Home In England Research Articles

Agreement of Nursing Home Staff With Palliative Care Principles: A PACE Cross-sectional Study Among Nurses and Care Assistants in Five European Countries

ContextTo provide high-quality palliative care to nursing home residents, staff need to understand the basic principles of palliative care. ObjectivesTo evaluate the extent of agreement with the basic principles of palliative care of nurses and care assistants working in nursing homes in five European countries and to identify correlates. MethodsThis is a cross-sectional study in 214 homes in Belgium, England, Italy, the Netherlands, and Poland. Agreement with basic principles of palliative care was measured with the Rotterdam MOVE2PC. We calculated percentages and odds ratios of agreement and an overall score between 0 (no agreement) and 5 (total agreement). ResultsMost staff in all countries agreed that palliative care involves more than pain treatment (58% Poland to 82% Belgium) and includes spiritual care (62% Italy to 76% Belgium) and care for family or relatives (56% Italy to 92% Belgium). Between 51% (the Netherlands) and 64% (Belgium) correctly disagreed that palliative care should start in the last week of life and 24% (Belgium) to 53% (Poland) agreed that palliative care and intensive life-prolonging treatment can be combined. The overall agreement score ranged between 1.82 (Italy) and 3.36 (England). Older staff (0.26; 95% confidence interval [CI]: 0.09–0.43, P = 0.003), nurses (0.59; 95% CI: 0.43–0.75, P < 0.001), and staff who had undertaken palliative care training scored higher (0.21; 95% CI: 0.08–0.34, P = 0.002). ConclusionsThe level of agreement of nursing home staff with basic principles of palliative care was only moderate and differed between countries. Efforts to improve the understanding of basic palliative care are needed.

The Complexity of Disengagement with Education and Learning: A Case Study of Young Offenders in a Secure Custodial Setting in England

This study explored the nature of disengagement in young people serving custodial sentences. This was in order to gain new theoretical insights into strategies for their reengagement with education. This is because 90% of young offenders who drop out of school prior to incarceration are reportedly disengaged (dropout being an indicator of disengagement). This paper reports on a qualitative ethnographic case study in one secure children’s home in England. Semi-structured interviews with 16 incarcerated young people were conducted from which five participated in in-depth case studies along with teachers and care staff. Data were collected as participants engaged with a learning opportunity over a period of time. Extending emerging theory of disengagement, findings showed that disengagement oscillated between both active and passive forms within the same individual and pointed to the need for a range of strategies needed for reengagement. This paper suggests that disengagement is complex where the physical and social context shapes how disengagement manifests. This has pedagogical implications for education in custodial settings and other at-risk children in alternative or mainstream education provision.

Young British adults’ homeownership circumstances and the role of intergenerational transfers

Despite the continuing preference for homeownership, it has become increasingly difficult for young adults to own a home in Britain. House prices have increased faster than real earnings between the mid-1990s and the 2010s, resulting in significantly deteriorated affordability. Mortgage products have also become less accessible, as a large deposit has been required to secure the loan after the financial crisis of 2008/09. Previous studies point to the increasing role of intergenerational transfers in filling this gap. Some young adults obtain help from family to become homeowners, either receiving monetary support or by saving through living at the parental home. Using the Wealth and Assets Survey, this study attempts to examine the effect of these two types of family financial support on young adults’ homeownership circumstances, and controlling for other characteristics such as parental homeownership. First, it examines the characteristics of homeowners among young adults cross-sectionally using logistic regression. Second, by focusing on the non-homeowner subsample it analyses the effect of direct (money) and indirect (co-residence) family support on young adults’ entry to homeownership in the six-year period using discrete-time event history analysis. The results show that chances of young adults’ homeownership between 2008/10 and 2014/16 are very much tied to family support. The odds of becoming homeowners who have received direct or indirect support are found to be three times higher, even after accounting for other characteristics.

Validation of the Cohen-Mansfield Agitation Inventory Observational (CMAI-O) tool.

