Part time PhD student
Research title: The role of the admissions assessment in monitoring the physical health of residents and the recognition of acute physical deterioration in the health of nursing home residents.
Supervisors: Professor Murna Downs and Professor Gerry Armitage
I started nurse training in 1978 and have worked with people across all ages as a midwife and as a health visitor. As a practice development nurse in a community trust I became interested in how nurses practice in different settings. I have been a lecturer in the School of Nursing since 2002 and was very fortunate to be given the opportunity to study for a PhD, commencing in 2013 on a part time basis. My interest in this subject for my PhD study came as a result of being involved in data collection in nursing homes for another project.
Older people living in care homes are vulnerable, frail and likely to have complex, clinically unstable health problems. Despite this, there is some evidence that acute physical health problems are badly managed in the care home setting resulting in unnecessary hospital admissions, increased risk of iatrogenic complications and morbidity. There is a need to improve the early recognition and appropriate management of acute physical deterioration of residents in the nursing home.
Admissions assessment and subsequent planned monitoring are key to the early recognition and appropriate management of acute deterioration in physical health of patients in hospital. However, there is little known about the admissions assessment and the relationship to planned subsequent monitoring of care home residents in the UK, and how this impacts on the recognition and management of acute physical deterioration. Interestingly, there also seems to be a tension between the key concepts of person centered care and patient safety, both central to improving the quality of acute care in the nursing home setting.
I plan to conduct a qualitative study underpinned by subtle realist methodology. The study objectives are to;
- Identify current practice in the assessment and documentation of physical health as part of the admissions process in the nursing home setting
- Describe how nurses and care staff monitor and document the physical health of residents in the nursing home setting and recognise acute physical deterioration.
- Identify how close relatives, care assistants and nurses report and escalate concerns over changes in the physical health of residents.
- Develop guidance for nurses, care staff and close relatives in recognising and reporting acute physical deterioration in nursing home residents.
So far this has been a challenging and enjoyable project. My supervisors and the other students have been very supportive and I am really pleased that I have the opportunity to undertake this study.