Understanding care homes safety: culture and safety in non-mainstream care settings

Background The care home sector provides 24-hour residential care or nursing care to more than 450,000 vulnerable older people in the UK with complex needs and high levels of dependency. These services face many challenges in relation to funding, increasing demand, staff shortages and relying on an unregistered workforce with almost 40% possessing no qualifications. Care homes present a unique setting that provides care to individuals at significant risk of harm but has received little attention or research. Care homes provide a particularly rich context in which to study safety, as they are inherently complex organisations that have historically suffered many catastrophic failures and scandals and continue to struggle to achieve safety goals. It was widely accepted that organisational culture was important for patient safety. Both the organisational culture and patient safety literature have been dominated by the positivist assumption that organisations are part of an external reality that can be both measured and manipulated. Many scholars now argue that positivist approaches do not reflect the complexity of contemporary organisations as they only capture the very surface of organisational cultures. The deeper levels of organisational culture and its impact upon safety have received little exploration in the patient safety literature and have not before been explored in the context of care homes. Aim The thesis aimed to empirically explore organisational culture and how this related to safety in care homes. The thesis focused on how residents, relatives and staff in this context made sense of their reality by investigating the basic underlying assumptions that underpin human perception and behaviour, specifically in relation to quality and safety. Through this exploration the thesis also captured how different groups contributed to and negotiated quality and safety. Research Question The thesis addressed the central research question: • How do employees, residents and relatives give meaning to and value issues of safety in care homes? Methodology The thesis aligned with the interpretive paradigm and adopted an ethnographic case study approach within the care home sector. Over 200 hours of observations and interviews with 50 participants took place across two care homes between January – December 2018. Inductive thematic analysis was used to analyse both interview and observational data. Research Gaps and Intended Contribution This study adds to the limited evidence base through its interpretive, ethnographic approach, accepted as a method suited to achieving a deeper level of cultural analysis. The approach taken has not previously been used to address safety in the care home sector, which presented a setting that was theoretically and empirically distinguished from mainstream care settings. Due to the under-researched nature of this care setting the study also enabled theoretical contribution to the patient safety literature. The findings from this study make a contribution to current debates around care home policy and practice, which was of particular relevance given the recent impact of the COVID-19 pandemic upon the care home sector. The thesis makes a new contribution to the literature around patient safety by presenting a conceptual understanding of how culture relates to safety in care homes that comprises of Uncertainty, Identity and Role, Responsibility and Relationships. My study argues that within care homes there was a disconnect between the formal culture and approaches, and the informal culture within the care home. The study has highlighted that traditional patient safety orthodox approaches being used within care homes may be inappropriate due to the unpredictability and the assumptions that underpin how people give meaning to and value safety in care homes. Moreover, my study has shown that safety in care homes was achieved through attempts to get to know residents, focusing on their identity, building relationships and the importance of promoting resident autonomy and responsibility for their own safety

The development and evaluation of a computer based e-learning tool to enhance knowledge of workplace wellness

Abstract Introduction: The study is the first to explore the overall workplace wellness knowledge of healthcare staff and students and the use of e-learning to improve this knowledge. Workplace health promotion is an essential part of improving public health, useful for reducing the burden of noncommunicable diseases. However, this emerging topic is not covered in healthcare staff or student education programmes. As no learning tools are available to improve workplace wellness knowledge, this dissertation describes the development and evaluation of an e-learning tool focussing on six workplace wellness topics; work-related stress, musculoskeletal disorders, diet and nutrition, physical activity, smoking and alcohol consumption. Methods: To develop the e-learning tool the Centre for Excellence in Teaching and Learning in Reusable Learning Objects Agile Development Workflow was followed, using expert peer review and a pilot study to create a high quality learning resource. Once developed, a one-group pre and post-test comparison design was used, testing baseline and post-intervention knowledge of workplace wellness. A knowledge questionnaire was used to collect quantitative accuracy scores and subjective evaluation questions were used to assess participants’ perceptions of usability. Results: Pre-questionnaire results showed a poor baseline knowledge of workplace wellness across all of the study sample (n=194). A statistically significant Emily Gartshore vii MNurSci Dissertation: 21/03/2014 improvement in knowledge was seen post-intervention (t(75)=-14.801, p < 0.0005), which also revealed a large effect size. Question specific analysis identified that the percentage of correct responses improved for all questions, identifying the success of the e-learning tool in improving workplace wellness knowledge. Conclusion: The dissertation gives insight to the poor baseline workplace wellness knowledge of healthcare staff and students. It reveals that the workplace wellness e-learning resource is an effective way to improve knowledge of workplace wellness in healthcare staff and students, with future implications for public health, health education and e-learning

