The evidence base for MHL
MHL has worked with over 60 academic researchers from universities across the UK to develop the evidence base for quality of life in care homes (NCHR&D Forum, 2007). The review of evidence explored ‘what residents want from care homes’ and ‘what practices work in care homes’. Eight best practice themes were identified which were then translated into a conceptual framework for use by the care home sector to inform and support practice. Sorted into three broad categories, the eight themes are:
Best Practice Themes
1. Maintaining Identity: Working creatively with residents to maintain their sense of personal identity and engage in meaningful activity.
2. Sharing Decision-making: Facilitating informed risk-taking and the involvement of residents, relatives and staff in shared decision-making in all aspects of home life.
3. Creating Community: Optimising relationships between and across staff, residents, family, friends and the wider local community. Encouraging a sense of security, continuity, belonging, purpose, achievement and significance for all.
4. Managing Transitions: Supporting people both to manage the loss and upheaval associated with going into a home and help them to move forward.
5. Improving Health and Healthcare: Ensuring adequate access to healthcare services and promoting health to optimise residents’ quality of life.
6. Supporting Good End of Life: Valuing the ‘living’ and ‘dying’ in care homes and helping residents to prepare for a ‘good death’ with the support of their families.
7. Keeping Workforce Fit for Purpose: Identifying and meeting ever-changing training needs within the care home workforce.
8. Promoting a Positive Culture: Developing leadership, management and expertise to deliver a culture of care where care homes are seen as a positive option.
You can find out more about all the 8 themes on the MHL UK website where each theme has a summary, resources and a DVD encouraging staff to learn more about residents’ lives and helps them to tailor their care to each individual. http://myhomelife.org.uk/research/8-key-themes/
Underpinning the evidence base is the importance of Relationship-Centred Care (RCC) and the Six Senses Framework (Nolan et al., 2006). Not to be confused with Person-Centred Care (PCC) which tends to focus on individual service users in promoting their independence and consumer choice, RCC focuses on developing positive relationships between older people, relatives and staff as interdependence is seen as an important ingredient of quality in care. For relationships within a care home to be good, consideration must be given not only to the needs of individual older people who live and die in the home, but also to the needs of relatives who visit the home and the staff who work in the home. Based on empirical research in long term care settings, Nolan et al. (2006) highlighted the importance of six senses (Six Senses Framework) for good relationships to exist between residents, relatives and staff. Nolan and his colleagues argue that each of these three groups of people in the care setting (older people, relatives and staff) need to feel a sense of:
1. Security – to feel safe
2. Belonging – to feel part of things
3. Continuity – to experience links and connections
4. Purpose – to have a goal(s) to aspire to
5. Achievement – to make progress towards these goals
6. Significance – to feel that you matter as a person
Belinda Dewar’s (2012) work on Compassionate Care 3 provides a vehicle for achieving relationship-centred care through a process of open questioning (The Seven C’s) which focuses on,
- being courageous (e.g. What matters? What would happen if we gave this a go? What is the worst that could happen if you did this?)
- connecting emotionally (e.g. How did this make you feel?)
- being curious (e.g. What strikes you about this? What prompted you to act in this way? What helped this to happen?)
- collaboration (e.g. How can we work together to make this happen? What do you need to do to make this happen?)
- considering other perspectives (Help me to understand where you are coming from. What do others think? What is real and possible? What might the other person be thinking?)
- compromising (What is important to you? What would you like to happen?)
- celebrating (What worked well here? Why did it work well? How can we help this to happen more of the time? What are our strengths in being able to achieve this?)