Procedimiento Experimental

Unstructured observations were chosen to enable flexibility during the case studies and to allow the researcher’s attention to focus on the management of BPSD as and when it occurred (Bailey, 2007). The researcher role was as ‘observer as participant’

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(Gold, 1958); an overt role involving observations in the shared spaces of the homes, while also participating in the setting with simple tasks. This level of involvement was chosen to allow a legitimate role from which to conduct the observations rather than being located on the periphery and as a way to facilitate relationships with members of the CH communities (Gold, 1958). Participating in tasks helped ‘give something back’ to the participating CHs; this reciprocity was important in offsetting any

inconvenience the research created for CH residents and staff. Participating in the CH settings meant observations felt less intrusive and more authentic, since the staff and residents did not feel like they were being explicitly watched; instead I became part of the setting. The tasks that I assisted with are set out in Table 5.5. Assisting residents with meals was a particularly good task since it allowed me, not only to build a genuine relationship with residents, but also gave me a valid role and vantage point from which to observe the conduct of others.

Table 5.5: Tasks undertaken as part of the observer as participant role Observer as participant tasks

Serving drinks

Assisting residents with food or drink Laying tables

Tidying

Arranged activities (bingo, crafts, cooking, quiz, exercises)

Assisting on trips out

Assisting with the tea/coffee trolley

Collecting plates/cups Hovering

Making drinks/breakfast Collecting things as asked by staff/residents

Washing up Folding laundry

Walking with residents Chatting to residents/staff

In practice, the role of observer as participant was found to be ambiguous and often had to be re-negotiated. As circumstances changed around me my role fluctuated along a continuum; sometimes the observer aspect of the role was more salient and at other times the participant part of the role was more prominent. This could change from moment to moment. Since I was a research tool within the case studies, how I acted, responded and interacted could change the situations in the CHs and alter the data available to me and the knowledge I would be able to gain (Dewalt & Dewalt, 2011). However, this was judged to be a risk worth taking, since by generating close relationships with the CH staff and residents I was better placed to gain a real

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understanding of issues important to them. The tasks I conducted did not appear to relieve the staffing pressures to an extent where stress was removed or to remove episodes of BPSD needing intervention. Staff members were predominantly busy with tasks I was unable to assist with, such as those in the private areas of the CHs, manual handling, personal care and medication administration. Therefore, it is improbable that the tasks I undertook impacted on the setting to the extent that they invalidated the data, except in rare circumstances when stepping in was required due to an imminent risk to a resident.

The CH staff in this study were not used to researchers within their homes. Instead, the usual people entering CHs were generally visitors, work experience students, volunteers or new staff needing orientation. Consequently, staff had different

expectations of my role. For example, shortly after starting the first case study a staff member asked me if I wanted to observe a bath; obviously I declined and explained the boundaries of my role. Re-negotiating the boundaries of my role was an ongoing process, since some grey areas existed. Personal care (except assistance with feeding), manual handling and going into the private areas of the CHs were clear boundaries I could not cross. However, the boundaries could be blurred for example, what if a resident invited me into their bedroom? In these cases I would go in, since I was invited, if possible I would check with staff before entering.

Taking on an observer as participant role within the CH settings had some negative aspects. Accountability was one issue. By conducting tasks such as those in table 5.5, if something went wrong I would be accountable. What if a resident choked while I was feeding them? What if I gave a resident their mobility frame (a task I was asked to do by residents frequently) and they then got up and fell? The issue of protecting myself as a researcher became salient. Tasks I was familiar and comfortable with from my role as a care worker suddenly appeared fraught with risk from a researcher

perspective. I did not stop participating with these tasks, but instead tried to reduce the risks. For example, when feeding residents I would mash the food a great deal if the resident could not swallow well and I would ask staff before I acted to retrieve a frame for a resident if at all possible (sometimes finding staff could be a difficult job). Another negative aspect of conducting tasks as part of the researcher role was

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creating expectations. If one day I helped with the tea trolley, I was expected to the next day and consequently this worked to restrict the observations by effectively tying me to one area at one time of day. As my confidence in the research role increased this became less of an issue as I would explain to staff what I would like to observe. My role in the CHs straddled both the insider and outsider positions. Being aware of the position of my role, the influence it might have on the data I could collect and the knowledge that could be gained was important to contextualise the findings (Merton, 1972). As an experienced care worker I had insider knowledge of the role and the pressures, tensions and expectations connected to it. Yet, within the case study CHs I was an outsider, not part of the staff team, not used to working within each particular home’s ethos and not in a position to partake in the main care worker tasks (for example, personal care or manual handling). My care work experience made me an insider of the wider care field, but not within the individual case study CHs. This prior insider experience from different establishments meant that I had knowledge of pertinent questions to ask and issues to explore in ways that a total outsider would not (Knight, 2002). My insider status also contributed to the ease of negotiations when gaining access to the CHs, helped to make stronger connections with potential participants and enabled my role to be reciprocal, since I felt confident enough to help within the CHs. The outsider aspect of my position in the CHs enabled me to maintain some distance between myself and the issue under study. Although I was located within the CH settings and I built relationships with the CH community, I was never an integral part of the care teams within the homes. My location and status within the CH communities is important when considering the study findings (Atkinson &

Hammersley, 1994); my perception was that I was viewed as both a researcher and a helpful volunteer simultaneously. By the end of each case study I had an built up a peripheral membership role in the CH communities (Adler & Adler, 1987; Dewalt & Dewalt, 2011). Close relationships meant that I was taken into the confidence of many of the actors within the CH communities. I aimed to utilise the positive aspects of my dual insider and outsider position; for example, by drawing on my knowledge of issues to get close to the data and by using my newcomer status to ask the naive question.

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