo

glycaemic attacks and act accordingly. Further, collaboration with other health

professionals such as the diabetes nurse specialist had improved confidence and

competence in dealing effectively with this resident group. Longer term plans

included the development of further links to support partnership working and wider

networks across community settings in the area, for example, neighbouring homes.

Staff Development

Participants identified what they described as ‘bad press’ about care homes

generally (an issue also described by the previous cohorts of Teaching Care Home

participants). All participants who raised this issue stated how upsetting this was to

them. However, being part of the Teaching Care Homes programme was viewed as

another way to showcase the good care and hard work that goes on behind the

scenes in care homes. Participants from both homes described the project as one

which improved knowledge and enabled collaboration with others. A common

description of the project was that it encouraged thinking ‘out of the box’. Examples

of change from both projects had included liaison with schools and the community

more widely; organizing a theatre production and workshops, videos of activities

(e.g. Namaste); fundraising activities; writing blogs; collaboration with other health

professionals (e.g. to support diabetes care); collaboration with universities; auditing

and guideline writing. Being part of the Teaching Care Homes programme had

enabled Kineton Manor to be involved in research projects and engage with

ENRICH, an organisation which aims to support the development of research in care

home settings. The FED had improved collaboration with the University of Salford,

which had enabled access to simulation suites and conference attendance.

Colleagues from the University of Salford and The FED had developed a poster

presentation about the project which was presented jointly at the Joint Social Work

Education and Research Conference in 2019.

19

Image

Participants from both homes agreed that being part of Teaching Care Homes

programme had improved the image of care homes and had indirectly strengthened

the marketability of their homes. The public had become aware of the good work that

was being undertaken and had subsequently recommended the homes to family and

friends. Nearly all admissions to both homes were from word of mouth from previous

families and friends and recommendations from primary care services. Participants

from one home suggested the need for accreditation for Teaching Care Homes, so

that they could maintain their highly prized status.

Kineton Manor raised their profile as a dementia friendly home by hosting two

theatrical performances. “Grandma Remember Me” (performed by the AZ2B Theatre

Company) was designed to give people a better understanding of what it is like for

people living with dementia. The performances took place at Kineton High School

and were well attended by students, villagers, relatives and staff. Staff had also

organised a dementia workshop, “Listening with your Eyes”. The aim of the

workshop was to provide an experience like dementia for the participants.

Attendance was low at the workshop and the team was exploring the most suitable

dates/times to host future events to attract the greatest number of people.

Participants were also focused on gaining further involvement with the students and

staff from the local high school. In October 2019, Kineton Manor was represented at

the Care Show and two of the senior nursing staff were asked to contribute to a

presentation by the FoNS; and in November 2019, they also facilitated a workshop at

a Skills for Care regional event in Birmingham.

Following the TCH community event in December 2019, during which Wren Hall and

Landermeads shared their experience of being part of the King’s Fund programme -

Care Homes, Housing, Health and Social Care, Priscilla Wakefield House

successfully applied to participate, alongside their education partners for the

Middlesex University.

20

Part Two

Part Two of this evaluation explores the ongoing support provided by Manchester

Metropolitan University for several members of the previous Teaching Care Home

programme cohorts from 2016 - 2020. This has included support with academic

writing to produce an article suitable for publication; involvement in two research

proposals and education/development support to promote resilience in the care

home setting.

Support with Academic Writing

Professor Kirsten Jack led a collaboration with the care home managers from Wren

Hall, Landermeads Care Home and Kate Sanders from FoNS, to co-write an article,

which is currently under review with the high impact journal Nurse Education in

Practice (Appendix Two). This collaboration has included the development of ideas

suitable for publication, support for the managers with academic writing, editing for

publication, submission of the article and ongoing correspondence. The overarching

aim of the article was to raise the profile of care home nursing through the discussion

of several education and development innovations of the two care home teams. The

aim of the innovation was to increase education and developmental opportunities for

the teams so that they could further deliver effective nursing care to residents.

