Exploring the meaning of care in nursing care homes for older people

Background: A burgeoning ageing population (age 65+) and concerns over malpractice and abuse of older residents living in nursing homes pose unique challenges for health and social care service commissioners and providers. Yet little is known about this context or staffs’ and older residents’ views of nursing home care in the United Kingdom (UK). The aim of the present Health Psychology doctoral research was to explore wider contextual influences on care delivery at organisation level; explore staffs’ and residents’ perspectives of the meaning of ‘care’; and identify barriers and facilitators to the delivery of this ‘care’ ideal. Methods: A Critical Realist and qualitative approach examined contextual and embodied influences on UK nursing home provision at national, organisational and individual levels. Participants were three nursing homes for older people in North England, four care staff, and fourteen residents. Data: Ethnographic observations, visual methods (photo-elicitation), and object-elicitation were adopted during data collection. The data corpus included a literature review; photographs and researcher observation field notes; and orthographic transcriptions from a focus group with nursing home care staff and interviews with residents. Analysis: The data corpus was analysed using Thematic Analysis (informed by Braun & Clarke, 2006) from a critical stance. Findings: At national and nursing home organisational level care was structured around risk-averse and rationalised (‘for profit’) discourses, and represented a medical model of care. Rationalised, prohibitive, medically-driven care provision was found to conflict with nursing home staffs’ and residents’ positioning of appropriate ‘care’, which was more aligned with relationship-centred models of care. Recommendations for future research and practice are made in light of present findings.