“What Works is What Matters” learning to care for people living with dementia in care homes

On 8^th July our own Dr Isabelle Latham took part in the ‘A conversation with…’ series, organised by Empowered Conversations. Empowered Conversations deliver communication training, one to one support for family carers of people living with dementia and workshops and online training for professionals. During COVID the team have increased online activity to involve carer groups, creative sessions and weekly online seminars’.

Izzie was presenting an overview and the findings from her PhD, which focused on ‘How do care workers in care homes learn to care for people living with dementia?’

Why this topic?

Izzie herself has a background as a care worker in a care home, a trainer and a researcher, and was keen to investigate an area that is actually far more complex than is often given credit. In addition to her own personal passion, there was an academic reason for exploring the evidence around the topic, especially when training is often seen as the obvious answer to improving care. Indeed, research indicates that learning – particularly informal learning – occurs in a variety of ways, not just through training sessions. There is also recognition that there is a complex interaction between day-to-day events, the type of work and relationships, all of which link closely to person-centred care where the focus is on relationships and communication between the care-giver and care-receiver.

The research

Research was carried out by Izzie in two contrasting care homes: one a nursing home specialising in end of life care and one a residential home specialising in dementia care. To gather her PhD evidence, Izzie conducted ethnographic research which was an immersive approach involving spending six months in each care home for two or three days a week. The research combined observing what was going on, chatting to both staff and residents, reading and looking at the available evidence, and carrying out interviews.

Findings

Through her research, Izzie identified that care workers tend to operate on the basis of doing what works at the time, but how they learn on a day-to-day basis is influenced by several factors including personal resources, resident influences and care home cultural knowledge, which in turn is affected by training and interactions with colleagues.

What works is what matters

Care workers learn when they see the results of their actions on residents, whether positive or negative, as well as feeling the need to fulfilling expectations. For example, there may be an unwritten assumption that staff should always be busy and ‘on the go’ even if it is not necessarily what is needed by either the residents or the staff. In dementia care especially, trial and error also plays an important role in terms of ‘seeing what works’ for the individual at that time, and there should not be a fear of trying something and finding out that it did not work as intended.

Negotiating conflicting pressures can also influence what care workers do, as there may be a mismatch between resources and needs which affects what the care workers are able to achieve. For example, there may not enough staff available to provide the level of care that they might wish to, or there may not be the right equipment to do a particular activity, forcing care workers respond and adapt to their situation.

Care workers can also often be thrown in at the deep end, especially when they are new to the job, and there is an expectation that they just have to get stuck in and give it a go, even in unexpected situations that they may not have been trained for.

Factors that influence learning and practice

Care workers learn about residents through their interactions with the residents themselves, as well as from others through the information they provide. This helps the care workers to learn about the residents’ choices and preferences, and adapt the care they provide accordingly.

Personal resources are also important in terms of a care worker’s work and life experiences and also their own personal values. All of these factors will influence how a care worker behaves and responds to residents and colleagues.

Components that feed into cultural knowledge

Interactions with colleagues also influence care workers’ learning in several ways. This could be through care workers formally being shown or told how to do something when shadowing a colleague or by a senior member of staff, care workers asking and being given advice from others, or care workers observing – and copying – each other. In addition, how expectations of care work are communicated, and the use of impersonal shorthand language rather than proper explanations can also impact on the messages being taken on board by care workers.

Formal training also has an impact, but not necessarily to the same extent as the less formal interactions. The focus within training sessions can be around tasks that enable you to be a care worker rather than about care, for example manual handling or how to use a hoist, instead of communication, interpreting behaviour, and inter-personal skills which could be considered as being equally important for dementia care workers. Thought also needs to be given to which training is provided to which care workers at which point in their careers in order to have the most impact.

What next?

Thanks to Izzie for such an interesting and informative discussion, we can see why it was a great topic for your PhD study.

You can listen to the webinar again by using this link – Webinar recording

If you have any questions about Izzie’s work, please feel free to contact her i.latham@worc.ac.uk

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