Behaviours associated with agitation are common in people living with dementia. The Cohen-Mansfield Agitation Inventory (CMAI) is a 29-item scale widely used to assess agitation completed by a proxy (family carer or staff member). However, proxy informants introduce possible reporting bias when blinding to the treatment arm is not possible, and potential accuracy issues due to irregular contact between the proxy and the person with dementia over the reporting period. An observational measure completed by a blinded researcher may address these issues, but no agitation measures with comparable items exist. Development and validation of an observational version of the CMAI (CMAI-O), to assess its validity as an alternative or complementary measure of agitation. Fifty care homes in England. Residents (N = 726) with dementia. Two observational measures (CMAI-O and PAS) were completed by an independent researcher. Measures of agitation, functional status, and neuropsychiatric symptoms were completed with staff proxies. The CMAI-O showed adequate internal consistency (α = .61), criterion validity with the PAS (r = .79, p = < .001), incremental validity in predicting quality of life beyond the Functional Assessment Staging of Alzheimer's disease (β = 1.83, p < .001 at baseline) and discriminant validity from the Neuropsychiatric Inventory Apathy subscale (r = .004, p = .902). The CMAI-O is a promising research tool for independently measuring agitation in people with dementia in care homes. Its use alongside the CMAI could provide a more robust understanding of agitation amongst residents with dementia.

The social value of the arts for care home residents in England: A Social Return on Investment (SROI) analysis of the Imagine Arts programme

BackgroundDirect involvement in creative activities can have benefits in terms of improved attention and positive engagement for older people. We used the social return on investment (SROI) approach to explore the social and economic benefits of arts activities for older people living in residential homes in England. MethodsWe complied with the CHEERS checklist and followed the six stages of SROI as reported in the literature. ResultsWe identified three main stakeholders: care home residents, care home personnel, and activity co-ordinators. For residents, the outcomes of interest were: community inclusion, mental and physical health, improved cognition and decreased social isolation. For care home personnel and activity co-ordinators the outcomes were: improved skills in caring for older people and increased confidence in using arts interventions. The analysis yielded an SROI of £1.20 for every £1 of expenditure. The sensitivity analysis revealed that when we consider a displacement rate of 15% for all the outcomes of all participating stakeholders, the Imagine study is unlikely to report a ratio that is less than £1.02 for every £1.00 invested. ConclusionsFindings could inform policy decisions about investment in the arts and health or social care.

Healthcare resource utilisation and costs of agitation in people with dementia living in care homes in England - The Managing Agitation and Raising QUality of LifE in Dementia (MARQUE) study.

BackgroundPeople with dementia living in care homes often experience clinically significant agitation; however, little is known about its economic impact.ObjectiveTo calculate the cost of agitation in people with dementia living in care homes.MethodsWe used the baseline data from 1,424 residents with dementia living in care homes (part of Managing Agitation and Raising QUality of lifE in dementia (MARQUE) study) that had Cohen-Mansfield Agitation Inventory (CMAI) scores recorded. We investigated the relationship between residents’ health and social care costs and severity of agitation based on the CMAI total score. In addition, we assessed resource utilisation and compared costs of residents with and without clinically significant symptoms of agitation using the CMAI over and above the cost of the care home.ResultsAgitation defined by the CMAI was a significant predictor of costs. On average, a one-point increase in the CMAI will lead to a 0.5 percentage points (cost ratio 1.005, 95%CI 1.001 to 1.010) increase in the annual costs. The excess annual cost associated with agitation per resident with dementia was £1,125.35. This suggests that, on average, agitation accounts for 44% of the annual health and social care costs of dementia in people living in care homes.ConclusionAgitation in people with dementia living in care homes contributes significantly to the overall costs increasing as the level of agitation increases. Residents with the highest level of agitation cost nearly twice as much as those with the lowest levels of agitation, suggesting that effective strategies to reduce agitation are likely to be cost-effective in this setting.

