Title: Exploring how the naturalistic skills of care-workers impact on the well-being of residents in care-homes: a micro-interactional study.
Funder: Department of Health and Social Care

Abstract: Background It is well established that the actions and behaviour of care-home workers are fundamental to the well-being of people they care for. Not only do they deliver basic day-to-day care, they also perform vital psychological and social roles by providing an underlying continuity to residents - many of whom will have dementia or other cognitive problems. Although care-home workers have a far-reaching influence on the well-being of the people they look after, they are routinely under-valued and under-trained; much of the impact they have may often simply result from the way they interact with people during their daily routines, rather than formal training. However, despite an emphasis on the value of interaction in healthcare generally, in contrast to other groups of healthcare professionals, little behaviour-based research has focused on understanding, or capitalising on, the natural or experientially informed skills that care-workers use. As a result of this, any training they do receive tends to focus on specific care skills, presented in isolation, rather than as knowledge embedded in a wider understanding of how they work. Against the backdrop of an under-utilised care-skills knowledge-base, this study will provide the first detailed picture of the key naturalistic behaviours that care-workers use, that have a positive impact on the well-being of those they care for. Aims and Objectives This will be an 18-month study which aims to: Provide the first systematic micro-analysis of the routine interaction that takes place between care-home workers and the people they care for. Work with participants (primarily care-home staff and residents themselves) to isolate a core set of behaviours - ways that interaction is approached and conducted by care-staff - which have the greatest potential to positively impact on the every-day experience of people in care. Use the findings of the study to develop a proposal for a substantive follow-on project that can take this core-set and translate it into an accessible, high-impact and nationally focused online training resource for care-workers. Setting and data 10 dementia-care providers will participate in the study as research sites. These represent a range of different care-home types and dementia-care settings including: residential care-homes (n=5); care-homes offering mixed or additional services including, nursing, respite and day-care (n=3); dementia day-care providers (n=2). Up to 20 staff and residents will be recruited from each site to participate in the study. Methods A combination of participatory and non-participatory qualitative methods will be used. Primarily: video-based observation and Conversation Analysis (CA). Semi-structured interviews with participants will also be used, along with a variation of the stimulated recall interview process which will allow for the more active involvement of participants in determining which aspects of their interactions are significant and might be suitable for further analysis. Impact The findings from this exploratory study will form the basis of a proposal to conduct a large-scale follow-on project. This will focus on developing what has been learned into an extensive and practical online e-learning support and training resource that can be made openly available to all UK care-workers.

Lay abstract: The focus of the research It is well established that the actions and behaviour of care-home workers has a major impact on the well-being of the people they care for. Not only do they provide practical care, but through their day-to-day presence they can also offer an underlying stability to residents. This can have many psychological and social benefits &ndash; particularly for those who may have dementia or other mental health problems. Although care-home workers have such a far-reaching influence on the well-being of the people they look after, they are a sector of the healthcare workforce that has traditionally been under-valued and under-trained. This situation is now improving, but in contrast to virtually every other group of healthcare professional, there has been very little research focused on understanding how they actually go about their work &ndash; how their routine one-to-one contact with residents plays out, and the effect this can have. Our study aims to give the first detailed picture of the key natural behaviours that care-workers use (that is, behaviour and ways of helping people that they have not necessarily been formally trained to use) that have a positive impact on the people they care for. What we plan to do With the full consent of staff and residents in a variety of different dementia care settings, we plan to video-record a wide range of every-day activity. We will analyse this to find particular aspects of verbal and non-verbal behaviour that appear to improve or maintain the well-being of residents. Importantly, we will then explore how these behaviours actually work at a very detailed level to see if they might be developed into techniques or approaches that could be taught as part of future care-worker training. In order to help ensure that what we find is actually relevant to real care-workers, we will also use a research process called stimulated recall where we play back selected video clips to the care-workers involved and ask them to give us their perspective on what they see. This helps us to build up an accurate picture of the aspects of behaviour that they see as significant. How will people be involved? Care-home residents, people who attend day-care centres, care-workers, and many other people with an interest in dementia care have helped with the development of the study. They will continue to be involved as active partners once the research gets underway. We have designed the study so that there will be regular opportunities for the people taking part &ndash; particularly the care-workers &ndash; to comment on the work and ensure that it remains focused, accessible and relevant to their real-life experience.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE;NEUROLOGICAL