An exploration of the challenges of providing person-centred care for older care home residents with obesity.

The aim of this study was to explore care home staff's views on the prevalence of obesity in older people and how well prepared they were for any rise in applications for placements. Thematic analysis was used to analyse focus group interview data collected from seven care homes/33 participants in N.E. England. Findings revealed rises in demand by older people with obesity for care home admittance, consistent with rising prevalence of obesity in this demographic nationally. Findings also highlight implications of rising prevalence of obesity in older people, particularly care home staff's ability to deliver person-centred care (PCC) and the importance of appropriate support/recognition of this as an emergent issue to be addressed at a higher executive level and by health/social care authorities. Ways of ensuring PCC are discussed. Given continuing trends towards rising prevalence of obesity in this population, the findings possess broader translational potential.

Care home staff's experiences and views of supporting the dietary management and choices of older residents with obesity.

BACKGROUND: Rising numbers of older people with obesity living in care homes is an international phenomenon. Addressing dietary management of residents with obesity is a cause of debate and controversy. On one hand, the 'obesity paradox' suggests obesity protects against morbidity in frail older people. On the other hand, obesity reduces functional status and restricts activity for this group. This paper considers care home staff's experience and views of supporting dietary management and choice for residents with obesity within the context of this controversy. DESIGN: In this qualitative study, 33 staff from seven care homes in the North East England participated in focus groups, and data were analysed using Braun and Clarkes's (2006) six-phase thematic analysis approach. FINDINGS: Findings indicate that participants' support of dietary management and choice for residents with obesity may be strongly influenced by the care home environment. Care priorities, dietary management approaches, care home life and family involvement in residents' dietary intake facilitate and encourage weight gain, and as such, pose challenges for staff attempting to support weight management of residents with obesity. CONCLUSION: Findings suggest that in the care home setting, nutrition policy, guidelines and service commissioning processes and staff nutrition education should include management of obesity. Furthermore, families should be supported to understand the implications of their own caring behaviours on residents' nutritional status.

Hydration Interventions for older people living in residential and nursing care homes: overview of the literature.

INTRODUCTION: Care home populations experiencing high levels of multi-morbidity and dementia require support from caregivers to meet their hydration requirements. This article provides an overview of literature related to hydration interventions and highlights gaps in knowledge. SOURCES OF DATA: This paper draws on UK-focused literature from Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, Medline, Proquest Hospital Premium Collection, Cochrane Library and RCN databases on hydration interventions for older people living with multi-morbidity and dementia in care homes. AREAS OF AGREEMENT: Fluid intake is too low in care home residents, and no single hydration intervention is effective in addressing the complex problems that older residents present. AREAS OF CONTROVERSY: There is a lack of consensus about how much fluid an older person should consume daily for optimum health. There is also lack of agreement about what interventions are effective in supporting individuals with complex physical and cognitive problems to achieve daily fluid intake targets. GROWING POINTS: To improve hydration care for residents, care home teams should be competent in the delivery of hydration care, and work closely with integrated multi-professional healthcare specialists to provide proactive case management. AREAS TIMELY FOR DEVELOPING RESEARCH: There is a need for understanding of what hydration practices and processes are effective for care home residents and including these in multi-component interventions.

Whole systems approach.

PURPOSE: The purpose of this paper is to ascertain primary care advanced clinical practitioners' (ACP) perceptions and experiences of what factors influence the development and identity of ACP roles, and how development of ACP roles that align with Health Education England's capability framework for advanced clinical practice can be facilitated in primary care. DESIGN/METHODOLOGY/APPROACH: The study was located in the North of England. A qualitative approach was used in which 22 staff working in primary care who perceived themselves to be working as ACPs were interviewed. Data analysis was guided by Braun and Clarke's (2006) six phase method. FINDINGS: Five themes emerged from the data - the need for: a standardised role definition and inclusive localised registration; access to/availability of quality accredited educational programmes relevant to primary care and professional development opportunities at the appropriate level; access to/availability of support and supervision for ACPs and trainee ACPs; a supportive organisational infrastructure and culture; and a clear career pathway. ORIGINALITY/VALUE: Findings have led to the generation of the Whole System Workforce Framework of INfluencing FACTors (IN FACT), which lays out the issues that need to be addressed if ACP capability is to be maximised in primary care. This paper offers suggestions about how IN FACT can be addressed.

Hydration practices in residential and nursing care homes for older people.

