Developing services for elderly people

Abstract

The establishment of a project to support and develop the role of nursing auxiliaries working with elderly people is described. Organised and run by two clinical facilitators, a variety of research methods, including interviews and non-participant observation of clinical practice, were used to establish baseline data. The interview information showed that there was general dissatisfaction among trained and untrained staff about the auxiliaries' roles, and clinical practice assessment of 206 auxiliaries demonstrated deficiencies in their communication, lifting and infection control techniques. Individual ward development and management of change plans were then set up and operated.

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“…55 Innovative educational methods or programmes were aimed at post-registration and student education in a number of studies. 44,60,[81][82][83][84][85][86] Innovative tools and technological developments included:…”

“…• the effect of an educational process model on participants' learning outcomes 85 • the usefulness and acceptability of portfolio learning to trainers and general practitioner (GP) registrars 81 • interactive drama for peer health promotion in schools of nursing 82 • GP fundholding 92 • a model of nursing care 59 • the impact of changes to acute medical care in a district general hospital on staff and patients 50 • the effect on quality of the King's Fund organisational audit. 80 Existing situations were the foci of other evaluations, including examination of the role, skills and attitudes of nursing auxiliaries, 84 the coordination of services for people affected by HIV 45 and research utilisation by nurses. 78 Making an assessment of the situation to identify the kind of intervention required was an aim or objective in 16 studies (31%).…”

“…• an increase in confidence; 43,44,51,59,77,78,82,84,86,90,94,96,98 for example, Burrows' project 44,90 led to improved confidence in staff in the management of acute pain • an increase in awareness; 59,80,96,107 for example, Marrow 107 reported that clinical supervision had led to increased self-awareness in the nurses concerned • the ability to recognise one's own strengths, weaknesses and limitations 86,94,98 • increased maturity. 94 The following quotation from one of the focus group interviews sums up these points well:…”

“…However, a number of researchers were not able to implement a change even after periods as long as 24-36 months. 84,95 Elliot 122 discussed real-world factors, in an action research environment, that are conducive to enabling effective change. He identified management structures that give rise to collegial relationships and peer accountability as being more receptive to change.…”

“…This included time to negotiate access, to understand the context, to establish group processes and relationships, to accommodate existing working practices, and to undertake analysis. Time was needed particularly in difficult or controversial situations 84,95 and when the time required spanned months:…”