The RIPE Project Protocol: Researching Interventions That Promote Ethics in Social Care
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The RIPE Project protocol: Researching Interventions that Promote Ethics in Social Care Ann Gallagher, Anna Cox Abstract Background: Recent reports into failures in residential care resulting in avoidable suffering for older people and their families have highlighted the need for, and importance of, ethical practice. Although there is a wide range of training available for care -givers, there is no mandatory requirement for ethics education as there is for registered nurses. Little is known about the impact of ethics education on the ethical competence of care home staff. Aim: To determine the impact of three ethics educational interventions on the moral sensitivity, work-related moral stress, ethical leadership, and empathy of care-givers in residential care homes. Method: A pragmatic cluster randomised trial exploring the effectiveness of three ethics educational interventions for care -givers working in residential care homes for older people. Baseline data will be collected before randomising each care home to one of three ethics educational interventions: 1) conventional ethics teaching within care homes for older people; 2) reflective ethics discussion groups within care homes for older people; and 3) experiential learning – immersing participants in a care recipient’s role within a simulation suite at the University of Surrey; or a control arm 4) where care-givers will receive no educational intervention. Conclusion: At the time of publication, the research team are recruiting to the project. The project interventions, data collection and analysis will be completed by December 2016. The research team would be pleased to work with other researchers interested to replicate the study and to compare findings. More detailed information regarding the recruitment process and interventions is available on request. Introduction Previous care home research (Gallagher ics educational interventions for care et al 2014) supports the value of ethics -givers working in residential care homes Recent reports into failures in residen- education in care homes. Little is known for older people. Baseline data will be tial care resulting in avoidable suffering about the impact of ethics education on collected before randomising each care for older people and their families (De- the ethical competence of care-givers in home to one of three ethics education- partment of Health 2012, Care Quality residential care homes. There have been al interventions: 1) conventional ethics Commission 2014, Learner 2014) have no previous comparative intervention teaching within care homes for older peo- highlighted the need for, and impor- studies evaluating a range of approaches ple; 2) reflective ethics discussion groups tance of, ethical practice. It is estimated to ethics education in this area. within care homes for older people; and that there are approximately 1.5 million 3) experiential learning – immersing par- care-givers in social care (Wills 2015). The RIPE (Researching Interventions to ticipants in a care recipient’s role within Although there is a wide range of train- Promote Ethics in social care) project is a a simulation suite at the University of ing available for care-givers, there is no pragmatic cluster randomised trial which Surrey; or a control arm 4) where care mandatory requirement for ethics edu- sets out to remedy this research gap by -givers will receive no educational inter- cation as there is for registered nurses. exploring the effectiveness of three eth- vention. The same data collection meth- ods will be used after the interventions to ascertain the impact of each approach Corresponding Author details Author details in comparison to a control group. Data Ann Gallagher, Anna Cox, collection methods will be quantitative Professor of Ethics and Care Research Fellow, (using measures to evaluate the impact International Care Ethics (ICE) Faculty of Health & Medical Sciences, of the interventions on moral sensitivity, Observatory, Faculty of Health & University of Surrey, Duke of Kent work-related moral stress, ethical leader- Medical Sciences, University of Building, Stag Hill Campus, Guildford, ship and empathy) and qualitative (gain- Surrey, Duke of Kent Building, Stag Hill Surrey, GU2 7TE ing the perspectives of care-givers and Campus, Guildford, Surrey, GU2 7TE Email: [email protected] their managers through semi-structured Email: [email protected] interviews). (See FIGURE 1 for project overview). Working Papers in the Health Sciences 1:11 Spring 2015 ISSN 2051-6266 / 20150064 1 Researching Interventions that Promote Ethics in Social Care Pre-assessments: Moral Sensitivity Questionnaire (MSQ); The Work-Related Moral Stress (WRMS) Questionnaire Ethical Leadership Questionnaire (ELQ); The Interpersonal Reactivity Index (IRI); Individual interviews within selected care homes. Intervention 1 Intervention 2 Intervention 3 Control group Experiential learning – immersing No intervention Conventional ethics Reflective ethics discussion teaching within care homes groups within care homes participants in a care recipient’s role within a simulation suite at the University of Surrey Immediate post intervention feedback Post assessments (1 month): Moral Sensitivity Questionnaire (MSQ); The Work-Related Moral Stress (WRMS) Questionnaire; Ethical Leadership Questionnaire (ELQ); The Interpersonal Reactivity Index (IRI); Individual interviews within selected care homes. Post assessments (3 months): Moral Sensitivity Questionnaire (MSQ); Focus groups in selected care homes. Figure 1: Researching Interventions that promote Ethics in Social Care In the light of findings, this 24 month pro- iii. To evaluate/measure the im- Summary Literature Review ject will develop an evidence-based so- pact of experiential learning, on cial care ethics education programme for the moral sensitivity, work-relat- The three approaches to ethics educa- care-givers in residential care homes for ed moral stress, ethical leadership, tion have not been evaluated systemati- older people that can be rolled out across and empathy of residential care cally although there is some evidence for the UK. Researchers will work actively -givers working with older people; effectiveness, for example, in relation to with the Ethox Foundation to apply for iv. To explore care-givers’ experienc- conventional teaching and simulation and funding for the educational programme es of care-giving within a residential also relating to the value of clinical ethics as we draw conclusions from the RIPE care home setting for older people, committees, similar to reflective ethics project. specifically considering challenges discussion groups, in other settings. A and enablers to ethical care practices; review of the literature was conducted Aim of the Project v. To explore residential care-givers’ for each approach to ethics education, a perceptions of induction, training, summary of these reviews is given below. To determine the impact of three educa- support and supervision, and ethics tional interventions on the moral sensi- resources within their organisation; 1. Conventional ethics teaching tivity, work-related moral stress, ethical vi. To explore residential care Face to face classroom-based teaching in leadership, and empathy of care-givers in home managers’ perceptions applied ethics is well-established in rela- residential care homes. of induction, training, support tion to healthcare professionals, although and supervision, and ethics re- less so in relation to social care, especially Objectives: sources within their organisation; residential care with older people. There i. To evaluate/measure the impact vii. To explore residential care- is a good deal of literature regarding the of conventional ethics teaching on -givers experiences of conven- aims and learning/teaching methods uti- the moral sensitivity, work-relat- tional ethics teaching in re- lised on ethics education programmes ed moral stress, ethical leadership, lation to their care practice; particularly for nurses and doctors. So- and empathy of residential care viii. To explore residential faer (1995), for example, examined four -givers working with older people; care-givers’ experiences of re- types of teaching methods namely, dis- ii. To evaluate/measure the impact flective ethics discussion groups cussion, student-led seminars, structured of reflective ethics discussion groups in relation to their care practice; debate and role play. The methods were on the moral sensitivity, work-relat- ix. To explore residential care-givers’ not evaluated separately to understand ed moral stress, ethical leadership, experiences of experiential learn- which method was more effective, how- and empathy of residential care ing in relation to their care practice. ever Sofaer (1995) concluded that as a -givers working with older people; result of the health care professionals’ Working Papers in the Health Sciences 1:11 Spring 2015 ISSN 2051-6266 / 20150064 2 participation in the experimental learn- They defined ‘moral case deliberation’ is then a good deal of research on differ- ing, they were able to reflect analytically as a specific form of clinical ethics, with ent approaches to ethical or moral delib- and participate in informed discussion. the objective of stimulating ethical reflec- eration, but no consensus regarding the Johnson (1983) argued that small group tion in daily practice, which improves the most appropriate approach or effective- discussions are very effective in increas- quality of care. They tried to understand