Metodología para calcular un flujo de caja

nursing staff in the evening was discarded and new staff rotas implemented to enable residents to get up and go back to bed at their desired time. In some facilities, mealtimes were staggered and activities were at different times of the day to meet residents’ preferences.

In some facilities, both public and private, resident and staff respondents commented on the caring ethos and how this shaped care within the facility. In some facilities this ethos was based on resident inclusion in decision-making, maximising resident capacity, facilitating choice and keeping residents involved. The manager’s role in shaping this ethos was commented on by staff and residents. One manager described the difficult and challenging path of implementing a new ethos of care and the time, commitment and support needed to see it through. Another manager described how the ethos pervaded all aspects of management of the facility. She described how this ethos involved caring for staff and investing in training and induction so that the best care could be delivered for residents. In other facilities, again both public and private, care was described as routinised and focused on tasks. In these facilities care was perceived as focusing mostly on the physical aspects. Some staff were concerned that the social and emotional needs of residents were not being met. In some of these facilities, it was evident that there was a real desire to change care practices but that many constraining factors had held back the pace of change (Table 8.4). In these facilities staff expressed the need for change in the routine of care and their frustration that little progress had been made. In other facilities the focus on routine had become so embedded, staff could not see how it could change. They explained that current staffing levels and resources made change impossible. A few staff respondents questioned the commitment of some staff to change and suggested that a few staff were not motivated to care for older people.

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Table 8.4: Individualised care and routine care Individualised care Routine care We are trying to look at people as

individuals. The respect and dignity and sense of humour, that’s so important because people do not want to be a number in a bed. (LC2 Director of Nursing, Private)

I think the first thing that struck me about the place when I came, that the ethos of care was very person-centred and holistic before those words were ever coined. (LC2 Nurse 01, Private)

If I go in and they say ‘look, I don’t want to get up’, I say ‘fine I’ll come back in an hour to you’. (YW3 Health Care Assistant 01, Private)

Each person has their own individual care plan and they are drawn up by a staff nurse, and it usually involves, we try as far as possible to involve the patient and their family, in devising the care plan. (YW1, Assistant Director Nursing 01, Private) I do know that there was an older school of thought here in this facility where some of the patients were put into bed really early in the day due to staffing sort of … that the staff rotated eight to four I think was one shift and some of the patients would be put back to bed before the four o’clock shift ends because I think there’s a lighter … the four to midnight shift is smaller and I know that there’s a push on for that not to happen. So that’s a definite quality of care issue that people are being put back into bed just for management of workload, but I think that that’s something that they’re … that they’re trying not to do. (PK2, Nurse 01, Public)

It is very open for them. Like even in the morning, you’d go in and say to some of them ‘did you want to get up yet, or are you going to stay there for another while?’. ‘Ah, no, sure I’ll get up now’, or ‘come back to me in ten minutes’, but they could say ‘come back to me in 15 minutes’. (YW1, Care Assistant 01, Private)

You’d have your breakfast in bed. You have a little bowl of porridge in the morning about six o’clock. (PK2 Resident 03, Public)

You’re told to get up at seven and I think that is too early. (YW3 Resident 05, Private)

It’s very hard (to treat residents as individuals) because we have so many patients; we try to but it is very difficult. … We have a work schedule and you must get your round done. (PK2 Nurse 03, Public) I would feel it’s very task orientated. You know, that the routine, ritualistic, we are doing this and that. (PK2, Nurse 04, Public)

It’s not too bad on this ward. The last ward I worked on I had to ask to come off it because there was this big mad rush and the last matron here stopped that rush. She said you’re here for 24 hours and she’s right. The patient gets up when they want to get up and back to bed when they want to go back and you should be able to judge a patient when she’s tired in the afternoon and she’d like to go in. On this particular ward, (the residents) they’re up at half eight, go back (to bed) at quarter past one, they’re in bed for 19 hours. Far too much, far too much. (GN1, Care Assistant 2, Public)

Because of our system and because of our staffing levels, and it is a huge issue our staffing levels, things are done according to a routine. (PK1 Director of Nursing, Public) You’re woken up quite early in the morning. … So you’re woken at six and breakfast isn’t until ten past eight. It’s a long day. The nurses change at six o’clock and it wakes you up. So is there a routine here, there is, yeah ok, and is every day the same then, every day is the same, absolutely the same. … The day is very long, yeah boring. (GN2, Resident 02, Public)

A lot of (the care) is routine, but on the other hand they all seem, the majority or all of them seem to be happy. (YW4, Care Assistant 01, Private)

It’s not very patient-centred and I’m not criticising anybody individually but it’s not and a lot of people who work here, I don’t know, I’m very compassionate about people but a lot of people who work here, it’s really not about the patients, it’s about their pay cheque or whatever. I find anyway and it’s not any group in particular, it’s everybody. It’s probably us sometimes as well you know.

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