Table 1
Appreciative Inquiry meeting dates and approximate length.
| Care home | CH1 | CH5 | CH6 |
|---|---|---|---|
| Meeting one | 25/01/2011 (01h10m) | 03/02/2011 (01h30m) | 19/01/2011 (01h10m) |
| Meeting two | 15/03/2011 (02h00m) | 24/03/2011 (01h45m) | 14/03/2011 (01h45m) |
| Meeting three | 28/06/2011 (02h10m) | 29/06/2011 (01h45m) | 20/06/2011 (01h10m) |
Table 2
Components of the intervention.
| Components | Description | Prompts | Phase(s) |
|---|---|---|---|
| Appreciative conversations, AKA “Good Gossip” | Participants are invited to recount “a successful story or positive memorable moment of working with others to provide end-of-life care for a resident dying with dementia”. Common attributes, values, skills and abilities identified around providing good end-of-life care are highlighted and discussed | “What made the situation special? What was your contribution? How did you feel? How did others, either in the home or in the community help you?” | Discover, Dream |
| Development of future directed statements, AKA Common “Vision” for the home | Participants asked to imagine the care home 5 years on and their ideal for end-of-life care for people with dementia. Future-directed statements are also referred to as the participants’ common “Vision” for the care home. Participants encouraged to develop future-directed statements” into specific ideas for EOL innovations | What is different? What is going on in the home? Who is here? How have residents benefited? | Dream, Design |
| Resident Death Reviews (RDR) | An example of actual end-of-life practice within the home used to reflect on working practices and tease out the specifics of a potential innovation for end-of-life care. Review of events focused on the process of care, the alignment of strengths and the adjustment of practice (where necessary) that would help move towards the participants’ “Vision” for the care home. | All participants Prompted to discuss the resident death from the point of view of (i) the primary care doctor and/or District Nurse (ii) the care home staff and finally from (iii) the resident and family point of view. | Design |
Table 3
Care home characteristics.*
| Care Home | CH1 | CH5 | CH6 |
|---|---|---|---|
| Provider type | Private not for profit | Private | Private |
| Number of beds | 46 | 67 | 57 |
| Number of dementia places | 46 | 67 | 57 |
| Location | Suburban | Rural | Rural |
| Building | Local authority | Conversion | Purpose built |
[i] *Source: CQC listings’ AQAA data and manager interviews.
Table 4
Characteristics of AI meeting participants.
| Role (M/F) | Attendance | Professional qualifications Time since qualified (HCPs only) | Time at post in CH/visiting CH Frequency of visits (HCPs only) | Specialist Training Dementia Care | Specialist Training EOL Care |
|---|---|---|---|---|---|
| Care Home 1 | |||||
| Care Home Manager (F) | All meetings | NVQ2, Btec NVQ4/Registered Manager’s award | 7 years | Basic & intermediate Dementia Care Dementia Care Mapping Leadership in Dementia Care | In-house training with District Nurses |
| Deputy Manager (F) | All meetings | NVQ2 NVQ3 Contuning Care Supervisory Management Course | 16 years | Certificate in Dementia Care Intermediate Dementia | In-house training with District Nurses |
| General Practitioner (F) | All Meetings | Lekarz, DCH, MRCPG 19 years | 6 years/Once a week and on request | No | No |
| District Nurse (M) | 1st meeting only | Registered Nurse 6 years | 6 years/1 to 2 visits per month | No | Trust-run palliative care course |
| Care Home 5 | |||||
| Care Home Manager (F) | 1st and 2nd meeting only | NVQ4, RMA, AI, VI, PTLLS | Over 4 years | ASET Level 2 – Various Dementia certificates | Death, Dying & Bereavement |
| Deputy Manager (M) | All Meetings | NVQ Level 3 Leadership in Management course | 15 months | Dementia level 2 award-currently working toward level 3 | EOL e-learning Training |
| General Practitioner (M) | All Meetings | MBBS MRCP DRCOG MRCGP 10 years | 6 months/Once a fortnight and on request | RCGP-run Dementia Management Course | No |
| District Nurse (F) | 1st meeting only | Registered Nurse 11 months | 11 months/1 or 2 visits per month | No | Trust-run training on syringe drivers & palliative care |
| Care Home 6 | |||||
| Care Home Manager (F) | All Meetings | Registered Managers award PETALS (Preparing to teach in the lifelong sectors) NVQ Levels 2, 3, 4 | 6 years | Currently completing Dip in Dementia Care Qualified Dementia instructor | EOL training within NVQ |
| Deputy Manager (F) | All Meetings | NVQ Levels 2&3 PETALS (Preparing to teach in the lifelong sectors) Currently completing NVQ Level 4 | 3 years | Level 2 Dementia training | EOL training within NVQ |
| General Practitioner (M) | All meetings | MBBS, MROGP, DFSRM, DRCOG 3 years | Just under a year/On request only | No | Palliative Care Course |
| District Nurse (F) | All Meetings | Registered Nurse 33 years | Over 1 year/More than once a week | Dementia Patient Course with end of life module | Palliative Care Degree |