Remote Health Care Provision in Care Homes in England: An Exploratory Mixed Methods Study of Yorkshire and the Humber

An increasing demand for care homes in the UK, has necessitated the evaluation of innovative methods for delivering more effective health care. Videoconferencing may be one way to meet this demand. However, there is a lack of literature on the provision of videoconferencing in England. This mixed-methods study aimed to map current attitudes, knowledge and provision of videoconferencing in the Yorkshire and Humber region of England. Qualitative interviews with care home managers, a scoping review and field notes from a Special Interest Group (SIG) informed the development of a descriptive convenience survey which was sent out to care home managers in the Yorkshire and Humber region of England. The survey had a 14% (n = 124) response rate. Of those who responded, 10% (n = 12) reported using videoconferencing for health care; with over 78% (n = 97) of respondents’ care homes being based in urban areas. Approximately 62% (n = 77) of the 124 respondents had heard of videoconferencing for health care provision. Of those who reported not using videoconferencing (n = 112), 39% (n = 48) said they would consider it but would need to know more. The top ranked reason for not introducing videoconferencing was the belief that residents would not be comfortable using videoconferencing to consult with a healthcare professional. The main reason for implementation was the need for speedier access to services. Those already using videoconferencing rated videoconferencing overall as being very good (50%) (n = 6) or good (42%) (n = 5). Those who were not using it in practice appeared sceptical before implementing videoconferencing. The main driver of uptake was the home’s current access to and satisfaction with traditionally delivered health care services.

The Warm South: How the Mediterranean Shaped the British Imagination by Robert Holland

Reviewed by: The Warm South: How the Mediterranean Shaped the British Imagination by Robert Holland Precious McKenzie (bio) The Warm South: How the Mediterranean Shaped the British Imagination by Robert Holland; pp. 317. Yale UP, 2018. $33.05 cloth. Robert holland's The Warm South: How the Mediterranean Shaped the British Imagination is an expansive, captivating analysis of European art, politics, and attitudes. Holland takes canonical British authors and illuminates the ways in which they were engaging in larger European issues of their time. Unlike other scholars of British writers, Holland no longer silos these writers in Britain but shows how far their travels extended beyond Great Britain. He examines how their travels in the Mediterranean influenced their personal lives and their creative works. Holland begins the book in 1822, with Lord Byron, Edward Trelawny, and Percy Bysshe Shelley's corpse on the beach at Viareggio, Italy. He situates these Romantics, as well as Mary Shelley and John Keats, at the centre of Britain's growing fascination with Italy and Greece. The Mediterranean, as Holland finds, is flexible and is able to reflect, like a prism, a traveller's hopes, desires, and anxieties. Holland maintains that the Britons who travelled to the Mediterranean "were almost wholly preoccupied with discovering themselves, and their purposes were defined in terms of their own lives and contexts" (18). From this premise, he offers a range of examples, moving from Byron and the Shelleys to Elizabeth Barrett Browning, Robert Browning, Dante Gabriel Rossetti, Benjamin Disraeli, Fanny Trollope, John Ruskin, and John Henry Newman, to name but a few. Holland's scope and depth is astounding. From the Victorian era, he moves deftly into the modern era, including discussions of Ernest Hemingway and T.S. Eliot, and then on to the filmmakers of the 1960s. Holland leaves no stone unturned, connecting literature, painting, architecture, opera, and politics to show how embedded the Mediterranean was in the British imagination. One of the many strengths of this book is Holland's commitment to connecting political uprisings and wars to the creative work being done during the period. He underscores the unique challenges, ideological and physical, that Napoleon's military campaigns created for British travellers to the Continent. Holland does not paint a rosy image of the Mediterranean of warm days spent in sun-drenched olive groves. Instead, he deftly balances the dreamlike experiences of travellers to the Mediterranean with more sinister experiences. He acknowledges that for some British travellers, the Mediterranean was the first place where they encountered extreme poverty. The Mediterranean, for others, represented a place of sexual fantasies and moral transgressions, and for some Protestants, the influence of the Catholic Church in Spain and Italy felt pervasive.While some Britons idealized, fetishized, or exoticized the Mediterranean, others satirized the region. Holland uses the example of Oscar Wilde and dress reform to illustrate this intellectual divide. For Wilde, [End Page 162] ancient Greek fashion symbolized a healthier, more functional mode of dress than corsets and large skirts (179). Wilde induced his friend—the mistress of the Prince of Wales, Lillie Langtry—"to adopt classical interests" (179). Langtry learned Latin and appeared at various social events in Greek dresses. W.S. Gilbert and Arthur Sullivan then poked fun at Wilde and Langtry in their operetta Patience (180). During the late nineteenth century, the idealizations of the past were called into question as Britons gained more scientific, archaeological evidence of how ancient Greek society functioned—a society in which women had lesser status and slave ownership was allowed (181). Holland analyzes the competing attitudes toward the Mediterranean, focusing on the fluidity of British sentiments as the times changed. In sum, Holland's book excels at drawing connections between the political and the artistic. The book delves deeply into networks of writers and artists, illustrating how extensive their travels were and how divided their sentiments toward the region were in comparison to their experiences at home in Britain. The Warm South leads readers into reflections on globalism and nativism, issues that are of particular relevance to our contemporary world. Precious McKenzie Rocky Mountain College Precious McKenzie PRECIOUS MCKENZIE is an associate professor of English at Rocky Mountain College, in...

