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Case study: Not your usual nine to five: Delivering research in care homes

Community settings such as care homes and pharmacies offer unique opportunities to deliver research.

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Delivering research in the community

Angus Sturrock, Mental Health Research Nurse, explains how to overcome some of the complexities of conducting research in care homes.

This morning I was in a care home in inner city Bradford talking to Doreen who’s in her nineties. This afternoon I’m heading to Skipton on the edge of the Dales to chat to a gentleman who lives independently, despite having dementia and impaired hearing. Tomorrow I’m going to HMP New Hall Women’s Prison in Wakefield to talk to women who self-harm. Next week I’ll be visiting care homes at 11pm to help get the night-shift up to speed on a new study.

Being a mental health research nurse is certainly not your usual nine-to-five job, especially if you want to overcome the complexities of conducting research in the community.

My career in healthcare began when I qualified as mental health nurse in 2006 I became a research nurse in 2012 and since then I’ve been helping to deliver research throughout Bradford District Care NHS Foundation Trust. When I joined the team you could count the number of R&D staff on one hand, we are now 13 strong.

We are essentially a mental health trust, but we also support physical health and social care research. In the financial year 2018/19 my trust supported the deliver of 32 different studies and recruited over 1000 participants to those studies. Currently we are predominantly supporting academic studies but my team has supported a few commercial studies in previous years. Consequently, I’ve worked on a wide range of studies and learnt a huge amount over the last seven years about delivering research in the community.

Care homes in particular can present a unique set of challenges but, if you’re prepared to adapt, anything is possible.

It can be equally rewarding and challenging. Care homes in particular can present a unique set of challenges but, if you’re prepared to adapt, anything is possible.

Flexibility is the key

The PITSTOP study was one of the first studies I supported. It was looking at how to differentiate between delirium and dementia in a care home setting. It was a very intense study, requiring us to visit participants every other day for a month. It gave me a real insight into the workings of a care home.

I quickly learnt that accommodating the needs of the care home always comes first. That, and building relationships with the care home employees, are both key factors in delivering a study successfully.

It also pays to be flexible. Of course you have to plan your week and book your visits, but you should also be prepared for all your plans to go out of the window. For example, one day I might arrive to find a participant is in the bath; which can mean at least an hour wait. Another time a participant might be too unwell to see me at all. Occasionally I have had to cancel visits because a virus has broken out resulting in a whole wing being closed to visitors for a week. It’s also important to remember, especially when you are working with people with dementia, that mental capacity can ebb and flow. There are occasions when a participant doesn’t feel up to talking to me in the morning, but in the afternoon they are much more lucid and keen to be involved in a study.

...you have to be agile and ready to adapt your plans.

In these instances you have to be agile and ready to adapt your plans. You are the visitor there, you need to comply with what’s happening in the care home.

And it’s not always about fitting in around the residents. Similarly, if I need to brief or train care home staff on a new study sometimes the best time to do that can be 10 or 11 o'clock at night. This is when the residents are in bed, and all the medication and meal rounds are complete. This is also when care home employees will have more time to talk to you, ask questions and generally engage with the requirements of the study.

The key is to fit around what works for them. This was certainly true of the MARQUE study which looked at how we can better manage agitation in people with dementia in care homes. For this study we had to speak to participants, relatives and care home staff and use all three perspectives to build an accurate picture of what was happening with a particular participant. Surprisingly, catching the staff at the right time was much harder than arranging to speak with residents and their relatives.

The personal touch

In addition to being flexible, building relationships with care home employees can make a real difference to study delivery.

Care home employees have a duty to care for their residents, first and foremost. So if a participant seems unwell the care worker will, quite rightly, ask you to come back another time. But sometimes it is when a participant is unwell that you really need to see them. For example, for the PITSTOP study we needed to assess if participants were suffering from delirium or dementia. Having that relationship of trust with the care home work force, and being able to work hand in hand with healthcare professionals is a really important part of the job.

We all work well together because the patient always comes first.

We all work well together because the patient always comes first. So while I am advocating for care home residents to be given opportunities to take part in research, this is always balanced with the views and opinions of the care home staff. They know their residents really well and they can quickly tell me who I should approach for a particular study. It’s about feeling confident that a study is right for the resident and vice versa.

That said, most of the time the residents want to be involved. I’d say about 95 per cent of the residents and relatives that I speak with agree to take part in research. For the participants I enrol it’s an extra visitor and, for many, that a little bit of one-to-one interaction goes a long way. I love the fact that I can go home feeling like I make a little difference to their day.