Project

SNAP. Piloting within district nursing with older people living in the community - PEOLC14

Started 1st Jan 2021

Summary

SNAP (the Support Needs Approach for Patients) is an intervention to enable a whole person-approach to identifying and addressing patient support needs: https://thesnap.org.uk/. This study will explore the acceptability, feasibility and practical benefits of delivering SNAP to better support older community-dwelling people via district nursing.

Background

We know from previous research that older people’s experience of health and well-being can be impacted by their unmet physical, psychological and social support needs. This is true not only for older people with complex health and social care needs but also those who need lower-level support to manage their life at home. We know that one of the reasons that support needs can remain ‘unmet’ is that older people experience a range of barriers to identifying and discussing these needs with care professionals. Therefore, care professionals cannot rely on older people to start discussions about the support they need – even when asked “how are you?”. Similarly, we know that professionals often refrain from opening up conversations about the full range of potential support needs experienced by older people due to the medical focus of most clinical encounters.

As a result, national reports have increasingly recommended that care professionals adopt what is called a whole person, holistic or person-centred approach to identifying needs. This means an approach which: 1) aims to address an individual’s physical, social and mental wellbeing and 2) seeks to involve people in identifying where they feel they would benefit from more support.

The Support Needs Approach for Patients (SNAP) provides an alternative to the common clinician-led assessment approach. Modelled on the internationally recognised evidence-based Carer Support Needs Assessment Tool (CSNAT) Intervention, SNAP comprises a concise evidence-based validated tool (short set of questions: the “SNAP Tool”) to help people directly consider where they need (more) support, which then informs a needs-led conversation between the individual and an HCP to identify, express, prioritise and address their individual unmet support needs. A pilot of SNAP in primary and secondary care, and with community respiratory teams showed that SNAP gave people “permission” to raise a range of support needs to HCPs (particularly non-medical needs), enabled conversations about those needs, and supported individuals to work with HCPs to consider and identify how those needs could be addressed. As a consequence, participants reported a range of practical benefits including accessing additional supportive input to overcome loneliness, get out-and-about and deal with their feelings and worries. In addition, SNAP opened up difficult conversations about ‘what to expect in the future’ and planning for future care. Results also suggest that SNAP may enable identification of need in relation to social isolation, community involvement and well-being which are known to be key issues for older people. In the light of the current COVID-19 pandemic, SNAP may also have potential utility for older people ‘in recovery’ from coronavirus. This study therefore seeks to explore whether SNAP could enable delivery of a whole person approach to community-dwelling older people.

Aim

To explore the acceptability, feasibility and practical benefits of delivering an intervention to enable a whole person-approach (SNAP) to supporting older community-dwelling people via district nursing.

Research Questions

RQ1) Is SNAP acceptable to community-dwelling older people and feasible for delivery by district nurses working with them?

RQ2) What are the practical benefits to community dwelling older people of using SNAP to consider the ‘whole’ person?

Activity

District Nursing services play a key role in helping older people with both chronic and acute conditions within a community-setting, and so provide an appropriate setting for exploring SNAP’s utility with older people. Two district nursing teams will take part. We will train all members of the District Nursing teams in how to deliver SNAP, and SNAP will be implemented as a District Nursing service improvement running independently of the pilot study (so that SNAP will be part of the teams’ routine care provision for all patients).

We will conduct a qualitative study of SNAP with older adults who are either living independently in the community or within sheltered accommodation. This study will run alongside delivery of SNAP in routine practice and will involve the four tasks outlined below.

Task 1) Pre-pilot workshops with District Nursing teams to identify District Nurses’ hopes, expectations and concerns about using SNAP within the pilot study.  

Task 2) Mid-pilot interviews with District Nurses to monitor and discuss SNAP use and identify (and address) any barriers to SNAP delivery.

Task 3) Patient Interviews – older people living independently in the community or within sheltered accommodation who have experienced SNAP will be invited to take part in an interview about their experience of using the SNAP Tool to consider their support needs and any conversation with their District Nurse that followed, whether their experience of the intervention differed from usual care, and what benefits (if any) they identify from having received SNAP.  

Task 4) Pilot Study-end focus groups/interviews with District Nurses will seek to identify feasibility (including barriers/facilitators to implementation) and benefits of delivering whole person care through SNAP.

Outputs and Impact

The findings of the study will be shared through:

  1. conferences aimed at health and social care practitioners who work with older people and researchers
  2. publication of a paper in an academic journal
  3.  briefing papers to be sent to relevant organisations (e.g. Age Concern, Queen’s Nursing Institute)
  4. articles targeted at professional magazines (e.g. Nursing Times)
  5. Social media: we already have an active dedicated SNAP Twitter account (@SNAPstudyteam) and are linked to Twitter, blogs and websites run by the University of East Anglia.
  6. SNAP related webinars for health and social care staff

SNAP is a fully-developed intervention which is already available to the health and social care system through the well-established SNAP website which provides SNAP training, resources and access to SNAP tool licencing (free for non-for-profit organisations): https://thesnap.org.uk. Licence uptake is gaining momentum, however demonstrating that SNAP can facilitate whole-person care for community-dwelling older people will enable wider uptake by district nurses to better support for this group. It has the potential to support the delivery of practical benefits that directly address those areas where older people themselves identify needing more support to manage, thereby improving the health and well-being of older people.

Funded by Abbeyfield Foundation

Related project - PEOLC07 – SUPPORT Programme (SNAP-CSNAT dyadic intervention in multi-morbidity)

PI - Carole Gardener (University of East Anglia)

Researchers and institutions - 

Carole Gardener & Morag Farquhar (University of East Anglia)

Gail Ewing (University of Cambridge/Manchester)

Corresponding researcher - Morag Farquhar M.Farquhar@uea.ac.uk