Exploring how the naturalistic skills of care-workers impact on the well-being of residents in care-homes: a micro-interactional study.

Background It is well established that the actions and behaviour of care-home workers are fundamental to the well-being of people they care for.

Not only do they deliver basic day-to-day care, they also perform vital psychological and social roles by providing an underlying continuity to residents - many of whom will have dementia or other cognitive problems.

Although care-home workers have a far-reaching influence on the well-being of the people they look after, they are routinely under-valued and under-trained; much of the impact they have may often simply result from the way they interact with people during their daily routines, rather than formal training.

However, despite an emphasis on the value of interaction in healthcare generally, in contrast to other groups of healthcare professionals, little behaviour-based research has focused on understanding, or capitalising on, the natural or experientially informed skills that care-workers use.

As a result of this, any training they do receive tends to focus on specific care skills, presented in isolation, rather than as knowledge embedded in a wider understanding of how they work.

Against the backdrop of an under-utilised care-skills knowledge-base, this study will provide the first detailed picture of the key naturalistic behaviours that care-workers use, that have a positive impact on the well-being of those they care for.

Aims and Objectives This will be an 18-month study which aims to: Provide the first systematic micro-analysis of the routine interaction that takes place between care-home workers and the people they care for.

Work with participants (primarily care-home staff and residents themselves) to isolate a core set of behaviours - ways that interaction is approached and conducted by care-staff - which have the greatest potential to positively impact on the every-day experience of people in care.

Use the findings of the study to develop a proposal for a substantive follow-on project that can take this core-set and translate it into an accessible, high-impact and nationally focused online training resource for care-workers. Setting and data 10 dementia-care providers will participate in the study as research sites.

These represent a range of different care-home types and dementia-care settings including: residential care-homes (n=5); care-homes offering mixed or additional services including, nursing, respite and day-care (n=3); dementia day-care providers (n=2). Up to 20 staff and residents will be recruited from each site to participate in the study.

Methods A combination of participatory and non-participatory qualitative methods will be used. Primarily: video-based observation and Conversation Analysis (CA).

Semi-structured interviews with participants will also be used, along with a variation of the stimulated recall interview process which will allow for the more active involvement of participants in determining which aspects of their interactions are significant and might be suitable for further analysis.

Impact The findings from this exploratory study will form the basis of a proposal to conduct a large-scale follow-on project.

This will focus on developing what has been learned into an extensive and practical online e-learning support and training resource that can be made openly available to all UK care-workers.