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Chapter 2: Literature Review
Murphy (2007) specifically examined quality of care in residential care services in
Ireland (public, private and voluntary). Adopting a mixed-method approach, one part
of this study used a self-response questionnaire and elicited a 68% response rate from
a sample of 498 nurses. The aim was to identify the underlying dimensions of quality
care and the key factors that have an impact on quality care. Organisational
approaches to care, such as resistance to change and being bound by routine, were
found to be factors that hinder overall quality of care.
Two projects in the UK have attempted to introduce different approaches to care and
subsequently examine the difference it makes to older people: the CARE profiles
(Faulkner and Davies, 2006) and the My Home Life project (Help the Aged, 2006).
These projects focused on the need to actively encourage older people to participate
in their care and thus enhance their autonomy and quality of life. The findings
support a link between an organisation’s approach to care, and autonomy and quality
of life. Faulkner and Davies (2006) outline the CARE profile (Combined Assessment
of Residential Environments), which was developed in Canada and tested in the UK.
This project represents a more flexible and client-driven approach to care. It aims to
potentially optimise the potential of clients, improve their quality of life and create a
more empowered workplace. The resident should be supported and enabled to lead
his/her own care to the greatest extent possible. The client and the caregiver should
actively engage in a partnership that builds on each other’s strengths, resources and
expertise to make care decisions. The project involves gathering information from
residents, residents’ families and from staff in order to celebrate what works well in
the home and to identify areas that need attention. The aim of the project was to
identify day-to-day events that could be made more positive in relation to residents’
autonomy and quality of life. It has involved 28 residents, 25 staff and 38 relatives in
seven care homes in South Yorkshire, UK. It has found so far that poor staffing
levels and workload constraints feature prominently, and consequently affect several
aspects of social care such as communal activities and one-to-one staff/resident
interactions. Simply “getting the work done” contributes to staff feeling dissatisfied
with their work and being socially detached from the residents. Ultimately this
affects the opportunities available for residents to express their autonomy and to
express a satisfactory quality of life.