Measuring context of care
Developing a tool to measure context of care in residential and community learning disability settings in England: An interdisciplinary endeavour
The project involved three systematic literature reviews which informed the development of the ‘Context of care tool’. Focus groups were used to assess the validity of the tool.
The tool was pilot tested across a range of services across England. Outputs of the project underpin the NHS National Quality Board and NHS Improvement’s improvement resource for sustainable and productive staffing for learning disability services.
About the project
The project started as a response to the very public concerns about nursing numbers needed to deliver safe and compassionate care. These concerns were further highlighted by the Francis Report and the Royal College of Nursing. As part of the implementation of the national Compassion into Practice Programme, UWL was commissioned to undertake this project for ‘ensuring we have the right staff with the right skills in the right place: learning disabilities’ (DH, 2012).
Three separate systematic reviews were undertaken using a thematic approach to synthesising data into a narrative. The first two focused on learning disability and the relationship of nursing staffing levels to the safety, quality and the delivery of compassionate nursing care. The third was broadened to include safe and sustainable staffing and interdisciplinary care.
Literature meeting inclusion criteria were reviewed and organised into eight themes, which included;
- level of client need
- staff attributes
- staff perception of challenging behaviour
- job satisfaction
- working as a team
- stress, burnout and work overload
- organisational support that includes staff feedback
- working in the community.
All of these themes comprise ‘factors’ extracted from the literature reviewed, which is collectively referred to as ‘Context of Care’ and was developed into a paper-based tool and subsequently into Microsoft Excel-based tool.
Fundamental to the development of this tool has been an underlying belief that focussing purely on numbers of staff alone would not address shortcomings in practice or services. Rather, it was thought important to develop a tool that could support clinicians' capability and capacity in their ‘context of practice’ to deliver safe and compassionate care.
The tool has been subjected to expert interdisciplinary validation, testing, and evaluation.
The developed tool will be available as a resource for use locally, regionally and nationally. Developmental work has been well received along with acknowledged limitations. Steps are being taken to move this work forward to help clinicians deliver safe and compassionate care to people with learning disabilities in various care settings in England and more widely.
The work undertaken demonstrates how different academic disciplines within a university environment can work collaboratively with colleagues in practice to generate a tool able to respond to a national health agenda.
Impact
The literature reviews and the context of care tool underpin the NHS National Quality Board improvement resource for sustainable and productive staffing for learning disability services.
The research team
- Professor Kay Mafuba, London College of Nursing, Midwifery and Healthcare, University of West London
- Professor Bob Gates
- Maria Cozens, Lecturer in Learning Disability Nursing, London College of Nursing, Midwifery and Healthcare, University of West London.
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