Involvement in Research

Positive Risk Taking, General Nursing Council Trust

In 2019 colleagues from FoNS, the care home teams and Manchester Metropolitan

University collaborated on a research proposal to explore positive risk taking in care

homes. The overall aim of the research was to improve the quality of care provision

by supporting residents and staff to engage in positive risk taking in the care home

setting and was in response to a call from the General Nursing Council Trust

(GNCT). Development of the research proposal was led by Professor Kirsten Jack

and Dr Gary Witham from Manchester Metropolitan University in collaboration with

Kate Sanders from FoNS. The proposal was co-developed with representatives from

21

the following care homes, who were all past or current participants in the

programme:

Wren Hall Nursing Home, Nottinghamshire

Rose Court Care Home, Manchester

Kineton Manor Care Home, Warwick

Landermeads Care Home, Nottingham

The FED, Manchester

Abstract

This research would be unique in that it would be the first study to examine resident

safety in terms of exploring positive risk taking from a resident/family perspective. It

is significant as it will increase capacity for positive risk taking in to improve resident

well-being, thereby enhancing resident safety, autonomy and empowerment. It

moves away from a ‘deficiency model’ of patient safety and views it in a holistic

context. Care homes present a distinctly different care setting, since they are the

residents’ home and, as such, they should play a part and contribute to the

organisational and safety culture. There is a paucity of evidence concerning

residents or relatives/informal carers in examining the safety culture and how this

has an impact on health and well-being. This research would support the

development of guidance that can underpin the further development of systematic

processes to make informed assessments on safety and positive risk taking. The

research process refocuses the power and decision making away from those who

currently make choices about risk taking (e.g. care givers, care planners, policy

makers) and redistributes it to the individual in care. Working in partnership with key

stakeholders such as residents and carers, the aim is to support the development of

solution-focused staff who can identify patterns and solutions, enabling an individual

to get involved in an activity. The removal of obstacles and finding solutions whether

this be the time of day, the type of activity, or the right support for the resident is at

the core of this research.

22

Outcome

The proposal was unsuccessful although Manchester Metropolitan University are

currently exploring other funding streams such as Abbeyfield (next call due October

2020), to pursue this research in collaboration with care home partners and the

FoNS.

The Health Foundation, Building Resilience in Social Care

In July 2020 Professor Kirsten Jack invited the FoNS and interested Teaching Care

Home participants, to collaborate on a research proposal concerning the

development of resilience in the care home setting during the Covid-19 pandemic.

This was in response to a call from the Health Foundation, the Covid-19 Research

Programme. The research team also involved colleagues from the Department of

Psychology at Manchester Metropolitan. The proposal was co-developed with

representatives from the following care homes, who were all past or current

participants in the programme:

Wren Hall Nursing Home, Nottinghamshire

Rose Court Care Home, Manchester

Kineton Manor Care Home, Warwick

Landermeads Care Home, Nottingham

Priscilla Wakefield House, London

Millbrook Lodge, Gloucester

Abstract

If we do not find the best way to pro-actively build the resilience of the care home

nursing workforce there is a risk that 1. The wellbeing of social care nurses will

worsen and lead to an increase in burnout; 2. The recruitment and retention crisis

will worsen and 3. Resident care quality will deteriorate at a time when worldwide,

there is a growing older population and one which is more at risk of suffering from

23

Covid-19. It is the aim of this exploratory study to address this Covid-19 knowledge

gap and use the findings to inform decision making and policy.

Currently the most effective way to support resilience development in the older

people care home nursing workforce during the Covid-19 crisis is unknown. Care

home managers are not trained to recognise psychological distress and have little

support to do so. In the current crisis, for the care home nursing workforce, The

Samaritans have extended the use of their helpline to enable access for staff,

although the effectiveness of this intervention is unknown. Research studies on

support taken from similar situations such as the Ebola, SARS and MERS crisis are

weak, undertaken in hospitals and do not address the longer-term impact.

What is known is that care home nurses are undergoing emotional trauma as they

provide complex care to older people who they often consider as family. They also

must balance the need for infection control and safeguarding with a group that often

have challenging care needs.

