Care home description and demographics 10.1
The care home was privately managed and registered to provide personal care to residents and care to people with dementia. It had 56 places available for residents.
During baseline data collection 55 beds were occupied, with one resident in hospital. It was rated ‘good’ overall at the most recent CQC inspection. It was not registered as a dementia specialist home but had a specialist unit for people with dementia experiencing behavioural difficulties. The care staff in the home had received one three hour session of dementia training in the past six months. Overall the home employed 41 permanent care staff and 2 permanent registered nurses.
The daytime staff: resident ratio was 1:2.8.
Study recruitment and retention 10.2
Resident recruitment and retention 10.2.1
Full details of resident recruitment and retention to the study are presented in Figure 10.1. 32/55 (58%) residents in the care home were eligible to participate in the study (either had a documented or probable diagnosis of dementia, scoring ≥2 on Noticeable Problems Checklist (Levin, 1989)). Of the 32 eligible residents, 17 participated (53%). Of these 17, only one had capacity to consent and so were approached directly, and the remaining 16 were consented by relative consultees.
The demographics of the participating residents are presented in Table 10.1. At baseline the mean age of residents was 88.9 years (S.D = 8.39) and the median length of stay was 27 months (IQR 17,67). Follow-up data was collected for 13 residents (76% overall retention; 95% Confidence Interval (CI) 50% to 93%); three had died and one left the home between baseline and 8 months.
142 English as a first language Yes
No
Figure 1: Resident recruitment and retention Figure 10.1: Resident recruitment and retention
143 Staff recruitment and retention 10.2.2
Full details of staff recruitment and retention to the study are presented in Figure 10.2. At baseline there were 43 members of staff working in the care home and 30 (70%) were eligible to participate. 22 (73%) of the eligible staff consented to participate at baseline. Sex and role of staff who completed baseline measures compared to those that did not are presented in Table 10.2. Demographic and employment characteristics of staff that consented at baseline are presented in Table 10.3. The mean age of staff was 45.9 years (SD=12.01) and 3 of the staff were registered general nurses. Follow-up data was collected from 17 staff members (77% retention rate; 95% Confidence Interval (CI) 55% to 92%).
Table 10.2: Sex and role of staff who did and did not participate in the study
Staff characteristic Participant
n (%)
Non-participants n (%)
Sex Female 20 (90.9) 8 (100)
Role Care assistant 9 (40.9) 6 (75)
Senior carer 6 (27.3) 0 (0)
Team leader 3 (13.6) 0 (0)
Deputy manager 1 (4.5) 2 (25)
Manager 1 (4.5) 0 (0)
Activities coordinator 2 (9.1) 0 (0)
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Table 10.3: Staff demographics and employment characteristics
Staff Characteristic n (%) English as a first language Yes
No
10 (45.5) 12 (54.5) Highest level of education No qualifications
O Levels/GCSE/NVQ Level 1or 2
Staff role Care assistant
Senior carer Years in current care home Less than 1 year
1-5 years GCSE (General Certificate of Secondary Education); NVQ (National Vocational Qualification)
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Acceptability and feasibility of the MARQUE intervention 10.3
MARQUE training session 10.3.1
At the beginning of the intervention there were 32 staff members eligible to attend training sessions. Of the eligible staff, 16 (50%) were care assistants, 6 (19%) were senior carers, 4 (13%) were team leaders, 3 (9%) were activities coordinators, 2 were deputy managers (6%) and 1 (3%) was the home manager. Overall, 27 (84.4%) of these 32 staff members completed all 6 of the intervention sessions (either attending group sessions or receiving an individual catch up). Three (9.4%) members of staff (2 care assistants and 1 team leader) completed 5 sessions, 1 (3.1%) care assistant completed 4 and 1 care assistant (3.1%) completed 2 sessions. The median number of sessions attended was 6 (IQR 6,6). The proportion of staff attending each session (including the numbers attending a group session or an individual catch up) are described in Table 10.4. Each group session was repeated three times on different days of the week. The reasons given for non-attendance at the group sessions are described in Figure 10.3.
