Table 3 Summary of key findings and themes across case study sites
From: A collective case study of the features of impactful dementia training for care home staff
Major theme | SC040 | SC042 | SC076 |
|---|---|---|---|
Sub-themes | |||
Training design and delivery | Introductory programme developed by training lead and tailored to care provider staff but not to organization. Didactic Too much content for allocated time Generic national standard training workbook. Format adapted by training lead to include face-to-face monthly sessions with reflective exercises. Gaining staff feedback challenging | Wide range of training available at different levels and for different staff groups Designed by training lead who had considered learner needs Majority delivered using small group discursive sessions One programme delivered by self-directed work book | Designed by experienced internal training facilitator Bespoke training tailored to organization and staff attending Combination of minimal didactic PowerPoint based content and interactive group discussion, exercises and case scenarios Minimal use of written materials and use of video-based scenarios Training delivered in care home lounge, not enough seating for all staff who had to sit on floor Rushed pace at times |
Staff reactions | Generally positive Relevant to role and own practice Valued face-to-face delivery and regular two-hour sessions spread over a prolonged period Valued case studies | Training felt to be generic and not easily transferable to considering how to work with individual residents Felt to be too basic/to cover content they already know by some staff Valued small group, face-to-face learning and interactive learning methods Including staff from range of roles in training seen as positive Simulation training evoked strong emotional and empathic reactions Disliked self-directed learning via work books | Preference for ‘hands on’ interactive methods Positive response to video-based scenarios as helping to understand what it might be like to live with dementia Importance of safe and relaxed environment to support discussion and asking questions External training also valued and seen as impactful |
Learning | Level of training good for someone with limited prior experience, but provided limited new learning for more experienced staff. Understanding of lived experience of dementia Understanding individual needs and differences Empowerment to challenge poor practice Generally positive attitudes, but a few who appeared not to do so | Evidence of knowledge gains on range of topics Improved understanding of dementia and changed attitudes towards those with it e.g. more patience Understanding of lived experience of dementia Practical skills developed e.g. writing care plans Learning through study work books hampered understanding Learning from each other in and outside of classroom Ideas for new approaches and practices Generally positive attitudes, but few staff who on occasions appeared unsure how to support more complex needs | Simulation and experiential learning helped develop empathy Many staff reported having a more person-centred understanding of people’s individual needs Some staff reported being unsure about what learning had been achieved given their existing experience Observations showed staff had a positive attitude and knowledge of the need for activity, occupation and engagement |
Behaviour | Understanding, interpreting and reacting differently to resident behaviours Improved communication Introducing new activities Shift from task focused to person-centred care Offering more choice to residents Not always clear changes due to training Staff interactions mainly positive and skilled, but occasions on one unit when practices were less person-centred. | More empathic care approaches Better able to diffuse difficult care situations Development of enriched care plans and delivery of care that is more individualized Introducing memory boxes and meaningful activities Staff interactions mainly positive and skilled, but occasions on one unit when practices were less person-centred. | Difficult for training lead to assess whether staff are implementing in practice Improved communication Provision of personalised activities Providing care at the right pace Changing the environment and care procedures Improved support for relatives Overall sensitive care that supported engagement, with few occasions where resident choice was limited. |
Experiences of care | Improved resident emotional and physical well-being Different experiences on each unit where observations carried out, with one offering residents greater opportunities for activity and generally higher well-being. Satisfaction of residents and relatives generally high although some suggestions offered for way care could be improved. | Staff perceptions of improved resident well-being due to increased activity and engagement More positive staff: resident relationships Limited evidence of resident activity and engagement during care practice observations Residents' generally experiencing neutral to positive mood. Satisfaction of residents and relatives high | Staff perceptions of increased resident well-being and reduced distress Evidence of good range of activity and engagement tailored to individual residents. Some residents had less opportunity to engage than others. Mood and engagement levels were on average above neutral trending towards positive Satisfaction and residents and relatives high |
Barriers to training implementation | Staff expected to complete training in their own time E-learning not viewed positively by staff Difficulties releasing staff to attend training Lack of appropriate training facilities Difficulties evaluating impact of training Lack of staff motivation to put learning into practice Staffing levels and turnover | Low status profession Tensions between staff and relatives due to conflicting views about care Staff turnover Use of self-directed learning Expectations of completing training in own time Difficulties releasing staff to attend training Lack of time to put training into practice Embedding changes sustainably | High costs of external training Just accessing internal training can create ‘inward looking’ Demands of managing training leadership alongside another role within the organisation Financial constraints in being able to access technology to support interactive learning Lack of time and staff shortages Lack of formal curriculum and quality assurance for social care sector Single trainer who is not linked to a community for peer support Gaps in facilitator knowledge Trying to meet learning needs of clinical and non-clinical staff in mixed-group training Staff wariness of and confidence using technology Lack of dedicated training space Challenges in getting feedback about training from staff |
Facilitators of training implementation | Organisational culture that valued training Training lead spent time on care home units Management support for staff Adapting standard training to make it accessible Being in a small organisation that could listen to staff and offer training flexibility Skilled facilitator Small, mixed-role and unit training Delivery methods that made training memorable, linked theory to practice and encouraged reflection Incentives to complete training (badge) Peer support and team-working Committed and motivated staff | Dedicated training room Mixed role training sessions Flexible and committed training lead Having a practice and training facilitation experienced dementia lead and training lead Supportive management Strong leadership for dementia training Proactivity by training lead in accessing additional resources | Good organisational support Ability to access external training Having an dedicated internal trainer Staff undertaking training during paid working hours Facilitator skill Motivated and proactive staff Engaged unit managers Using supervision to reinforce and feedback on training implementation Peer support |