What are the links between walking and spiritual care?

Reflecting on a Care Home Research Forum - from an Anna Chaplaincy Perspective

As training and development lead for Anna Chaplain, Julia Burton-Jones attended an online forum for care home research on April 29. The Margaret Butterworth Care Home Forum enables those working in care homes to hear about the latest research and how it might feed into their practice (Margaret Butterworth Care Home Forum | King's College London).

Two areas of research were explored at the forum, both of which Julia reflected were relevant to pastoral and spiritual care for residents living in care homes.

Quality of life-focused care planning in care homes

The first piece of research was presented by Nick Smith, a Research Fellow at the University of Kent who leads the NIHR National Priority Programme for Wellbeing in Care Homes project. Nick outlined collaborative work exploring care planning approaches in care homes that focus on quality of life outcomes. He described the development and testing of two approaches, ASCOT for Care Planning (Home - Care and Outcomes Research Centre) and ICECAP (ICECAP-SCM | Bristol Medical School: Population Health Sciences | University of Bristol). 

The ASCOT tool includes guided conversations with residents and those in their ‘circle of care’, combined with observations. The ASCOT approach to care planning has eight domains to enable staff to explore quality of life with residents:

·        Control over daily life

·        Food and drink

·        Personal cleanliness and comfort

·        Personal safety

·        Social participation and involvement

·        Occupation

·        Accommodation cleanliness and comfort

·        Dignity

Staff who took part in the study said using the ICECAP and ASCOT tools in care planning enabled more meaningful conversations.  Nick concluded that even in well-rated care homes, conversations focused on quality of life with residents and relatives are not always happening. ASCOT provides a framework for these conversations.

After hearing about the study, Julia asked Nick if the ASCOT tool allows exploration of spirituality – meaning, purpose and belonging – for residents. He said the tool explored outward practices associated with religious beliefs (such as a desire to attend faith gatherings or wishes for food and dress) better than it allowed expression of inner thoughts and beliefs.

FREEDEM study on ‘wandering’ in care homes

The second presentation was from Bryony Waters-Harvey, a postdoctoral researcher at the University of Sheffield. The FREEDEM research she presented focuses on care and support for people with dementia and MND or other long-term health conditions. She shared findings from a study which explored ‘wandering’ in care homes, with researchers working alongside care homes to understand what supports and prevents wandering by people with dementia. She signposted excellent free to download resources: (https://sites.google.com/sheffield.ac.uk/freedem/home).

Having worked in the field of dementia care for many years in collaboration with care homes, Julia has followed the development of ideas about ‘wandering’. The phrase has been surrounded by controversy; ‘walking with purpose’ has been the description preferred by some as countering negative connotations and allowing for the possibility there are many reasons we choose to walk throughout our lives. 

Research shows that 60% of care home residents experience repetitive walking which can be challenging due to the risk of falls, fatigue, dehydration or leaving the building.   Responses by care homes have often resulted in strategies which restrict walking and thereby strip it of the benefits it holds.

The FREEDEM research used a Wayfinding Environmental Mapping Tool to map each of the seven care homes taking part which included a broad range of building designs. There were then 64 days of observations and 56 interviews, while 32 care plans were reviewed.  An interesting finding was that the amount of wandering varied according to the attitudes of staff, the layout of the home and resident to staff ratios. Where all staff (not just care staff) were trained in how to support and supervise walking, this increased the amount of ‘wandering’.  Staff were observed walking with residents to discover their motivations for walking; they knew much about their past lives and how this explained patterns of wandering. 

Most residents needed support to find their way around the building. Staff were unsure if signs were helpful but sometimes smell was used to orientate. In one home researchers never saw a resident go into the garden though there were clear signs they wished to do so but could not access it. Some homes had snack and drink stations residents could access on the go, with grazing menus seen as important for active residents. 

The research team said that homeliness in the environment was important in providing cues, and better than a setting with hotel-like or clinical features. They found it was possible to promote walking with a positive risk-taking culture but that clutter-free pathways are needed, and life history knowledge is key, including awareness of a person’s occupational background.

Discussion following this presentation on the FREEDEM research included: exploration of night time wandering; the influence of corridor width, shape and length on walking; the impact of residents going into one another’s rooms and associated tensions; how design helps or hinders ability of staff to observe; the training and role of housekeepers, maintenance and kitchen staff in visual monitoring and redirecting.

Implications for Anna Chaplaincy

The contribution of Anna Chaplains to understanding quality of life for individuals could be significant.  Anna Chaplains may be part of the resident’s ‘circle of care’, helping them express the significance of faith and spirituality in seeking the best outcomes in care planning, alongside wider aspects of their lives before they moved into care.

It is also good for Anna Chaplains and anyone visiting care homes from local churches to understand reasons for repetitive walking, or ‘wandering’, and the part it plays in the lives of a large number of residents. Like staff, they can come alongside the person as they walk and discover their reason for ‘wandering’. They might have insight into the resident’s life story and contexts and roles where they walked regularly and could share this with staff.

Mutually rewarding conversations can take place while walking together, as found by walking groups established in other contexts supporting people with grief or mental health challenges. 

'We might even suggest that spiritual conversations can take place on the go, and find ourselves praying with an older person while walking, if they wish this!  Companionable silence while walking can also convey love, respect and value.'

Finally, understanding the pressures repetitive walking can place on under-resourced staff teams enables us to show empathy. Might we support staff in keeping residents safe by informing them if someone’s walking is placing them at risk? Might we enable residents we visit to go out into the garden with us?  Could we help staff understand the reasons a person is walking based on what we know of their earlier life?

In conclusion, it would be unkind and untrue to suggest we can only accompany a person spiritually if they are not moving! If being on the go is helpful for the person, for whatever reason, why not accompany them in their walking , as well as in their spiritual lives?

(Photo credit: Pixabay)

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