British Adults’ Rntry to the Housing Market and the Role of Intergenerational Transfers

Despite the continuing preference for homeownership, it has become increasingly difficult for young adults to own a home in Britain. House prices have increased faster than real earnings between mid-1990s and 2010s, resulting in significantly deteriorated affordability. Mortgage products have also become less accessible, as a large deposit has been required to secure the loan after the financial crisis of 2008/9. Previous studies point to the increasing role of intergenerational transfers in filling this gap. Some young adults obtain help from family to become homeowners, either receiving monetary support or by saving through living at the parental home. Using the Wealth and Assets Survey, this study attempts to examine the effect of these two types of family financial support on young adults’ homeownership circumstances, and controlling for other characteristics such as parental homeownership. First, it examines the characteristics of homeowners among young adults cross-sectionally using logistic regression. Second, by focusing on the non-homeowner sub-sample it analyses the effect of direct (money) and indirect (co-residence) family support on young adults’ entry to homeownership in the six-year period using discrete-time Event History Analysis. The results show that chances of young adults’ homeownership between 2008/10 and 2014/16 are very much tied to family support. The odds of becoming homeowners who have received direct or indirect support are found to be three times higher, even after accounting for other characteristics.

‘He just gave up’: an exploratory study into the perspectives of paid carers on supporting older people living in care homes with depression, self-harm, and suicide ideation and behaviours

AbstractThis study explored the concept of ‘giving up’ from the perspective of care staff working in care homes, and their everyday communication and hidden knowledge concerning what they think about this taboo topic and the context it reflects. Moving to a care home is a major transition where cumulative losses can pose risks to mental health in later life. If not recognised, this vulnerability can lead to depression which extends to suicide ideation and behaviours in the form of self-harm and self-neglect. Care homes are a significant place of care until death, yet a discourse of silence means that self-harm and suicide is under-reported or not attended to with specialist expertise. The layperson's concept of an older person ‘giving up’ on life is hardly discussed in the literature. This co-produced qualitative study used an inductive approach to explore this phenomenon through focus groups with 33 care staff across four care homes in South-East England. Findings paint a complex picture, highlighting tensions in providing the right support and creating spaces to respond to such challenging situations. ‘Giving up’ requires skilled detailed assessment to respond to risks alongside improved training and support for paid carers, to achieve a more holistic strategy which capitalises on significant relationships within a wider context.

Pilot of a Charter to Improve Management of Medicines and Oral Care for Residents with Dysphagia in Care Homes.

Research in care homes has demonstrated that medication management practices in patients with dysphagia and those receiving medicines covertly may be inappropriate, illegal, and potentially cause harm. This paper presents the results of a feasibility study piloting a resident and healthcare professional best practice charter to improve such practices in care home residents with dysphagia. A charter was developed through a multi-professional expert panel, implemented in one care home, and then piloted in 22 homes in England, Wales, and Northern Ireland. A website was setup and developed iteratively to support the process. Care home staff and residents provided initial feedback on the implementation process and on perceived outcomes six months post implementation. A total of 16 (88.9%) out of 18 respondents from nine homes for six months reported a positive response to the charter. More than 80% of responses regarding the implementation process, impact on staff confidence, and perceived usefulness of the charter were positive. Perceived effectiveness and usefulness could, however, be further improved especially the perceived effect on frequency of medication review, which is reliant on external stakeholder involvement. The charter and supporting website were well received with respondents believing that it was useful, staff showing more confidence, and residents having enhanced care. Approaches to enhancing the charter’s effectiveness were identified.

