3.6.3. Qualitative Analysis of Staff Interview Data
Analysis of the 12 interview transcripts revealed five themes and 13 subthemes (see Table 8
Ten participants spoke about the impact of organisational barriers on programme implementation.
Existing heavy workload. Some described their job as “stressful” without the additional demands of the intervention. It seemed that implementing any programme on top of this felt like a significant addition.
“care staff are inundated and under, sort of, are under it with their work pressures and their day to day routine”.
Existing task-focused approach. Participants spoke about the multiple tasks that they needed to complete as part of their job role. There was a sense that they were unable to dedicate time to a single resident as multiple residents needed their attention.
“I can’t sit in one place and only do one thing because it’s the work place”.
It was especially difficult to implement the programme during a morning shift, as participants were preoccupied with care tasks during this time.
“if there is still someone not up, you can’t just go to do the programme, you have to keep going around”.
Difficult to find the time. Many participants described their job role as ‘busy’. The lack of time available to do the programme meant that several participants had to work on the programme outside of work hours by coming in early, working during their breaks or working at home.
“I had to work overtime, to catch up with work I couldn’t do”.
Absence of managerial facilitation. Four participants described how managerial factors prevented them from implementing the programme. They reported that their shift was frequently located on a different care floor to the resident or that they were not allocated to work with the resident participant.
“I am nearly always in the last stage of dementia, when (resident) is in the first stage… so it was a lot harder to do any of the work”.
Staffing provisions also seemed to be a problem, as low staffing levels meant that participants had more responsibilities.
Programme Factors Acting as Barriers
Another theme was that elements of the programme made it less feasible to deliver.
Documentation was challenging. Half of participants commented on the SettleIN documentation, describing it as “confusing” and “difficult”.
“the problem is only the writing. It’s very stressful.”.
The documentation was perceived to be time consuming and more challenging than delivering the programme. Recommendations were made to reduce the volume of documentation or to move it on to an electronic format, a method of recording that was more familiar.
Inflexibility of programme structure affects programme completion. The weekly structure of the programme was seen as a barrier to programme completion. Outside factors such as annual leave, resident or staff illness meant that the programme was delayed and not completed within the four to six weeks.
“it took me two weeks to finish week one itself.”
One participant recommended that the programme should be more flexible as to accommodate these outside influences.
Individual Resident Factors
All of the staff who delivered SettleIN noticed the impact of resident factors on ease of delivery.
Dementia severity affected implementation. The programme seemed more difficult to carry out in the context of more severe dementia. Dementia severity was perceived to affect residents’ ability to remember personal information, understand the questions asked and communicate their answer.
“I cannot assume that she does not understand, but she is not responding back, just a smile”.
Some felt that the programme would be easier to deliver with residents whose dementia was less severe.
“I think this is focused on the early stages of dementia”.
In contrast to this, one participant felt that it was not the severity of the dementia that mattered, but rather the skill set of the staff.
Resident preference affected engagement. Five participants expressed difficulties carrying out SettleIN activities due to individual resident factors including mood, personality and physical wellbeing. On occasions, residents did not want to engage in conversation.
“It was challenging for me trying to engage with her … cos she was very ‘no no no, I don’t want to talk’”.
Acceptability of SettleIN
All participants also spoke about the different feelings they had about the programme.
SettleIN is difficult for staff. Four participants discussed the elements of the SettleIN experience that felt testing. Two talked about having initial difficulties with the programme, struggling to understand it or feeling overwhelmed by it, which delayed implementation.
“I found it quite daunting to get it up and running.”
There was also a perception that others would find the programme difficult in the context of their busy work role, and one participant felt that, consequently, the programme was too lengthy for a care home setting. Two participants also spoke about finding some of the conversations with residents ‘uncomfortable’, and one commented that the programme would be difficult for staff who were ‘not as chatty’.
“I didn’t feel that comfortable to ask her those kinds of things… the more personal questions.”
SettleIN content is acceptable to staff. In contrast, some described the intervention as “manageable” and “easy”. Indeed, the majority spoke about their positive experiences of delivering SettleIN despite the challenges present. The programme was felt to be both “helpful” and “enjoyable”. Specifically, participants spoke about enjoying the opportunity for more in depth conversations with residents and working more closely with family members.
“It is nothing to not enjoy, because its, all the tasks, we are finding they are pleasant to do… And it is just for the benefit of knowing the person more”.
Participants also spoke about how much they developed during the experience. SettleIN provided them with an opportunity to be exposed to new experiences and to learn more, suggesting that there was a demand for the intervention.
“this sort of training will help people acknowledge more about dementia”.
SettleIN is positive for residents. All staff participants felt that the programme had been of some benefit to the residents. The intervention helped them get to know residents more quickly and facilitated friendships with residents. Participants gave specific examples of changes they noticed in the resident as a result of the programme.
“Independence. Definitely. She’ll still come and say something, you know ‘where’s my room’ and I’ll go ‘… You show me’. And off she goes … You just stand up here with a silly grin on your face! Yeah! She’s doing this!”
Eight participants spoke about ways in which they had attempted to overcome the feasibility issues they faced.
External support is needed. Half employed colleagues to support programme implementation and some relied on others to complete care tasks whilst they delivered the programme. Those who conducted the programme in pairs found this to be particularly valuable.
“If you have partner, your colleague who you can ask… they give you good ideas”.
Participants expressed that more support was required from the researchers for SettleIN to be fully implemented.
Adopting problem solving. When challenges were present, participants came up with various ways to try and solve these. Solutions included planning ahead, relying on family members, being flexible with the programme structure and using alternative means to document SettleIN conversations.
“I have no time to write it down on the paper. But I have a list … for myself”.