The aim of this research is to develop, implement and evaluate an educational

resource, ‘Social Care Trauma Resilience Management’ (SCTRiM), which will be

created in partnership with care home managers and care teams, to support the

nursing workforce to develop resilience. This is important, to support a healthier

workforce, which will lead to better recruitment and retention of staff and ultimately

more effective care provision for the residents, during and beyond this crisis. The

materials will be developed to enable the creation of policies which are designed to

support a resilient workforce culture, without placing the responsibility for this on the

individual worker. The underpinning philosophy for this work will be one of proactive

self-care and peer support, with the aim of reducing nursing burnout and distress.

Outcome

The outcome is due October 2020. However, even if the bid is unsuccessful,

Manchester Metropolitan University will support the six homes, to co-develop

resilience resources to inform workforce wellbeing in their homes, based on the

principles of TRiM. This will consist of a one to one workshop for the home

managers and ongoing online support. Developing resilience support for the homes

24

aligns well with work already being undertaken by FoNS (Resilience Based Clinical

Supervision programme) and supports collaboration across the two organisations.

Recommendations

This evaluation has highlighted several examples of practice development driven by

collaborative working between FoNS and the care teams involved in the Teaching

Care Homes programme. Such collaborative practice is essential to drive continuous

improvements linked to resident wellbeing and workforce development. FoNS have

been successful in supporting both current and past members of the Teaching Care

Homes programme, along with representatives from Clinical Commissioning Groups,

to develop a community of practice. Such communities are essential to drive future

practice improvement, opportunities for research and raise the profile of the care

home sector. The following recommendations are grounded in the findings of the

evaluation and ongoing collaboration between FoNS and Manchester Metropolitan.

• Promote the sharing of good practice and learning gained from the current

Teaching Care Home projects on diabetes and dementia care across the care

home sector.

• Publish the findings from the current Teaching Care Home projects e.g.

through relevant social care journals.

• Identify opportunities to promote the FoNS Teaching Care Home model.

• Identify funding streams to enable continuation of the Teaching Care Home

programme.

• Continue to collaborate with the existing care home community of practice to

promote opportunities for practice development.

• Maintain partnerships with academic colleagues to enable the development of

research opportunities.

25

Appendix One

Teaching Care Home Project Questionnaire

Manchester Metropolitan University is leading an evaluation of the innovative work

which has been developed by the care homes taking part in the Teaching Care

Homes (TCH) programme. The aim of the evaluation is to highlight best practice and

share findings.

As part of this work, could you please take a few minutes to fill in this questionnaire

about your TCH project and its outcomes. We will use this information to develop

case studies of your care homes that we will then disseminate to a wider audience.

Please give as much information as you would like, and then email the filled

questionnaire to Dr Annamari Ylonen (A.Ylonen@mmu.ac.uk). We may follow this up

with some additional question via email, phone call or visit. If you have any questions

about this evaluation, please contact Dr Kirsten Jack (k.jack@mmu.ac.uk)

We would appreciate if you could return the completed questionnaire to us by

Monday 25 November 2019. Many thanks in advance for your help with this.

1. What is the name of your care home?

2. Who was involved in your TCH project? (Please give names of individuals,

their organisations and what role they had in the project).

3. Please give a brief summary of your project and its overall aims.

4. What were the top three best or most successful learning experiences of the

project for your care home?

5. What would you say were main achievements and outcomes of your project

for your care home and/or the wider sector?

6. Where there any unexpected findings or discoveries?

26

7. Is there anything you would change about the project or would do differently if

you could go back?

8. Is there anything that did not work out as well as intended? Why do you think

this happened?

9. Are you planning to continue running the project, or aspects of it, in the

future?

10. Any further comments? (Please use this space to highlight anything else not

covered by the previous points)

Appendix Two

Astle, A., Heath, R., Sanders, K. and Jack, K. (2019) Raising the Profile of Care

Home Nursing through Collaborative Working Submitted to Nurse Education in

Practice and currently in the review process

Abstract

Meeting the long-term care needs of older people remains a challenge and the

nursing workforce need to be adequately supported o deliver effective care.