Table 10.4: Staff attendance at each session
Attendance n (%)
Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Group
Session
25 (78) 27 (84) 26 (81) 23 (72) 26 (81) 26 (81)
Individual catch up
7 (22) 4 (13) 4 (13) 7 (22) 5 (16) 3 (9)
Overall attendance
32 (100) 31 (97) 30 (94) 30 (94) 31 (97) 29 (90)
147 Supervision and troubleshooting period 10.3.2
The supervision period lasted for six weeks and began after the post intervention focus groups described in Chapter 11. During this time I delivered three, one hour clinical supervision sessions in the home. I met with 12 members of staff once and three members of staff twice. Staff role of those attending clinical supervision sessions is detailed in Table 10.5. Additionally, the research assistants who facilitated the sessions visited the home on four other occasions and offered informal troubleshooting sessions on the care home floors. They spoke with 24 members of staff over the course of these visits.
Figure 10.3: Reasons given for not attending a group training session
34%
(n=13)
8%
(n=3) 13%
(n=5) 5%
(n=2) 3%
(n=1) 24%
(n=9) 5%
(n=2) 5%
(n=2) 3%
(n=1)
Annual leave Emergency leave Not on shift Not on staff list Refused Sick leave
Too busy covering floor In meeting
Not known
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Table 10.5: Staff role of attendees at clinical supervision
Clinical Supervision session Staff role of attendees n (%)
Session 1 Care assistants
Senior carer
Session 3 Care assistant
Activities coordinator groups being delivered in the care home and rated for fidelity by up to 9 research assistants (8 rated sessions 2 and 6, 9 rated session 4). Five research assistants rated all three of the sessions. The intra-cluster correlation was 0.77 which indicates excellent agreement (Cicchetti, 1994). The overall mean fidelity score for session 2 was 4.33 (SD=.37), for session 4 was 4.85 (SD=.12) and for session 6 was 4.73 (SD=.21). The mean percentage of session components covered for session 2 was 91.2% (SD= 5.42, range 84-96%), for session 4 was 94.3% (SD= 4.94, range 87.5-100%) and for session 6 was 93.4% (SD= 5.65, range 85.7-100%). The mean rating for each process factor for the three recorded sessions is presented in Table 10.6.
Table 10.6: Mean fidelity rating of process factors for recorded sessions Fidelity rating
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Therefore I do not present the results. The main resident outcome measures (CMAI and DEMQOL staff proxy) were completed by staff proxy for 100% of residents at baseline and 8 month follow-up. Of the thirteen residents who remained in the study at 8 month follow-up, at baseline only one had a clinically significant level of agitation (scored ≥45 on CMAI) and at 8 month follow-up four residents had clinically significant level of agitation.
Table 10.7: Resident outcome scores at baseline and 8 months Resident measure CMAI = Cohen Mansfield Agitation Inventory; NPI = Neuropsychiatric Inventory
Staff outcomes 10.5.2
Staff outcome measures at baseline and at 8 month follow-up are presented in Table 10.8 below. 20/22 (91% completion; 95% Confidence Interval (CI) 71% to 99%) staff at baseline and 16/17 (94% completion; 95% Confidence Interval (CI) 71% to 99%) staff at follow-up completed all of the main outcome measures (Brief COPE, MBI and SCIDS). On the MCTS at baseline 53% of staff reported that they had witnessed or perpetrated at least one abusive behaviour at least sometimes in the last three months. This was 47% at 8 months. Details of the number and proportion
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of care home staff reporting that they had seen or carried out each potentially abusive or positive behaviour included in the MCTS are presented in Appendix 31.
Table 10.8: Staff outcomes at baseline and 8 months Staff measure COPE = Coping Orientations to Problems Experienced; MBI = Maslach Burnout Inventory; SCIDS = Sense of Competence in Dementia Care Staff
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