Dr Melinda Taylor, Senior Research Fellow in Organisational Behaviour, NIHR CLAHRC Wessex Data Science Hub
The first blog in this series described how health professionals in our study found it difficult to define ‘frailty’ but agreed that it was an extremely broad concept with no defined boundaries. This has an impact on training in frailty care. This second blog outlines our participants’ views on frailty care training.
Our study evaluated particular aspects of four initiatives intended to enhance the care provided to people regarded as frail. The diverse nature of the initiatives further demonstrates the complex nature of frailty.
The initiatives aimed to:
- reduce hospital admission of frail patients by providing specialist assessments when the patients were brought to A & E and making detailed onward care plans;
- enhance closer relationships between health care, social care and the voluntary sector;
- provide a fast response community-based team of specialists to assess patients experiencing conditions associated with frailty such as confusion, falls or, the often used term being ‘off legs’; and
- build on the work being carried out by an existing Integrated Care Hub and Elderly Care Service to move from reactive to proactive care for people living with frailty and complex needs.
The staff involved needed to learn about how to operate the specific initiative they were working on but most agreed that to be effective in caring for frail people, a wide range of additional knowledge was required and this was difficult to specify as it differed vastly according to the particular patient and the context. Staff recognised individual responsibility to identify their own knowledge and skills gaps and to seek out appropriate training opportunities. They were also aware that while they valued training, they would often forego sessions due to pressure of work, commenting that while this felt this to be the right way to respond to a busy ward or clinic situation, in the long run they might serve patients better by being better trained.
A key factor influencing effective training was that all staff wanted to do a good job of caring for frail people and this was an important driver in their enthusiasm to learn more about frailty. On many occasions they talked of integrity of care, shared values and wanting to learn more in order to do the best they could for their patients.
There was further consensus on the need for combined formal and informal training, as many aspects of frailty care could not be taught on a course, but were learned through the experience of working within the speciality.
We found from the interviews and discussions that staff felt they learned better from working within multidisciplinary teams, particularly where there was some blurring of roles, enabling them to gain wider experience, and where they could learn from group case study meetings.
Shadowing staff within their own teams and also other health professionals working in frailty helped staff to understand the wide and complex nature of frailty more fully and to find out about additional resources for patients and carers. Hospital staff were keen to shadow community staff to learn about frailty care outside of the hospital environment. In particular, they felt that this additional knowledge helped in developing their confidence, improving their decision making and, thereby, making more effective discharge decisions. Similarly, those who chose to carry out frailty care training in the community found that they themselves were learning from care within a different context.
What emerged was an understanding that to care for frail patients effectively, staff needed clinical knowledge, experience, and also an understanding of the organisational system in which they operated. Their specific professional skill was important but they also needed to know something of how other professions operated, who and where they were, what they provided, how to access them and to have good lines of communication with them. They aspired to a means of providing joined-up care rather than piecemeal service provision, truly integrating health services, organisations and sectors.
The next blog in this series will be written by our PPI representative whose contribution to the study was significant and who has some valuable insights to share.