Employers have an important role in supporting the educational and developmental

needs of nursing staff so that they can fulfil their challenging roles. This article

explores the innovative practices of two care home teams based in the United

Kingdom (UK) who aimed to provide education and developmental opportunities for

their teams so that they could further deliver effective nursing care to residents.

Key Words: Care Homes, Development, Education, Innovation

Background

27

The provision of effective long-term social care for older people in residential settings

is a global challenge and one which is yet to be fully understood (Gordon et al,

2018). Many older people are cared for in residential care settings. It is

approximated that one third to one half of people suffering with dementia in high

income countries are cared for in care homes (CPA, 2014). Further, it is predicted

that the amount of older people needing care is set to rise. By 2050 nearly 30% of

the European population will be over 65 and over 11% will be over 80 (Knight Frank,

2014). Meeting the needs of older people in social care settings will require a skilled

and motivated workforce. However, there is a problem in that the care of the older

person is not always considered as a viable career option with nurses preferring to fit

this type of work part-time, around other commitments, citing lack of continuing

professional development as one reason to work elsewhere (Spilsbury et al, 2015).

Indeed, in the United Kingdom, despite there being three times the number of

nursing home beds than acute National Health Service (NHS) hospital beds, and

approximately 41,000 nurses working in social care there has never been specific

professional development for this group. Residents living in care homes have

increasingly complex needs and both General Practitioners and social care nurses

working in care homes feel ill equipped to meet these increasing needs of complexity

(British Geriatric Society, 2011).Care home nursing is viewed as an unattractive

career option and one with few opportunities for progression (Jack et al, 2019). This

perception might have been compounded by the renaming of nurses by the UK

Commission for Social Care Inspection in 2004 as social care, rather than health

care, nurses.

The poor retention rate for nurses working in care homes is a global problem. For

example, in the United Kingdom, in 2016/17 the turnover rate for registered nurses in

care homes, which provide nursing care, was 32.1% (approximately 10,700 leavers).

Internationally the nursing turnover rate in similar settings is 27% in Japan and 16%

in the United States of America (USA) (Colombo et al, 2011). The ongoing

employability churn in care homes is somewhat linked to the provision of education

and development for nurses who are employed there.

28

This article explores the innovative practices of two care home teams based in the

United Kingdom, which sought to address the problem of retention of care home

nursing staff and explore how developmental opportunities could be provided.

The Homes

Xxxxxx care home is based in xxxxxx, UK (name removed for anonymous

review). The home employs 185 staff of which approximately 25 are registered

nurses, 4 are Nursing Associates (a further 6 are training to become Nursing

Associates) and 150 are care support staff. XXXX Nursing Home is based in xxxxx

UK. It is a 53 bedded home employing 142 staff, 11 Registered Nurses, 2 Nursing

Associates and 103 Care Staff (4 are training to become Nursing Associates).

What they did

Both homes were established 30 years ago and education and development for staff

has remained a priority during that time. Managers at both homes understood that

there were two important requirements when considering the recruitment and

retention of staff. The first was immediate in that the current nursing workforce need

to be equipped and educated to perform effectively in their current role. Optimum

Workforce Development (Nottinghamshire County Council, UK) is an organisation

focussed on the quality improvement of local services. Building relationships with this

organisation was crucial when exploring different ways to develop and fund

education for continuing professional development for nurses and the shaping of

new roles. This organisation has shared a passion for the development of the

nursing workforce recognising the integral part it plays in health and social care. As a

consequence of the work that the two home teams had undertaken, Health

Education England (HEE) subsequently funded a Delphi study which identified the

skills needed for nurses to work in social care, for example, learning about frailty,

and subsequently provided continuing professional development for registered

nurses in the area. HEE is a body which supports workforce development and skills

with a view to developing the quality of healthcare. This education enabled staff to

complete modules which counted towards a formal degree level qualification.

29

Indeed, frailty is now a recognised long-term condition (NICE, 2016) and its

incidence and prevalence are associated with several factors, most notably age and

multimorbidity. The increasing severity of frailty is also associated with increased risk

of hospitalisation and length of stay, future nursing home admission, and mortality

(Clegg et al, 2016).

