Most of the 370,000 people living in UK care homes have complex needs, yet the staff who care for them often lack structured opportunities to learn on the job. This project tackles a specific gap: care homes rarely have a clear, evidence-based model for creating supportive learning environments that include formal training, informal mentoring, and everyday experience. The researchers will refine their existing ‘Learning to Care’ model by observing nine diverse care homes, interviewing staff, and analysing training records. They will then co-design an implementation toolkit with residents, families, and staff, and test it in four care homes over six months, measuring costs, staff learning, and changes in care practices. If successful, the toolkit could give care home managers a practical, ready-to-use resource for building a culture where staff continuously improve their skills. That would directly affect the quality of care for older adults with dementia and other complex conditions—a quiet but critical part of the UK’s social care infrastructure. The study does not aim to discover new biological mechanisms; it is applied research focused on making existing knowledge work in real-world settings.
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RESEARCH QUESTIONS RQ1: What do supportive, inclusive learning environments look like in care homes (CHs) for older adults? RQ2: How can a supportive learning environment be operationalised and implemented? RQ3: What is the impact of a supportive learning environment on CH costs, staff learning and care practices? BACKGROUND Most of the 370,000 people living in the UKs 15,000+ CHs have complex needs including dementia and health problems. CH staff need the right knowledge, skills and attitudes to deliver good care to this group. Our team has developed the ‘Learning to Care’ (LtC) model explaining the learning environment in CHs, which includes formal training, informal (shadowing/mentoring) and incidential (on the job experience) learning, influenced by workplace culture and resources. Little is known about how to deliver ideal learning environments in CHs AIMS/OBJECTIVES This study will address this gap by understanding what ideal learning environments look like in CHs and how they can be implemented Through OB1: understanding what supportive learning environments inclusive of diverse CH staff look like and operationalise this through refinement of the LtC model OB2: co-designing an LtC model implementation toolkit and logic model OB3: understanding how the LtC toolkit can be implemented in diverse CHs for older adults, including barriers, facilitators and the impact on costs, staff outcomes and care practices OB4: refining the toolkit and supporting its wide adoption METHODS Mixed-methods study underpinned by the Knowledge to Action Framework with iterative work packages (WPs) WP1a (Months 1-6): systematic reviews a) mixed methods review of learning environments and their components in CHs, b) review of reviews of learning environments and their components in health and social care WP1b (m1-18): ethnographic case studies in n=9 diverse care homes from 3 geographic locations including in each CH: general observations of the learning environment and learning opportunities, focussed observations of individual staff (n=6) and how they learn, informal conversations, semi-structured interviews with staff (n=up to 10) and documentary analysis of training records and other documentation WP2 (m17-25): intervention co-design of a toolkit to assess and improve the CH learning environment based on a refined LtC model developed from WP1a/b findings, involving CH residents, their relatives, CH staff and managerial/training leads WP3 (m21-38): implementation of the LtC model in 4 diverse CHs. Mixed methods evaluative case studies and cost-consequence analysis to assess impact on practice. Collecting the following data at baseline, 3 and 6m to explore change over time: general observations of the learning environment and learning opportunities, focussed observations of individual staff and how they learn, informal conversations, semi-structured interviews/focus groups with staff, standardised measures of CH and staff outcomes, and documentary analysis of training records INVOLVEMENT A CH residents and families and a separate staff advisory group will be set up. They will input to study design, delivery, analysis, interpretation and dissemination IMPACT AND DISSEMINATION The study will produce a refined LtC toolkit that can be implemented in CHs nationally. Skills for Care, the National Care Forum, Alzheimer’s Society and other networks will support us to disseminate this to and support uptake in CHs, commissioners, policy makers and the public
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