QUALITY OF LIFE IN NURSING HOMES: ELEVATING THE STATUS OF RECORDING TO A RELATIONAL PRACTICE

Abstract

Internationally, nursing home care provision demands radical change. Lack of honesty about the complexity of so-called ‘basic care’ together with performance cultures have created a more transactional and confused environment, detracting from authentic care work grounded in human relationships. A personal outcomes approach, comprising three inter-related components of engaging, recording and using information, can result in more effective, inclusive, enabling and relational ways of working, but raises particular challenges in collective living settings for older people with complex and often fluctuating needs and priorities. This session presents results from an action research study conducted in collaboration with multi-disciplinary staff from six nursing homes in Scotland to facilitate a focus on personal outcomes. Grounded in the philosophy of relationship-centred care, the study recognised the importance of everyday acts of noticing alongside scheduled care planning processes, including being attentive to, and properly valuing, the life stories and more embodied stories of people with communication or cognitive impairments. Building upon the ways staff already come to understand and negotiate what matters to a person and to family members, and thinking about how such insights might be used by others, the study facilitated a shift from recording as a bureaucratic task with a primarily retrospective orientation demonstrating compliance, to a practice foregrounding information useful for maintaining the identity of the older person, building relationships and shaping future care. It also highlighted the practical and ethical dilemmas encountered daily, and the necessity of successful negotiation amongst everyone involved in individual and collective decision making processes.