The development and evaluation of a computer based e-learning tool to enhance knowledge of workplace wellness

Abstract Introduction: The study is the first to explore the overall workplace wellness knowledge of healthcare staff and students and the use of e-learning to improve this knowledge. Workplace health promotion is an essential part of improving public health, useful for reducing the burden of noncommunicable diseases. However, this emerging topic is not covered in healthcare staff or student education programmes. As no learning tools are available to improve workplace wellness knowledge, this dissertation describes the development and evaluation of an e-learning tool focussing on six workplace wellness topics; work-related stress, musculoskeletal disorders, diet and nutrition, physical activity, smoking and alcohol consumption. Methods: To develop the e-learning tool the Centre for Excellence in Teaching and Learning in Reusable Learning Objects Agile Development Workflow was followed, using expert peer review and a pilot study to create a high quality learning resource. Once developed, a one-group pre and post-test comparison design was used, testing baseline and post-intervention knowledge of workplace wellness. A knowledge questionnaire was used to collect quantitative accuracy scores and subjective evaluation questions were used to assess participants’ perceptions of usability. Results: Pre-questionnaire results showed a poor baseline knowledge of workplace wellness across all of the study sample (n=194). A statistically significant Emily Gartshore vii MNurSci Dissertation: 21/03/2014 improvement in knowledge was seen post-intervention (t(75)=-14.801, p < 0.0005), which also revealed a large effect size. Question specific analysis identified that the percentage of correct responses improved for all questions, identifying the success of the e-learning tool in improving workplace wellness knowledge. Conclusion: The dissertation gives insight to the poor baseline workplace wellness knowledge of healthcare staff and students. It reveals that the workplace wellness e-learning resource is an effective way to improve knowledge of workplace wellness in healthcare staff and students, with future implications for public health, health education and e-learning

Understanding care homes safety: culture and safety in non-mainstream care settings

Background The care home sector provides 24-hour residential care or nursing care to more than 450,000 vulnerable older people in the UK with complex needs and high levels of dependency. These services face many challenges in relation to funding, increasing demand, staff shortages and relying on an unregistered workforce with almost 40% possessing no qualifications. Care homes present a unique setting that provides care to individuals at significant risk of harm but has received little attention or research. Care homes provide a particularly rich context in which to study safety, as they are inherently complex organisations that have historically suffered many catastrophic failures and scandals and continue to struggle to achieve safety goals. It was widely accepted that organisational culture was important for patient safety. Both the organisational culture and patient safety literature have been dominated by the positivist assumption that organisations are part of an external reality that can be both measured and manipulated. Many scholars now argue that positivist approaches do not reflect the complexity of contemporary organisations as they only capture the very surface of organisational cultures. The deeper levels of organisational culture and its impact upon safety have received little exploration in the patient safety literature and have not before been explored in the context of care homes. Aim The thesis aimed to empirically explore organisational culture and how this related to safety in care homes. The thesis focused on how residents, relatives and staff in this context made sense of their reality by investigating the basic underlying assumptions that underpin human perception and behaviour, specifically in relation to quality and safety. Through this exploration the thesis also captured how different groups contributed to and negotiated quality and safety. Research Question The thesis addressed the central research question: • How do employees, residents and relatives give meaning to and value issues of safety in care homes? Methodology The thesis aligned with the interpretive paradigm and adopted an ethnographic case study approach within the care home sector. Over 200 hours of observations and interviews with 50 participants took place across two care homes between January – December 2018. Inductive thematic analysis was used to analyse both interview and observational data. Research Gaps and Intended Contribution This study adds to the limited evidence base through its interpretive, ethnographic approach, accepted as a method suited to achieving a deeper level of cultural analysis. The approach taken has not previously been used to address safety in the care home sector, which presented a setting that was theoretically and empirically distinguished from mainstream care settings. Due to the under-researched nature of this care setting the study also enabled theoretical contribution to the patient safety literature. The findings from this study make a contribution to current debates around care home policy and practice, which was of particular relevance given the recent impact of the COVID-19 pandemic upon the care home sector. The thesis makes a new contribution to the literature around patient safety by presenting a conceptual understanding of how culture relates to safety in care homes that comprises of Uncertainty, Identity and Role, Responsibility and Relationships. My study argues that within care homes there was a disconnect between the formal culture and approaches, and the informal culture within the care home. The study has highlighted that traditional patient safety orthodox approaches being used within care homes may be inappropriate due to the unpredictability and the assumptions that underpin how people give meaning to and value safety in care homes. Moreover, my study has shown that safety in care homes was achieved through attempts to get to know residents, focusing on their identity, building relationships and the importance of promoting resident autonomy and responsibility for their own safety