Recruiting care homes to a randomised controlled trial

BackgroundThere are more than a quarter of a million individuals aged ≥ 65 years who are resident in care homes in England and Wales. Care home residents have high levels of cognitive impairment, physical disability, multimorbidity and polypharmacy. Research is needed to ensure there are robust, evidence-based interventions to improve the quality of life of this frail group. However, there is a paucity of research studies in this area. Recruiting care homes and their residents to research is challenging.A feasibility, cluster randomised controlled trial was undertaken as part of a research programme to identify ways to develop and test methods to enhance the physical activity of care home residents. This paper describes two methods of recruiting care homes to the trial and draws out learning to inform future studies.MethodsEligible care homes met the following criteria: they were within a defined geographical area in the north of England; provided residential care for adults ≥ 65 years of age; had not previously been involved in the research programme; were not taking part in a conflicting study; were not recorded on the Care Quality Commission website as ‘inadequate’ or ‘requiring improvements’ in any area; and had ≥ 10 beds. Care homes were identified by a ‘systematic approach’ using the Care Quality Commission website database of care homes or a ‘targeted approach’ via a network of research-ready care homes. A standardised method was used to recruit care homes including eligibility screening; invitation letters; telephone contact; visits; formal letter of agreement.ResultsIn the systematic approach, 377 care homes were screened, 230 (61%) were initially eligible and invited to participate, 11 were recruited (recruitment rate (RR) 4.8%). In the targeted approach, 15 care homes were invited to participate, two were recruited (RR 13.3%). Overall, 245 care homes were approached and 13 recruited (RR 5.3%). A variety of care homes were recruited to the trial in terms of size, location, ownership and care provision.ConclusionsSystematic recruitment of care homes to the study was time-consuming and resource-heavy but led to a variety of care homes being recruited. The targeted approach led to a higher recruitment rate.Trial registrationISRCTN registry, ISRCTN16076575. Registered on 25 June 2015.

Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study

Background: Nursing homes are among the most common places of death in many countries. Aim: To determine the quality of dying and end-of-life care of nursing home residents in six European countries. Design: Epidemiological survey in a proportionally stratified random sample of nursing homes. We identified all deaths of residents of the preceding 3-month period. Main outcomes: quality of dying in the last week of life (measured using End-of-Life in Dementia Scales – Comfort Assessment while Dying (EOLD-CAD)); quality of end-of-life care in the last month of life (measured using Quality of Dying in Long-Term Care (QoD-LTC) scale). Higher scores indicate better quality. Setting/participants: Three hundred and twenty-two nursing homes in Belgium, Finland, Italy, the Netherlands, Poland and England. Participants were staff (nurses or care assistants) most involved in each resident’s care. Results: Staff returned questionnaires regarding 1384 (81.6%) of 1696 deceased residents. The End-of-Life in Dementia Scales – Comfort Assessment while Dying mean score (95% confidence interval) (theoretical 14–42) ranged from 29.9 (27.6; 32.2) in Italy to 33.9 (31.5; 36.3) in England. The Quality of Dying in Long-Term Care mean score (95% confidence interval) (theoretical 11–55) ranged from 35.0 (31.8; 38.3) in Italy to 44.1 (40.7; 47.4) in England. A higher End-of-Life in Dementia Scales – Comfort Assessment while Dying score was associated with country (p = 0.027), older age (p = 0.012), length of stay ⩾1 year (p = 0.034), higher functional status (p < 0.001). A higher Quality of Dying in Long-Term Care score was associated with country (p < 0.001), older age (p < 0.001), length of stay ⩾1 year (p < 0.001), higher functional status (p = 0.002), absence of dementia (p = 0.001), death in nursing home (p = 0.033). Conclusion: The quality of dying and quality of end-of-life care in nursing homes in the countries studied are not optimal. This includes countries with high levels of palliative care development in nursing homes such as Belgium, the Netherlands and England.