AIM: To scope and explore hydration practices in care homes. BACKGROUND: Older residents do not regularly consume adequate fluids to support health. Achieving this is difficult with residents who have coexisting health, sensory and functional problems, as well as challenging hydration habits. DESIGN: This project used a sequential exploratory mixed method design to scope and explore existing hydration practices. METHODS: Data were collected via two stages. First was a survey of hydration practices. Twenty-nine responses were received from 81 care homes (response rate: 35.8%). Second was the exploration of practitioners' experiences and perceptions of hydration practice via semi-structured interviews (54 staff: 43 interviews). Descriptive statistics summarised the survey findings. Open coding and thematic analysis were applied to the qualitative data, and details of the methods are reported in adherence to COREQ criteria. RESULTS: It is important to provide hydration support in addition to regularly offering drinks to residents. Hydration practices include the following: use of social interaction to encourage drinking; verbal and nonverbal prompts to drink; giving fluids with routine practices and social activities; providing drinks-related activity, use of aids and equipment to support drinking; and creating a drink-friendly environment. Practices are implemented in care homes; however, no one care home implements all these hydration strategies at any one time. CONCLUSIONS: Older care home residents need support and encouragement to drink adequate fluids which can be difficult to achieve with residents who have complex needs and challenging drinking habits. In addition to the routine offer of drinks, hydration support should be used to facilitate residents to drink sufficient amounts of fluid. RELEVANCE TO CLINICAL PRACTICE: Staff working in care homes have an important role in assessing the hydration needs of residents and using multiple hydration practices to support residents to achieve their hydration requirements.

A collaborative approach to developing student placements in care homes.

If high-quality, person-centred care is to be provided for older people with complex needs, it is essential that nurse education should aim to extend students' knowledge and skills in longterm care, and integrated health and social care. Northumbria University, local care homes and NHS organisations have collaborated to develop integrated, cross-sector practice placements that support this learning for nursing students. While there have been challenges in developing these placements, initial feedback is positive, suggesting the placements promote improved interorganisational working and learning for staff as well as students.

"I'm not sure I'm a nurse": A hermeneutic phenomenological study of nursing home nurses' work identity.

AIMS AND OBJECTIVES: To explore nursing home nurses' experiences and views of work identity. BACKGROUND: Nursing home nurses are in a unique position as they work at the interface of health and social care. Little is known about nursing home nurses' perceptions and experiences of working within this context. Evidence suggests that using the concept of work identity can support understanding of how workers make sense of their work. DESIGN: Hermeneutic phenomenological study. METHODS: The study was carried out in seven nursing homes in North East England. Findings are based upon literary analysis of multiple episodic interviews with 13 nursing home nurses. RESULTS: Participants' responses suggested that nursing "residents" is different to nursing "patients," and nursing home nurses are required to modify their care activities to account for these differences. Participants also proposed that they are isolated and excluded from the rest of the healthcare workforce group. These issues led participants to feel uncertain about work identity. Many participants attempted to strengthen their work identity by aligning their role with what they perceived the "nurse identity" to be. CONCLUSION: Nurses' work activities and professional group identity influence their work identity. When work activities and professional group identity do not align with role expectations, as can be the case for nursing home nurses, work identity may be compromised. These nurses may attempt to change work practices to strengthen their work identity. RELEVANCE TO CLINICAL PRACTICE: Health- and social care providers need to account for work identity factors in the organisation of care, and planning and implementation of integrated health- and social care initiatives.

Integrated Working for Enhanced Health Care in English Nursing Homes.

BACKGROUND: The increasingly complex nature of care home residents' health status means that this population requires significant multidisciplinary team input from health services. To address this, a multisector and multiprofessional enhanced healthcare programme was implemented in nursing homes across Gateshead Council in Northern England. STUDY AIMS: To explore the views and experiences of practitioners, social care officers, and carers involved in the enhanced health care in care home programme, in order to develop understanding of the service delivery model and associated workforce needs for the provision of health care to older residents. METHODS: A qualitative constructivist methodology was adopted. The study had two stages. Stage 1 explored the experiences of the programme enhanced healthcare workforce through group, dyad, and individual interviews with 45 participants. Stage 2 involved two workshops with 28 participants to develop Stage 1 findings (data were collected during February-March 2016). Thematic and content analysis were applied. FINDINGS: The enhanced healthcare programme provides a whole system approach to the delivery of proactive and responsive care for nursing home residents. The service model enables information exchange across organizational and professional boundaries that support effective decision making and problem solving. CLINICAL RELEVANCE: Understanding of the processes and outcomes of a model of integrated health care between public and independent sector care home services for older people.

Older people's views and experiences of engagement in standardised patient simulation.

