Facilitation of an end-of-life care programme into practice within UK nursing care homes: A mixed-methods study

• Published in: International journal of nursing studies 2018-06, Vol.82, p.1-10
• Main Authors: Kinley, Julie, Preston, Nancy, Froggatt, Katherine
• Format: Article
• Language: English
• Subjects: Action learning; Appreciative systems; Cognitive style; Coordinators; Cost control; Cultural change; End of life decisions; End-of-life care; Facilitation; Gold Standards Framework in Care Homes; Health care; Home health care; Home practice; Implementation; Long-term care; Mixed methods; Mixed methods research; Nursing; Nursing homes; Older people; Palliative care; Professional practice; Residential care; Savings
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2018.02.004

The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process. To identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice. A mixed-methods study. Nursing care homes in south-east England. Staff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme. Study data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by ‘following a thread’. This paper reports study data in relation to facilitation. Three facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: ‘fitting it in’ facilitation; ‘as requested’ facilitation; and ‘being present’ facilitation. ‘Being present’ facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the programme required an external facilitator who could mediate multi-layered learning at an individual, organisational and appreciative system level. The cost savings in the study outweighed the cost of providing a ‘being present’ approach to facilitation. Different types of facilitation are offered to support the implementation of end-of-life care initiatives. However, in this study ‘being present’ facilitation, when supported by multi-layered learning, was the only approach that initiated the change