Second, there was a need to consider both medium to long term planning. The

Nursing Associate role was introduced to England following the Shape of Caring

Review (Health Education England) in 2015. This review identified a role gap

between unregistered care support workers and registered nurses. The Nursing

Associate is a stand-alone role and was viewed to free up registered colleagues so

that they could care for more complex nursing cases. The role also offers a route into

pre-registration education. The Nursing and Midwifery Council became the legal

regulator for Nursing Associates in 2018 (NMC, 2018). Both homes were involved in

one of the many pilot Nursing Associate schemes which took place across 35 test

sites in 2017. The East Midlands pilot scheme for Nursing Associates had 8 staff

enrol (involving 4 care homes in this region in total). These students have now

successfully completed the Nursing Associate programme and the homes have

supported additional students in 2018. All the Nursing Associate students were

employed in the care homes as support workers before commencing their course

and supporting them through their education is a way to develop and retain staff who

are committed to caring for older people. Indeed, it has been shown that the care

home setting can facilitate effective learning opportunities for students (Jack et al,

2019). In addition, the students benefitted from an integral working relationship

between social care and the English National Health Service and clinical placements

were coordinated by a Placement Lead responsible for all Nursing Associates across

the region as well as having support from an in-house clinical educator. Social care

providers offer placements to students in acute settings enabling the latter to

recognise the strengths and potential of care home nursing.

The home teams also invested in the advanced nurse practitioner role to develop the

skills and competence of existing registered nursing staff. The amount of nurse

practitioners working in long term settings globally is increasing (Pulcini et al, 2010)

and their work has been shown to enhance the quality of care provided. To support

this initiative, funding was sourced from The Burdett Trust, an independent

30

organisation which seeks to support nurses’ contribution to healthcare by awarding

grants to develop knowledge skills and expertise. However, many of the registered

nurses currently employed in the homes are educated to Diploma, not Degree level.

The Advanced Nurse Practitioner course is at master’s level and therefore the staff

are not eligible to undertake this programme without initially completing Bachelor

level credits, making this a longer-term goal for the homes.

Teaching Care Homes Programme

In their continued drive to seek opportunities to profile and advance the excellent

work undertaken in care homes, to raise greater awareness about the care sector as

a career option for nurses and wider support workers, both homes successfully

applied to become part of the Teaching Care Homes (TCH) Programme in early

2018. This Care England Programme, in partnership with the Foundation of Nursing

Studies was initially funded by the Department of Health, and currently supported by

the Burdett Trust for Nursing, the TCH aims to develop a geographically spread

network of homes that:

• Demonstrate an ongoing commitment to person-centred care and ways of

working, which will be experienced by all who live, die, visit and work in the

home

• Are centres for learning, practice development and research, actively

engaging with staff, students, residents and communities

• Have strong working relationships with academic and education providers and

are a resource for other care homes

A key element of the teams’ involvement has been their commitment to ‘inspiring

others’ to consider the care sector as a positive career choice.

Promoting Care Home Nursing

Both homes are passionate about their work and keen to promote care of older

people in various ways. Care for older people in long term settings is not considered

a viable career option by many registered nurses and nursing students are more

likely to choose to work in settings such as high dependency upon qualification

(Stevens, 2011). However, care home settings offer opportunities to practice person-

31

centred care, something which is valued by students (Carlson, 2013). Xxxx care

home are committed to dispelling the negative myths about older people care and

produced a video, ‘Why wouldn’t you?’. The idea for this resource originated from the

TCH Programme as one of the objectives identified was to celebrate working in

social care and attract the most suitable people. The video was made with care

home staff at XXXX Care Home and their enthusiasm and passion are the reasons

for its success – the message being clearly that social care is a fulfilling place to

work. This video was supplemented by XXXX Care Home with one called ‘Just …’

which celebrated the intrinsic importance of roles outside direct support such as care

home maintenance and catering. Both videos were subsequently adopted by the UK

Department of Work and Pensions, to be shared across the Job Centre Plus network

and the Department of Health and Social Care for their social care recruitment

campaign (see https://we.tl/t-ULNGop5I2w )

Discussion

The aim of this article was to share ideas about how the provision of education and

development for care home nursing staff can be supported. Investing in education

has reduced unscheduled admission rates into the acute sector from both homes.