Background: The last two decades have witnessed initiatives aimed at improving the care of older people, including educating nurses so that they are equipped with the skills to care for older people with frailty and complex multimorbidities. It has been suggested that involvement of older service users in nurse education can facilitate the development of nurses' caring skills by promoting understanding of the reality of older people's situations. One method of involving older service users is standardised patient simulation (SPS). While some recent studies have acknowledged the importance of considering standardised patients' experiences and perceptions of simulation, to date few have focused specifically on the experiences of older people. Methods: In this qualitative study, data were collected via focus groups, whereby older people were invited to discuss their views and experiences of involvement in SPS. Data were analysed using open coding. Findings: Four themes emerged from the data, demonstrating that involving older people in SPS may be beneficial for their well-being. The four themes were: 'using personal experiences to improve care', 'having a sense of purpose', 'preparation and support for SPS' and 'feeling appreciated'. Discussion: While most participants reported that they enjoyed the SPS activities, engagement appeared to have had a much deeper significance for them. Many participants' responses suggested that involvement assisted them to 'make sense' of their experiences of illness and healthcare, and also gave a sense of purpose, of belonging and of being valued. Conclusion: Findings support the need for nurse educators to consider developing SPS programmes that involve older people.

'I feel like a salesperson': the effect of multiple-source care funding on the experiences and views of nursing home nurses in England.

The difficulties faced in the recruitment and retention of nursing staff in nursing homes for older people are an international challenge. It is therefore essential that the causes of nurses' reluctance to work in these settings are determined. This paper considers the influence that multiple-source care funding issues have on nursing home nurses' experiences and views regarding the practice and appeal of the role. The methodology for this study was hermeneutic phenomenology. Thirteen nurses from seven nursing homes in the North East of England were interviewed in a sequence of up to five interviews and data were analysed using a literary analysis method. Findings indicate that participants are uncomfortable with the business aspects that funding issues bring to their role. The primary difficulties faced are: tensions between care issues and funding issues; challenges associated with 'selling beds'; and coping with self-funding residents' changing expectations of care. The findings of the study suggest that multiple-source care funding systems that operate in nursing homes for older people pose challenges to nursing home nurses. Some of these challenges may impact on their recruitment and retention.

The impact of stroke aphasia on health and well-being and appropriate nursing interventions: an exploration using the Theory of Human Scale Development.

AIMS AND OBJECTIVES: This paper considers the impact of aphasia on health and well-being and provides suggestions for appropriate nursing interventions. Background. Effective communication is essential to holistic care and positive outcomes for individuals affected by aphasia. When verbal communication is absent, nurses fail to adequately use alternative strategies so that the standard of nurse/patient communication is frequently poor. DESIGN: This is a discursive paper which reviews relevant literature and uses the Theory of Human Scale Development as a framework for discussion. METHOD: The Theory of Human Scale Development is introduced. This theory emphasises that quality of life depends as much upon self-actualisation and relation building as on physical health. The theory is used within the discussion to highlight the significance of communication to quality of life and how its loss has profound psychological and social consequences. RESULTS: Aphasia results in 'loss of self'. The situation is exacerbated by inadequate healthcare communication strategies. Suggestions are offered regarding more appropriate strategies. Efficacy of family input is considered; nursing competence regarding language practice therapies is discussed, and the 'quest approach' is explored. Aphasia has a negative impact on relationships by denying access to support networks, which results in isolation. The individual's predicament is worsened by negative nursing responses. Positive nursing strategies, which alleviate effects of aphasia on individuals' social health, are investigated. Concept analysis and self-awareness exercises as methods of enhancing compassion skills are explored. The social model of disability is discussed to highlight the benefits to individuals of environmental adaptations. The social benefits of aphasia-group affiliation are discussed. CONCLUSION: The paper concludes by emphasising that fundamental human needs involve social and psychological as well as physical aspects. RELEVANCE TO CLINICAL PRACTICE: Nursing interventions must address all needs to provide holistic care in its fullest sense.

Transformational leadership can improve workforce competencies.

Staffing problems can arise because of poor delegation skills or a failure by leaders to respond appropriately to economic factors and patient demographics. Training dilemmas, meanwhile, can arise because of managers' confusion about what constitutes 'training' and what constitutes 'education', and where responsibility of provision lies, with the consequence that they neglect these activities. This article uses Kouzes and Posner's (2009) transformational leadership model to show how managers can respond. Leaders who challenge budgets, consider new ways of working and engage effectively with the workforce can improve productivity and care, while those who invest in appropriate learning will have a highly trained workforce. The author explains how integration of leadership roles and management functions can lead to innovative problem solving.

Power to the patient.

For UK nurses, holistic care, patient empowerment and multidisciplinary approaches to care are constant themes in our professional codes, as well as health policies and funding principles.