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Journal article

Relational practice as the key to ensuring quality care for frail older people: discharge planning as a case example

Authors:
WILLIAMS Sion, NOLAN Mike, KEADY John
Journal article citation:
Quality in Ageing, 10(3), September 2009, pp.45-55.
Publisher:
Pier Professional
Place of publication:
Brighton

Discharging frail older people from acute hospital settings has been an issue of concern for over 40 years and recent studies suggest that enduring problems remain. This paper explores the experiences of discharge from three different units: an acute surgical ward, an acute medical ward and a specialist ward for older people. Based on extensive data from interviews with older people, their family carers and ward-based staff, a grounded theory of the discharge experience is presented. This suggests that the quality of discharge hinges largely on whether the focus of efforts is on ‘pace’ (the desire to discharge older people as rapidly as possible) or ‘complexity’ (where due account is taken of the complex interaction of medical and wider social issues). When pace is the focus, ‘pushing’ and ‘fixing’ are the main processes driving discharge. However, when attention is given to complexity, far more subtle processes of ‘informing’ and ‘brokering’ are in evidence. These latter processes are conceived of as forms of ‘relational practice’ and it is argued that such practices lie at the heart of high quality care for older people.

Journal article

Developing personal relationships in care homes: realising the contributions of staff, residents and family members

Authors:
WILSON Christine Brown, DAVIES Sue, NOLAN Mike
Journal article citation:
Ageing and Society, 29(7), October 2009, pp.1041-1063.
Publisher:
Cambridge University Press

Using a constructivist approach, the nature and types of relationships between residents, staff and family members were explored in three care homes in England using combined methods including participant observation, interviews and focus groups. The data collection and analysis occurred iteratively over 21 months and three types of relationships were identified: ‘pragmatic relationships’ that primarily focus on the instrumental aspects of care; ‘personal and responsive relationships’ that engage more fully with the particular needs of individual residents; and ‘reciprocal relationships’ that recognise the roles of residents, staff and family members in creating a sense of community within the home. This paper explores the contributions made by staff, residents and family members in the development of these relationships. The findings enhance our understanding of the role of inter-personal relationships in care home settings and of the factors that condition them. The implications for developing improved practice in care homes are also considered.

Journal article

The impact of information and communication technology on family carers of older people and professionals in Sweden

Authors:
MAGNUSSON Lennart, HANSON Elizabeth, NOLAN Mike
Journal article citation:
Ageing and Society, 25(5), September 2005, pp.693-713.
Publisher:
Cambridge University Press

This article explores the perceived benefits of, and barriers to, information technology as a means of supporting family carers of older people. Following a brief overview of the care-giving literature, with particular reference to the Swedish context, interview and questionnaire data collected from 34 families who took part in the Swedish ACTION project are used to explore the role of user-friendly information and communication technology to inform and enable family carers of older people to exercise choice, to care more effectively and to work in partnership with professionals. Interview data from two groups of professionals that utilised ACTION are also examined to throw light on its potential benefits for both carers and professionals. Consideration is given to the barriers to using information technology, and to identifying those carers most likely to benefit. Areas for further development are the need for practitioners' education and a wider range of programmes to address carers' diverse needs. Clearly, lessons learned from the Swedish project have wider relevance, given that new forms of support are being developed in most technically advanced countries.

Journal article

We do things together’:a case study of ‘couplehood’ in dementia

Authors:
HELLSTROM Ingrid, NOLAN Mike, LUNDH Ulla
Journal article citation:
Dementia: the International Journal of Social Research and Practice, 4(1), February 2005, pp.6-22.
Publisher:
Sage

The value of the single case study is well established in dementia care with the seminal contributions of Alzheimer and Kitwood being based on the study of individuals. This article presents a case study of an elderly married couple living with dementia and explores how their relationship has continued to flourish. In drawing on their story we highlight ways in which both partners seek to ‘maintain involvement’ of the person with dementia (PWD), and consider the various types of ‘work’ that is required. We suggest that whilst the ‘personhood’ of the PWD as an individual has received much recent attention, a consideration of ‘couplehood’ is also essential to a full understanding of how spouses live with and respond to the impact of dementia.

Journal article

Gauging quality in constructivist research: the Aldre Vaste Sjuharad model revisited

Authors:
NOLAN Mike, et al
Journal article citation:
Quality in Ageing, 4(2), August 2003, pp.22-27.
Publisher:
Pier Professional
Place of publication:
Brighton

The Aldre Vaste Sjuharad Centre in West Sweden has as its main goal the promotion of partnerships between older people and their families. In pursing these goals the Centre adopts a broadly constructivist method to research that is 'authentic and meaningful' to those that take part. This paper assesses the quality of the resultant research.

