Table 4.
Supporting evidence from realist interviews with stakeholders
| CMO1: Namaste Care provides regular, structured access to social and physical stimulation for people living with advanced dementia | |
| • ‘When you see proper results is when it’s a programme, when it happens 7 days a week … and that involves a huge change in the culture of the care home’ Nam03 • ‘But I think the skill in actually developing somebody’s understanding and application of Namaste [Care] is to take them down that journey, to help them connect and emotionally connect.’ Nam05 • ‘I think that’s a really big thing that Namaste [Care] adds is that there’s like structured time to really pay attention to the residents and yeah, and give them that extra time, extra, and also the opportunity to make contact with the residents.’ Nam09 • ‘[We] make them feel safe, make them feel comfortable, and then you see the results that we’re getting and I do think that’s the whole package, that’s the taste, that’s the smells, that’s the touch, that’s all of it.’ Nam01 • ‘I think that it’s very difficult for care home staff .. to be given space and time and energy and permission to do.’ Nam05 • ‘You just get to kind of focus and bond with the residents.’ Nam02 • ‘I think it …encourages them and gives them permission to find space for their residents… and the fact that everybody’s doing it makes it acceptable within the care home.’ Nam04 • ‘I think when Namaste [Care] really works is when you can create a space where people who are overstimulated will settle down, calm down and may go to sleep and that’s great but where people who are withdrawn can actually come out of that shell and can connect and make eye contact and maybe start to try and talk again’ Nam03 • ‘I think most of us are sort of social people, we don’t spend twenty four hours a day in a room … by bringing them out into a shared space they’re in a room that’s set up for that, they’ve got people around them, and I think the staff there do have good connections with their residents.’ Nam04 • ‘What they felt positive about was that they’d managed to create and access what they called a special atmosphere, an environment to practice Namaste Care.’ Nam06 • ‘what sort of ignited my passion was just seeing people sat and left for hours and hours in chairs and in beds and the only interaction that they would have would be to deliver a care task, so there is definitely a massive gap in care provision [that Namaste Care addresses].’ Nam10 | |
| CMO2: Namaste Care equips staff to work with people with complex behaviours and variable responses | |
| • ‘I think watching staff I think what you see is that they realise that this person that may be End of Life, they may have really quite advanced dementia but we’re still reaching them… they’re still living Nam01 • ‘You go in there and you just see residents that won’t, you won’t ever engage with as such and they just kind of really come out of their shell and it is really satisfying after.’ Nam02 • ‘We’re a lot more involved with the residents and it’s a lot more, you can have a lot more conversation with them ..but obviously with the Namaste [Care] it’s kind of brought out of a lot of things in people we never saw.’ Nam02 • ‘People’s perception of going into a care home, where people were loud and screaming and shouting, and actually with Namaste Care in it was calm, people were relaxed, people were engaged with what they were doing.’ Nam04 • ‘Some days [the resident] liked it, and some days she didn’t, and so for me, the key is knowing the resident, which the staff did…but also this idea of, and I think more and more I’m becoming convinced of the importance of being mindfully attuned to how a person is responding on any given day.’ Nam06 | |
| CMO3: Providing a framework for person-centred care | |
| • ‘a structure around these very human, very person-centred, very, uh, subjective things that you can do to engage with somebody that I would say good dementia care practitioners would do anyway, but it gives a sense of structure and permission for care staff to do this’ Nam 05 • ‘If I really had to say what I thought the main impact was, I think it’s the impact on the staff because we have our session and my residents go away and it’s gone but I have not lost the sense that actually, I can make you smile, I can do it and also that if I wait you may talk to me and once that gets into my head, why wouldn’t I use that when I’m trying to get you up and dressed or give you a bath or whatever else’ Nam03 • ‘I’ve got a lady at the moment, she’s completely, we have to do everything,… it’s just watching whether you get that spark of recognition in her eyes because that’s all you’re going to see, there is no other body language, but you’ll see her follow the lights with her eyes or she’ll open her mouth when you go to give her something, and that’s massive because somebody like that a few years ago would have just been left sat in a chair.’ Nam01 • ‘While you’re doing it and while you’re observing it you notice things that actually that might not work so well for that person … so it’s about thinking about your residents and how they’re changing and what we need to do to keep people involved.’ Nam01 • ‘it’s a lot of one-on-one time with the residents as well as in the groups.’ Nam02 • ‘you’ve got to have fundamentally good nursing care and the staff need to have good dementia care training as well,… but what I think Namaste [Care] does is to make it real for them, you know, it makes the person-centred care real for them and it then feeds into the basic care that they’re giving.’ Nam03 • ‘I think there’s something about setting up the Namaste Care programme, that people pay attention to people’s responses within the Namaste Care space.’ Nam04 • ‘The key to it was the capacity to offer interventions for the purpose of offering comfort, but facilitating opportunities for intentional presence and connection.’ Nam06 • ‘I hear people say that they feel that there’s this trickledown effect with Namaste [Care], …, that how they care for a person outside of the Namaste [Care] room is more caring.’ Nam07 |