Community Education Provider Network (CEPN) Narratives in care homes
Dr Lukshmy Jeyalingam
The background to the project
At a meeting of Brent and Harrow GP educators, concern was expressed about the difficulty of providing effective training to staff working in residential care home settings, with a particular focus on reducing some of the homes' high call out rates to London Ambulance Service.
It was also recognised that, as well as GPs, other agencies were also involved in healthcare provision including the local acute trusts, community pharmacists, London Ambulance Service, palliative care teams, and local hospices. It was strongly felt that they should be also included in any educational process.
The Community Education Provider Network (CEPN) was created as a pilot scheme, bringing together professionals across different care home disciplines and using narrative reflection in order to explore their concerns and educational needs.
Funding came from a bid from HENWL.
The high number of emergency call outs, admissions and deficiencies of daily personal and pastoral care of care home residents frequently hit the headlines.
Listening to others’ experiences and anecdotes has led primary care educators to question current training and attitudes towards this patient group and consider how
best to work with learners and carers to bring about positive change.
How Narrative groups can make a difference
These narrative based techniques for learning, Balint groups, are evidence based and already utilised in training for other healthcare providers.
- To provide an opportunity for participants to reflect on their work.
- To provide an emotional outlet for anxieties and frustrations generated by their work.
- To rekindle a participant's curiosity in a patient whom they have previously found difficult or upsetting.
- To open a participant's mind to alternative ways of managing a patient.
- To enhance the sense of satisfaction in one’s work.
- Introducing narrative reflective learning methods into four care homes in Brent and Harrow.
- Bringing together all the agencies involved in delivering acute care to care home residents.
- Exploring the educational needs of care home workers.
What we did
We set up narrative-based groups for carers in four care homes in Brent & Harrow that had high Ambulance Service call-out rates. Each group is enriched by innovative multi-disciplinary facilitator pairings.
Before the first sessions we interviewed the care home managers to identify their own perspective on the educational challenges facing their staff.
We took care to arrange the sessions for a time of day when the care home staff would be available, as well as arrange a room for the session that would be free at that time.
Selection of the multi professional facilitators began with two taster sessions run by GP Programming Directors who had experience in running narrative groups.
The narrative education sessions were delivered in two phases:
We set up narrative-based groups for front line care home staff in four care homes in Brent & Harrow that had high Ambulance Service call-out rates. The homes were offered 7 narrative group sessions each 2 hours long.
To enrich the process we ensured that the group facilitators were from different, related, disciplines. We consulted the relatives groups in the homes to gain insights into carer, residents and relatives wishes.
The phase 2 model invited care home staff to attend 4 whole days of training, run by trained multi-professionals, held in a single venue (the hospital postgraduate centre) enabling each of the homes to send as few as 2 or as many as 8 staff for training.
The mornings provided personal development and narrative based group work, while the afternoons delivered sessions on four key areas that had been identified as priorities in Phase 1. These were: Wound Care, Managing Challenging Behaviour, End of Life Care and Reducing Falls.
For delivery of Phase 2 we recruited 10 multi-professional fellows: 2 LAS Paramedics, 3 GPs who had completed their training in the last year, a Palliative Care Social Worker, a Healthcare Assistant, a Community Psychiatric Nurse, an Occupational Psychologist and a consultant in Old Age Psychiatry.
The feedback suggests that it did make a difference to those who attended and sustained investment is needed. Care home workers would recommend this style of narrative group to colleagues and would like narrative groups to continue.
The group’s found learning with other managers to be of great value.
Free text comments from participants
"Priceless- support at a level that is much needed. An approach that focussed on inner issues, while improving functioning".
"I have gained better insight into the importance of making staff feel valued".
“I learned that we have to be able to ask and talk about the needs that we are unable to solve in ourselves. We are there to support each other”.
“It is easy to deal with the next situation because of the experience and knowledge we have shared”.
“It was helpful to discuss the stress, hardship and feelings staff encounter when dealing with residents”.
“In previous meetings we were never asked about how we feel, I know this is important now”.
"By the final session the group was very talkative, described themselves as a family, were happy to discuss more complex cases and share insights about themselves (including things they had never shared before), were happy to sit in a circle beside other carers and the facilitators, and were very sad that this was the final session”.
What we achieved
In creating a narrative forum, we enabled the participants to share many emotionally challenging experiences with the narrative group. This form of sharing was beneficial to them individually and also the wider group.
We provided the participants with an opportunity to reflect on the work they do and gave them an emotional outlet for anxieties and frustrations generated by their work.
We evaluated the groups with qualitative feedback from care home workers, care home managers, group facilitators and relatives. We also performed quantitative assessments of compassion and burnout.
100% of care home workers felt sessions were useful.
100% care home workers learned something new about their residents through the groups.
100% care home workers would feel more prepared to manage similar residents in the future as a result of the discussions in the groups.