Monthly Archives: June 2019

Thoughts ahead of the Enabling Research in Care Homes forum (12th July)

Hospitals in England are facing unprecedented demand that they are struggling to meet. More people are being admitted to hospital in emergency situations that ever before. The increase in demand has led some people to look for admissions that could be considered avoidable. One group of people who have received particular attention are care home residents. Care home residents are amongst the ‘oldest old’ in society – research suggests that over half of all care home residents aged 85 years or above. What is more, care home residents often have multiple health conditions and a wide range of complex health and social care needs.

For some care home residents, the risks associated with a stay in hospital can outweigh the potential benefits. Care home residents are at risk of further physical decline due to prolonged periods of inactivity and the risk of contracting hospital-acquired infections. A transfer to a busy hospital can also be confusing, stressful and associated with cognitive decline. In particular, people with moderate and advanced dementia may become increasingly agitated and frightened at being placed in unfamiliar surroundings, cared for by unfamiliar people.

In recent years a number of NHS organisations have introduced initiatives to reduce the number of hospital transfers from care homes. Published evaluations of these schemes are lacking and hospital transfers from care homes remain poorly understood. A particular gap in knowledge surrounds the views of care home staff. This is surprising given the pivotal role that care home staff play in managing residents health conditions. Often care home staff are involved in initiating a transfer – for example, when a carer notices a resident is “not quite right”.

The research I am conducting as part of my PhD is seeking to understand the work that goes on in a care home prior to a hospital transfer taking place. This includes the chain of events that precede a transfer and the decision-making processes that staff undertake. I have interviewed 30 members of care home staff across 6 care homes in both the East and West Midlands. The findings that I will present during the ENRICH East Midlands forum on Friday 12th July will outline some of my key findings.

In particular, my talk will cover: how do care home staff feel about transferring residents to hospital, who is involved in the transfer process, how do staff decide when to call for help, what factors influence the decisions that care home staff make? In addition, I will also cover a number of practical take home messages for care home staff about how to improve the care of residents around hospital transfers.

My research takes a new approach towards understanding hospital transfers from care homes, by listening to the views and experiences of care home staff. This approach could provide new insights about how to reduce the number of ‘inappropriate’ transfers and be an important first step in developing high quality alternative services for care home residents.


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EnRICH  (Enabling Research in Care Homes) is a network specifically set up to promote research in care homes and provide the opportunity for care home residents to take part in research . EnRICH supports care home staff and researchers to set up studies and organises 3-4 Forums a year .

Post written by Fawn Harrad ahead of the ENRICH forum. Fawn is an PhD student at the University of Leicester. She has previously worked in both the NHS and social care settings. Fawn’s research focuses on hospital transfers from care homes. In particular, she is interested in the work that goes on in a care home before a transfer takes place, including the actions and decisions that care home staff undertake before a resident is transferred to the hospital.

Contact details: /  @FawnHarrad



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When Rest in Peace is not enough:Nursing my tribute to the Late Sarah Wheeler, Founder of The Dragon Café


When I was a student nurse, I often wondered if there was a space outside the acute mental health wards where people could experience the type of freedom that they talked about away from the mundane, restricted and controlled environment that offered little or no activities to stimulate the mind. I asked for placements in community mental health services, and I was very disappointed to see that some of the nurses in the community mental health services had similar attitudes as some nurses that I saw on the wards. Some mental health nurses are tired with very high levels of empathy fatigue, lack of compassion and the depersonalisation of people that had their identities replaced with labels such as bed number 3, the one that paces about and the one this, and the one that. Thus, when I qualified as a mental health nurse, I knew exactly the kind of nurse that I wanted to be; the opposite of the nurses that I described above. Why do you care so much a nurse once asked? I remember suggesting to some nurses that they should use my method of care, which I refer to as ‘The JoBardi’s Face Off Model of Care in Nursing’. Face Off is when a nurse replaces the face of the patients with the face of a family member, friend or loved one. I am confident that the quality of care will improve if nurses adopt ‘The JoBardi’s Face Off Model of Care in Nursing’.

And so, as a mental health nurse, my search for a community space where people could be themselves without the restrictions continued until 2014 when I joined LinkedIn and wrote a summary with a conclusion that read something like ‘I would like to do a PhD in Social and Community Psychiatry’.  A few days later, I received a message from Alan Sarll, who suggested that I contact Sarah Wheeler and consider researching The Dragon Café for my PhD. I emailed Sarah, she replied, we met, discussed the PhD and the rest is in the past, present and the future that now beholds my PhD and me. I should probably thank the nurses because their attitude motivated me to seek out something different; I found Sarah and The Dragon Café. 


Last two weeks when I have received the 2018/2019 Tri-Campus Postgraduate Prize, I reflected on how my PhD started, and I took another look at Sarah’s Order of Service which I have had on my study desk since 2016. This year marks the third anniversary of Sarah’s death, and it reminds me of how it all started. You know, the journey that most of us now call Josephine’s PhD, the award-winning presentation Floorboards, Whitewalls and Butterflies, and poster, S P A C E.

I feel extremely privileged to have received the Economic and Social Research Council (ESRC) PhD funding to study The Dragon Café. I am in the final year and still wondering how I got here. Yes, how did this all start? In the last few months, I have been writing my findings chapter, and the meaning that participants attached to ‘a sense of loss’. As I write this blog, I am feeling the loss of someone who gave me something that I did not quite realise was the gift that would take me to several parts of the world where I have attended and presented at 18 conferences, met, interacted and learned a lot from some wonderful people.

Over the years, I have thanked and will continue to thank a lot of people for their support of my PhD journey. Indeed, I would not have started or continued without the ESRC funding, my extraordinarily supportive supervisors; Professor Paul Crawford, Professor Stephen Timmons and Dr Nicola Wright , who nurtured my unconventional way of thinking,  @UoN_SHS and the  @UoNgradschool. More importantly, I want to thank 250 plus patrons including volunteers and gatekeepers who accepted, socialised, participated in activities, interacted with me informally and formally, and provided me with rich and diverse data about their experiences of attending The Dragon Café.

However, the first credit truly belongs to one person; the Late Sarah Wheeler, Founder and Creative Director of The Dragon Café. Therefore, in this final lap of my PhD and the third anniversary of Sarah’s passing, I would like to pay this tribute to Sarah. To say thank you, my friend, and my inspiration, for creating something that made it possible for me to access a crypt in a church where I saw myself in others and others in me through my ethnography of The Dragon Café where I learnt the true meaning of the word; SPACE.


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Josephine NwaAmaka Bardi  is a final year Economic and Social Research Council (ESRC) PhD Student at the University of Nottingham and Founder of the Campaign the Raise Awareness of Mental Health in Higher Education 

She has developed The RAMHHE Research Activity Model for Educators, a novel, non-clinical and pedagogical model for exploring the meaning and understanding of mental health among university students. This will soon be published in the Nurse Educator Journal (Wolters Kluwer Health).





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