Exploring expertise: new research on residential care for older people in Ireland

Published: 20 February 2013

The All Ireland Gerontological Nurses Association is conducting exciting new research exploring nursing expertise in residential care for older people in Ireland. AIGNA members Amanda Phelan and Professor Brendan McCormack report.

Building on previous work (Heath and AIGNA 2010), the All Ireland Gerontological Nurses Association (AIGNA) and Nursing Homes Ireland (NHI) commissioned the new study.

Data collection

Twenty-three “case study nurses” were recruited from Irish nursing homes. The research used six data collection methods:

1.   Each case-study nurse was shadowed for a period of two-and-a-half hours by one of the researchers and notes were taken about his/her nursing practice
2.   for each case study, interviews were undertaken with a nominated colleague (registered nurse or a health care attendant) and
3.   interviews were undertaken with an older resident with mental capacity in receipt of care from the case study nurse
4.   a demographic profile was completed by the case study nurse
5.   a survey was completed by the case study nurse’s director of nursing
6. delegates at AIGNA’s annual conference in June 2012 participated in modified focus groups to explore nursing expertise in residential care of older people.

Analysis

All data sources were analysed using predetermined categories.

Firstly, the admission to residential care presented the complexities of the resident’s needs and the skills required - this expertise was immersed in needs related to functional and cognitive challenges but also issues such as the psychological adjustment to nursing home life. The establishment of depth relationships was fundamentally considered to be embedded not only in professionalism but in genuine friendship and unconditional positive regard.

Secondly, the context of the nursing home was examined as this was found to significantly contribute to the expertise of the case study nurse.

To provide an alternative lens to examine nursing expertise in residential care, one case was analysed using Titchen’s framework (2001). This is based on examining aspects related to “skilled companionship” of the case study nurse in his/her daily nursing practices.

Findings: revealing the extraordinary

Findings revealed the depth of expertise involved in the daily interactions of the case study nurses. The examination of the “ordinary” revealed the “extraordinary”, as the complexity and diversity of care was uncovered. Such care was immersed in domains such as the delivery of direct, empirically based nursing care to residents, collaboration within a multi-disciplinary team, leadership skills, practice development, supervision and education of colleagues as well as expert intuition in practice. As such the case study nurses worked within a defined community of practice to deliver excellence in reflective, person-centred care through genuine engagement with colleagues, relatives and most importantly, the residents.

This research is significant as it distinguishes the importance of registered nurses in residential care and dispels the notion that such practice is unchallenging, lacks expertise or could be substituted unproblematically within a more diluted skill mix team.