Engaging with the Nursing Associate role has bolstered the nursing workforce and

provided a developmental route for support staff, already employed by the care

homes, giving them an opportunity to remain in their chosen field of older people

care. Engaging in the Teaching Care Home Programme has afforded opportunities

to develop person centred care practices and the development of communities of

practice, thereby reducing the isolation often felt by independent care homes.

Working together, staff from both homes have developed promotional videos aimed

at attracting others into this speciality. Central to their success has been their ability

to collaborate with each other and engage with other stakeholders who have a

vested interest in developing quality care provision for older people. They have also

reached out to funders, which has enabled them to provide continuing professional

development for staff, through university-based education. Many care homes in the

UK are in financial difficulty and there is a shortfall in terms of the amount they

receive versus the costs incurred to run the homes effectively. The homes discussed

32

in this paper have chosen to invest in their workforce, taking a longer-term view that

a happy successful home will attract motivated staff who choose to work with older

people, rather than viewing this speciality as a last resort.

To summarise, using the multiple approaches outlined in this piece, the homes have

shown positive impact not only on older people care but the development of their

teams. Considering the workforce shortage and employability churn, it is hoped that

these ideas can offer inspiration to others in the sector, facing similar problems.

Further ongoing research is needed to explore the long-term effects of such changes

and to meet the need for a workforce which offers a quality service to older people.

This is imperative so that older people in the UK can receive the care they deserve.

References

British Geriatric Society (2011) Quest for Quality London: BGS

Carlson, E. (2013). Meaningful and enjoyable or boring and depressing? The

reasons student nurses give for and against a career in aged care Journal of Clinical

Nursing 24, 602 – 604. DOI: 10.1111/jocn.12425

Clegg A, Bates C, Young J et al. (2016) Development and validation of an electronic

frailty index using routine primary care electronic health record data. Age and Ageing

45 (3): 353–360.

Colombo F, Llena-Nozal A, Mercier J & Tjadens F (2011). Help wanted? Providing

and paying for long-term care. http://dx.doi.org/10.1787/9789264097759-en

Centre for Policy on Ageing (2014) Rapid Review: The care and support of older

people - an international perspective. London. CPA

Gordon, A.L., Goodman, C., Davies, S.L., Dening, T., Gage, H., Meyer, J.,

Schneider, J., Bell, B., Jordan, J., Martin, F.C. and Iliffe, S. (2018) Optimal

healthcare delivery to care homes in the UK: a realist evaluation of what supports

effective working to improve healthcare outcomes. Age and Ageing. 47, 4, 595-603.

Jack, K, Tetley, J & Chambers A (2019). The education of nurses working in care

homes for older people: An Appreciative Inquiry. International Journal of Older

People Nursing. 14(2), pp.e12223-e12223.

33

Knight Frank. (2014). European Healthcare Care Homes Report London: Knight

Frank

NICE (2016) Multimorbidity: clinical assessment and management. NICE Guideline

56. Available at: www.nice.org.uk/ng56 (last accessed 11th August 2019)

Nursing and Midwifery Council (2018) Standards of Proficiency for Nursing

Associates NMC: London

Pulcini J, Jelic M, Gul R & Loke AY (2010) An international survey on advanced

practice nursing education, practice, and regulation. Journal of Nursing Scholarship

42, 31–39.

Spilsbury, K., Hanratty, B. & McCaughan, D. (2015). Supporting nursing in care

homes London: RCN Foundation

Stevens, J.A. (2011). Student nurses’ career preferences for working with older

people: A replicated longitudinal survey. International Journal of Nursing Studies. 48,

944 – 951. DOI: 10.1016/j.ijnurstu.2011.01.004

34

35

We would like to thank the participants who contributed to this evaluation.

Faculty of Health, Psychology and Social Care Manchester Metropolitan University Brooks Building 53 Bonsall Street Manchester M15 6GX For more information, please contact k.jack@mmu.ac.uk Website: www.mmu.ac.uk Twitter: @MMUHPSC