Development and evaluation of an educational training package to promote health and wellbeing

Background: Supporting the health and wellbeing of healthcare employees is a UK national priority. Aims: To design, deliver and evaluate an educational package to promote health and wellbeing for nurses and midwives Methods: An online training package was developed and administered in two ways: online (HAWN-online) or in a face-to-face workshop (HAWN-contact). A mixed- methods evaluation was used to assess usability and acceptability of HAWN training. Findings: 316 nurses, midwives and students completed the online training package. 16 participants attended the workshop. HAWN-online significantly increased knowledge in core areas of workplace health and wellbeing. Nurses and midwives valued online and face-to-face delivery but raised barriers to attendance at workshops. Participants advocated that training in workplace health should be mandatory for all frontline staff. Conclusions: Employers should take steps to promote staff wellbeing through HAWN training, and address barriers to accessing workplace health training or supportive services

Workplace wellness using online learning tools in a healthcare setting

The aim was to develop and evaluate an online learning tool for use with UK healthcare employees, healthcare educators and healthcare students, to increase knowledge of workplace wellness as an important public health issue. A ‘Workplace Wellness’ e-learning tool was developed and peer-reviewed by 14 topic experts. This focused on six key areas relating to workplace wellness: work-related stress, musculoskeletal disorders, diet and nutrition, physical activity, smoking and alcohol consumption. Each key area provided current evidence-based information on causes and consequences, access to UK government reports and national statistics, and guidance on actions that could be taken to improve health within a workplace setting. 188 users (93.1% female, age 18–60) completed online knowledge questionnaires before (n = 188) and after (n = 88) exposure to the online learning tool. Baseline knowledge of workplace wellness was poor (n = 188; mean accuracy 47.6%, s.d. 11.94). Knowledge significantly improved from baseline to post-intervention (mean accuracy = 77.5%, s.d. 13.71) (t(75) = −14.801, p < 0.0005) with knowledge increases evident for all included topics areas. Usability evaluation showed that participants perceived the tool to be useful (96.4%), engaging (73.8%) and would recommend it to others (86.9%). Healthcare professionals, healthcare educators and pre-registered healthcare students held positive attitudes towards online learning, indicating scope for development of further online packages relating to other important health parameters

Patient safety culture in care homes for older people: a scoping review

Background: In recent years, there has been an increasing focus on the role of safety culture in preventing incidents such as medication errors and falls. However, research and developments in safety culture has predominantly taken place in hospital settings, with relatively less attention given to establishing a safety culture in care homes. Despite safety culture being accepted as an important quality indicator across all health and social care settings, the understanding of culture within social care settings remains far less developed than within hospitals. It is therefore important that the existing evidence base is gathered and reviewed in order to understand safety culture in care homes. Methods: A scoping review was undertaken to describe the availability of evidence related to care homes’ patient safety culture, what these studies focused on, and identify any knowledge gaps within the existing literature. Included papers were each reviewed by two authors for eligibility and to draw out information relevant to the scoping review. Results: Twenty-four empirical papers and one literature review were included within the scoping review. The collective evidence demonstrated that safety culture research is largely based in the USA, within Nursing Homes rather than Residential Home settings. Moreover, the scoping review revealed that empirical evidence has predominantly used quantitative measures, and therefore the deeper levels of culture have not been captured in the evidence base. Conclusions: Safety culture in care homes is a topic that has not been extensively researched. The review highlights a number of key gaps in the evidence base, which future research into safety culture in care home should attempt to address