Journal article

Training together: a challenge for the future

Authors:
NOLAN Mike, KEADY John
Journal article citation:
Journal of Dementia Care, September 1996, pp.10-13.
Publisher:
Hawker

The rise in status of dementia care and respect for its expert practitioners throws the issue of training into the spotlight. The authors open the debate with this overview of current deficits in professional education.

Journal article

Older people and decision-making following acute stroke in China: ‘hiding’ as a barrier to active involvement

Authors:
WANG Yue, NOLAN Mike
Journal article citation:
Ageing and Society, 36(7), 2016, pp.1526-1554.
Publisher:
Cambridge University Press

Decision-making among older patients with stroke, their families and professionals has been extensively studied in a Western context, but there has been little prior work in China. The study reported here explored how decision-making took place between older people with stroke, their family carers and professionals in an acute care context in mainland China using a constructivist grounded theory approach. Data were collected through semi-structured interviews, participant observation and documentary analysis. Constant comparative analysis of the data was carried out. This paper focuses on the key social process of ‘hiding’ and its dynamic relationship with the core category ‘keeping the peace’. In order to meet the traditional Chinese cultural value of ‘maintaining harmony’, both family carers and professionals hid essential information from older stroke survivors who, as a consequence, were effectively precluded from playing an active role in major decisions. In understanding ‘hiding’, the paper draws upon both Chinese cultural values and ‘awareness context theory’ and in so doing questions the relevance to the Chinese context of key Western notions such as involvement in health-care decision-making. A better understanding of the experiences of decision-making processes between older people with stroke, their family carers and professionals in China will help professionals to provide the best possible support and care whilst promoting informed decision-making amongst all concerned.

Journal article

Transitions in care homes: towards relationship-centred care using the 'Senses Framework'

Authors:
NOLAN Mike, DAVIES Sue, BROWN Jayne
Journal article citation:
Quality in Ageing, 7(3), September 2006, pp.5-14.
Publisher:
Pier Professional
Place of publication:
Brighton

Long-term care in general, and care homes in particular, have never enjoyed high status as a place to live and work. This marginalised position is largely due to the continued failure to value the contribution that care homes make to supporting frail and vulnerable older people. In order to promote a more positive vision of what can be achieved in care homes, this paper argues for the adoption of a relationship-centred approach to care. The need for such a model is described, and how it might be applied using the 'Senses Framework' is considered. It is argued that adopting such a philosophy will  provide a clearers sense of therapeutic direction for staff working in care homes, as well as more explicitly recognising the contribution that residents and relatives can make to creating an 'enriched environment' of care.

Journal article

'Making the move': relatives' experiences of the transition to a care home

Authors:
DAVIES Sue, NOLAN Mike
Journal article citation:
Health and Social Care in the Community, 12(6), November 2004, pp.517-526.
Publisher:
Wiley-Blackwell

Despite a growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the caregiving career, relatively few studies in the UK have explored this experience in depth. The research on which the present paper is based sought to better understand experiences of nursing home placement from the viewpoint of relatives. The study was informed by a constructivist perspective. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a nursing home. Data analysis revealed three phases of the transition from the relatives' perspective: 'making the best of it'; 'making the move'; and 'making it better'. The relatives' experiences across these phases were understood in terms of five continua, reflecting the extent to which they felt they were: operating 'under pressure' or not; 'working together' or 'working alone'; 'supported' or 'unsupported', both practically and emotionally; 'in the know' or 'working in the dark'; and 'in control of events' or not. This paper reports on the findings which relate to the second phase of the transition, 'making the move', which relates to experiences around the time of relocation to the care home environment. The findings suggest that health and social care practitioners have enormous potential to influence relatives' experiences of nursing home entry. Experiences are enhanced if family carers perceive that they are able to work in partnership with care staff in order to ease the transition for the older person.

Journal article

'Making the best of things’: relatives' experiences of decisions about care-home entry

Authors:
DAVIES Sue, NOLAN Mike
Journal article citation:
Ageing and Society, 23(4), July 2003, pp.429-450.
Publisher:
Cambridge University Press

Despite the growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the care-giving career, relatively few British studies have explored this experience in depth. Informed by a constructivist perspective, this study sought a better understanding of nursing home placements from the viewpoint of relatives. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a nursing home. Analysis revealed three perceived phases to the transition: ‘making the best of it’, ‘making the move’ and ‘making it better’. The relatives' experiences through these phases had five perceived elements, all of which were continua, from absent to very strong, reflecting the extent to which they were felt. They were: operating ‘under pressure’ or not; ‘in the know’ or ‘working in the dark’; ‘working together’ or ‘working alone’; ‘in control of events’ or not, and ‘supported’ or ‘unsupported’ both practically and emotionally. This paper reports findings about the first phase of the transition, ‘making the best of it’, and documents the experiences of decision-making about nursing home placements. It is argued that health and social care practitioners have enormous potential to influence whether or not helping a relative to move into a nursing home is perceived as a positive choice.

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