From the Tuileries to Twickenham: The Orléans, Exile and Anglo-French Liberalism, c.1848–1880

Abstract Between the 1848 Revolution and the Franco-Prussian War, the Orléans dynasty relocated to the suburbs of London. For the Orléans as for the Bourbons and the Bonapartes, exile was a fundamental aspect of nineteenth-century royalism. Deprived of the French throne, Louis-Philippe’s heirs nonetheless remained highly engaged with the political culture of Victorian Britain and the British Empire. Studying the interactions between the Orléans and their British hosts challenges existing narratives about the stagnation and decline of the Orleanist cause after 1848 as well as the divergence between French and English variants of liberalism. Taking as its focus Henri, duc d’Aumale, and his nephew Philippe, comte de Paris, this article charts the family’s evolving ambitions, divided between building a new home in Britain, and keeping the prospects open for a possible restoration in Paris. The Orléans engagement with Britain is traced through several channels. Firstly, through their participation in British elite sociability, thanks to their devoted champion and neighbour in Twickenham, Frances, Countess Waldegrave. This London hostess played a central role in facilitating the family’s interests and favourable press coverage. Secondly, through the Orléans’ engagement with global politics in the mid-nineteenth century, in which British perspectives helped to reshape their own vision of France’s imperial future. Thirdly, through their exploration of British parliamentary debates and the problems of industrial society. Far from simply prolonging the vision of the July monarchy, this article suggests that the Orléans’ engagement with questions of mass politics was more dynamic and extensive than previously believed. Although the revised and vicarious vision of liberalism formulated by the Orléans during the London exile was never applied after the family returned to France in 1870–71, it continued to inform and constrain the subsequent development of French monarchist politics.

The experiences of midwives and women during intrapartum transfer from one-to-one midwife-led birth environments to obstetric-led units

ObjectiveTo explore the transition from midwifery one-to-one support in labour within a midwife-led birth environment to an obstetric-led unit from the perspectives of midwives and women. DesignEthnographic study. Data was collected from eleven transfers to an obstetric-led unit. The transfer process was observed for four women.Semi-structured interviews were completed following the births with eleven women and eleven midwives. Nine maternity records were also analysed. SettingAn alongside midwife-led unit, freestanding midwife-led unit, women's homes in England. FindingsTerritorial behaviour was the main theme experienced by midwives when transferring women to obstetric-led units. Territorial behaviour manifested itself as a feeling of 'us versus them' behaviours, 'feeling under scrutiny' and being aware of 'conflicting ideologies'.For women there were four themes that had an impact on their experiences of transfer obstetric-led units including: (1) their midwife continuing the care on the labour ward, (2) having time to adjust to their new situation, (3) all staff introducing themselves and (4) not being separated from their baby for long periods of time. Conclusion and implications for practiceTransfer from a midwife-led birth environment to an obstetric-led unit is a stressful situation for midwives and women. This paper highlights how territorial behaviours impacted negatively for midwives during transfer to an obstetric-led unit. More research is required to understand territorial behaviours within the maternity services and how more respectful compassionate working relationships can be created. Additionally, from the perspective of women this paper highlights four aspects of care that positively impacted on the experiences of women and even helped them to build resilience to cope with the change of location, situation, medical interventions and new carers when transferring to an obstetric-led unit.

Whiteness, class and place in two London suburbs

ABSTRACTThis article addresses a specific intersection of class, place and whiteness by focusing on distinctions between middle-class owner-occupiers in suburban London. Where whiteness is constructed through association with an imaginary of the unchanging nature of rural England and, in particular, the village, some suburban places provide a more ready village metaphor in support of whiteness than others. In a securely middle-class suburb residents are able to misrecognize their neighbourhood as a village, and beyond the metaphor, report feeling at home in rural England. In a marginal middle-class suburb whiteness is founded on weaker claims to the English village metaphor and, moreover, residents feel less at home in rural England. This article demonstrates the need to go beyond the often made distinction between the tactics of middle class (owner-occupiers) and working class (tenants) by identifying distinctions within the former group.

