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Belinda Dewar speaks about her experience since taking up the post of Nurse Consultant for care homes across Scotland in April 2006.

The post is funded by the Scottish Executive and I am employed by the Scottish Commission for the Regulation of Care (known as the Care Commission). It is a national post and the first of its kind. It was set up with a view to maximising the quality of life of residents in care homes by encouraging and supporting staff in this sector to deliver evidenced based care. There are 997 care homes for older people across Scotland. The post was developed against the backdrop of the current policy which emphasises an integrated approach to health that is wider than the NHS; to develop skills which anticipate more readily the needs of vulnerable older people; and to develop both the capacity and capability of leaders within the care home sector.

The post acknowledges that nurses in the care home sector can play a key role in delivering new policy agendas.

The priorities of the post are also set within the principles of the Care Commission, whose aim is to raise standards of care by involving people who are cared for, their families and carers, and those who provide care.

Following consultation with key stakeholders three priorities were established for the post.

• To develop a learning culture within the care home sector, which draws on key partnerships
• To foster evidenced based relationship centred care that promotes dignity, respect and citizenship
• To promote a positive identity of the care home sector with relevant stakeholder groups

The post is working alongside the national My Home Life (MHL) programme led by Help the Aged. The overall vision driving the work of the MHL programme is to improve quality of life of those living in, dying in, working in and visiting care homes.

Relationship-centred care
The evidence-base underpinning the My Home Life programme is provided by a review of the literature on best practice (NCHR&D Forum, 2007). It argues that ‘relationship-centred care’ is considered to be at the heart of delivering quality of life for residents and captures the importance of good interaction between residents, relatives and staff. The Senses Framework (Nolan et al., 2006) emerged partly in response to the dignity agenda, and provides a useful tool for delivering relationship-centred care. Developed in consultation with those living in, visiting and working in care homes for older people, the framework highlights the importance of residents, relatives and staff having a sense of security, belonging, continuity, purpose, fulfilment and significance in their daily lives.

Progress to date with the 3 priorities includes the following activities:

• Established a care home learning network of which there are 300 members registered on the web based element. The network has been positively evaluated. It can be accessed at www.carecommission.com
• Established action projects in thirteen regions throughout Scotland. These focus on, for example, improving partnership working across NHS and care home boundaries, developing the ‘ideal care plan’, rolling out of a programme on good skin care, sharing best practice, and palliative care.
• Established formal partnerships with two major care home national networks, My Home Life and Connect in Care. These partnerships will enhance sustainability of the Nurse Consultant’s programme of work
• Developed a quality framework based on relationship centred care for use in inspection and assessment of quality, by the care home with their residents.
• Secured £210,000 to support 2 national practice development projects. These projects aim to recruit key champions; promote relationship centred care; promote education on, for example, nutrition and strategies to support change in practice; support management in the care homes; elicit the involvement of local experts, older people who use the service; link closely with the Care Commission particularly in relation to implementation of the National care Standards; promote ownership of the development by frontline staff; develop action plans that are meaningful to the context; develop opportunities to share best practice and issues with others through a community of practice; and finally, to support the resolution of complex issues related to changing practice through action learning

We have recruited 100 champions to the first national practice development project on nutrition and have commenced a second project in partnership with Alzheimer Scotland which focuses on meeting the palliative care needs of people with dementia. This project brings relatives and care staff to learn together how to better communicate end of life issues to residents with dementia.

In addition to these activities the post has been important in ensuring that policy, educational and research organisations include the care home sector in their debates and developments.

Belinda Dewar
Nurse Consultant for Care Homes in Scotland