Topic: Dementias and neurodegeneration, Ageing
Conditions
Interventions
CLECC has been designed for use by ward nursing teams in inpatient settings for older people. The implementation programme takes place over a 4 month period but it is designed to lead to a longer-term
Sponsors
University of Southampton
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Wards: The two adult medical inpatient wards in each NHS hospital trust with the highest proportion of patients aged 65+ years will be included in the study. These are likely to be medical wards specialising in older people's care. In addition we will include the medical/surgical ward with the highest proportion of older patients that is not a medicine for older people ward. This ward mix will enable us to explore feasibility in a mix of medicine for older people and nonmedicine for older people wards. 2. Staff: All nurses and care assistants (CAs) (health care assistants, assistant practitioner, nursing auxiliaries) working on participating wards during any data collection period will be invited to be interviewed and eligible to complete the nursing questionnaires. For the observations, all interactions between patients and staff (of any discipline) working on the ward or visiting the ward will be recorded during the planned periods. 3. Patients: All adult patients on participating wards will be eligible to take part in the qualitative interviews, to be included in observations of care and to complete the questionnaires. Routine collection of age and cognitive status data will enable assessment of the relative participation rates of different groups. Only people who are able to complete a questionnaire in English with interviewer help (as assessed by the researcher and/or ward staff) will be invited to take part in the patient survey. The decision to focus on including people who understand English is a practical one, in that we anticipate some communication difficulties in relation to old age in a high proportion of the sample, and we are concerned that the likely small sample of people with language differences will not enable us to properly represent the views of people who have language difficulties. Ability to speak English will not determine whether or not patients are invited to have their care observed. Only people who speak English and who have the cognitive and communicative capacity to agree to take part in a research interview and to be interviewed (as assessed by the researcher and/or ward staff) will be invited to take part in the qualitative interviews. 4. Carers/visitors: Primary family carers of patients on participating wards or, where there is no primary family carer, regular visitors (visits 3+ times per week).
Exclusion criteria
Exclusion criteria: 1. Wards: Critical care units will not be included. Wards will be excluded if departure of ward manager is anticipated in the subsequent 6 months of attempted recruitment 2. Staff: all nurses and care assistants (CAs) (health care assistants, assistant practitioner, nursing auxiliaries) working on participating wards during any data collection period will be invited to be interviewed and eligible to complete the nursing questionnaires. Nursing students, bank and agency staff will not be eligible. For the observations, all interactions between patients and staff (of any discipline) working on the ward or visiting the ward will be recorded during the planned periods. 3. Patients: Patients will be excluded if they: 3.1. Are assessed by the recruiter or by clinical staff who know the patients as lacking capacity to decide about taking part in the research and/or unable to communicate their choices about taking part in the research AND 3.2. A consultee (as defined by the Mental Capacity Act) cannot be consulted (NB patients who lack capacity will be included if a consultee advises this is appropriate and the patient indicates that they are happy for data collection to proceed) 3.4. Patients who indicate either verbally or nonverbally that they do not wish to take part 3.5. Patients who are unconscious or where there are clinical concerns that may preclude them from being approached 3.6. Patients receiving continual clinical care that would impair their capacity to make a decision about taking part that is free from distraction 3.7. Patients with communication difficulties, including e.g. language differences, auditory impairments, that impair the recruiter's ability to communicate the research or the patient's ability to communicate their choice about taking part 3.8. Patients are unable to complete a questionnaire in English with or without interviewer help 3.9. People will be excluded from the qualitative interviews if the researcher and/or clinical staff assess them as lacking the cognitive and communicative capacity to be interviewed
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. The quality of staff-patient interactions using QUISS, a time sampling tool that gives a measure of both the volume and quality of interactions; Timepoint(s): Timepoints 1 and 2 (pre and post intervention). 2. Patient-reported evaluations of emotional care measured using PEECH and PPE-15 2.1. The Patient Evaluation of Emotional Care during Hospitalisation (PEECH) survey tool focuses on the nature of interpersonal interactions with hospital staff and patient-reported assessment of the extent to which therapeutic emotional care has occurred. Questionnaires will be distributed to all eligible patients over a 4 week period at each assessment period and response rates will be assessed on an ongoing basis. 2.2. Nurses’ self-reported empathy will be established using the Jefferson Scale of Empathy (JSE)(Physician/HP version). All nursing staff currently working on each ward will be invited to complete the written questionnaires at each assessment period. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Climate for Care (CC) and Factors that Enable Climate for Care (FECC) questionnaires will be administered. 2. We will also assess nursing staff perceptions of workload using items from the International Hospital Outcomes Study battery (IHOS) 3. Perceptions of improved quality of care could also lead to higher job satisfaction and reduced burnout so we will measure levels of burnout using the 22 item Maslach Burnout Inventory (MBI). The target sample is 40 nurses per ward recruited, so a total of 120 per site. 4. Further all eligible carers/visitors on each ward over a four week period will be targeted and invited to complete a Carer Experiences of Care (CEC) questionnaire. The target sample is 16 carers/visitors per ward per assessment period. | — |
Countries
England, United Kingdom
Outcome results
None listed