Midwifery one-to-one support in labour: More than a ratio

To explore midwifery one-to-one support in labour in a real world context of midwife-led birth environments. Ethnographic study. Data was collected from 30 observations inside and outside the birth environments in three different birth settings. Semi-structured interviews were completed following the births with 29 low-risk women and 30 midwives with at least one year labour support experience to gain their perspectives. Twenty-seven maternity records were also analysed. An alongside midwife-led unit, freestanding midwife-led unit and women's homes in England. Six components of care were identified that required balance inside midwife-led birth environments: (1) presence, (2) midwife-woman relationships, (3) coping strategies, (4) labour progress, (5) birthing partners and (6) midwifery support. Midwives used their knowledge, experience and intuitive skills to synchronise their care for the six components to work in balance. Balancing of the six components have been translated into continuums representing the labour care and requirements. Midwifery one-to-one support in labour is more than a ratio when translated into clinical practice. When the balance of the six components were tuned into the needs of women, women were satisfied with their labour and birth experience, even when it did not go to plan. A one midwife to one woman ratio should be available for all women in labour.

Turning the Co-Production Corner: Methodological Reflections from an Action Research Project to Promote LGBT Inclusion in Care Homes for Older People.

Background: Older lesbian, gay, bisexual and trans (LGBT) residents are often invisible in long-term care settings. This article presents findings from a community-based action research project, which attempted to address this invisibility through co-produced research with LGBT community members. Particular Question: What conditions enable co-produced research to emerge in long-term residential care settings for older people? Aims of Project: To analyse outcomes and challenges of action-oriented, co-produced research in the given context. In particular, we explore how co-production as a collaborative approach to action-orientated research can emerge during the research/fieldwork process; and reflect critically on the ethics and effectiveness of this approach in advancing inclusion in context. Methods: The project was implemented across six residential care homes in England. Reflections are based on qualitative evaluation data gathered pre- and post-project, which includes 37 interviews with care home staff, managers and community advisors (two of whom are co-authors). Results and Conclusions: We discuss how the co-production turn emerged during research and evaluate how the politics of this approach helped advance inclusion—itself crucial to well-being. We argue for the value of co-produced research in instigating organizational change in older people’s care environments and of non-didactic storytelling in LGBT awareness-raising amongst staff.

Facilitation of an end-of-life care programme into practice within UK nursing care homes: A mixed-methods study

BackgroundThe predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process. AimTo identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice. DesignA mixed-methods study. SettingNursing care homes in south-east England. ParticipantsStaff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme. MethodsStudy data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by ‘following a thread’. This paper reports study data in relation to facilitation. ResultsThree facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: ‘fitting it in’ facilitation; ‘as requested’ facilitation; and ‘being present’ facilitation. ‘Being present’ facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the programme required an external facilitator who could mediate multi-layered learning at an individual, organisational and appreciative system level. The cost savings in the study outweighed the cost of providing a ‘being present’ approach to facilitation. ConclusionsDifferent types of facilitation are offered to support the implementation of end-of-life care initiatives. However, in this study ‘being present’ facilitation, when supported by multi-layered learning, was the only approach that initiated the change required.

Family perceptions of care at the end of life in UK nursing care homes.

Over a fifth of the population of developed countries die in care homes. While studies are emerging on the outcomes of care in the last few weeks of life, few report on the experience as perceived by the family members. As part of a wider study to improve the delivery of end-of-life care, bereaved relatives of residents who had died in a care home/hospital were sent the Family Perception of Care Scale questionnaire to evaluate their experience of care provision for their relative in the last month of life. The Family Perception of Care Scale questionnaire was posted to bereaved relatives, from 37 nursing care homes in south-east England, 3-6 months following the resident's death. The questionnaires were posted over a 14-month period from 1 October 2009 to 31 November 2010. A total of 869 questionnaires were posted, with a 42% response rate. A global question within the Family Perception of Care Scale looking at the overall satisfaction with the quality of end-of-life care (Q24) indicated that bereaved relatives were satisfied with the care provided. Qualitative responses from family members highlighted some excellent care, although issues in relation to medical input, professional teamwork, last days of life and spiritual care remain problematic. Results provide an important insight into care provision at the end of life within these care homes. While some issues can be addressed through education, relationships and value-based issues are likely to be more difficult to address in light of increasing pressure of healthcare support for UK care homes.