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Not just a simple dressing: A practitioner inquiry exploring the complexity within residential care homes and the district nursing response

Dudman, Jennifer A. (2014). Not just a simple dressing: A practitioner inquiry exploring the complexity within residential care homes and the district nursing response. (Unpublished Doctoral thesis, City University London)


People living in residential care homes are older, frailer and sicker than ever before. Levels of dependency and co-morbidity are increasing, with neurodegenerative diseases, and dementia in particular, having a significant impact. Previous research has reported high levels of unmet needs, including healthcare needs, amongst the resident population, yet has given a limited understanding of why staff may struggle to meet these healthcare needs.

This qualitative study used a practitioner research approach to answer the following questions. Firstly, what challenges do care staff face in meeting the healthcare needs of residents, in particular those living with dementia, and secondly, what are the challenges faced by the district nursing service in supporting care staff to meet the healthcare needs of residents. Data were initially generated from an in-depth case study involving one residential care home, specialising in the provision of dementia care. Data were collected from individual (n= 7) and group interviews (n=1) with care staff and interviews with members of the district nursing team supporting this care home (n=4), together with documentation and contextual data. The practitioner researcher used herself as a research instrument to reflect on the findings from the case study, in relation to her own knowledge and experience of working as a district nurse with care homes, focusing in particular on those aspects of the work that were familiar and those that surprised. Data were analysed using thematic data analysis (Braun and Clarke 2006). To add strength to these findings, the experiences and challenges faced by staff (n=14) from other residential care homes were also sought, as well as from community nurses (n=12), community matrons (n=4) and specialist nurses (n=2) attached to these care homes. These data were compared to the findings from the original case study and reflections of the practitioner researcher, to identify findings that resonated, as well as identifying any perceived gaps.

Findings suggested that staff could struggle to manage the healthcare needs of residents, as a result of the complexity present in today’s residential care homes, complexity that was not always recognised or acknowledged, especially by those supporting care homes, including community nurses. This thesis makes a unique contribution by drawing on complexity thinking, suggesting that residential care homes are diverse, embedded systems, which are constantly adapting and are governed by simple rules, which are interpreted and applied differently by agents, according to context and individual interpretation. These are characteristics, which others, including community nurses, may be unaware of, or fail to respond to. It identifies ‘simple rules’ which could explain the response of community nurses to this complexity and suggests certain contextual and behavioural issues that may need to be addressed if the relationship between the two services is to improve and the healthcare needs of residents are to be better met.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: School of Health & Psychological Sciences > Psychology
Doctoral Theses
Doctoral Theses > School of Arts and Social Sciences Doctoral Theses
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