How well your residents use their garden depends on your care culture by Step Change Design
6th March 2017
In the previous article, Mark and Debbie, designers and consultants at Step Change Design Ltd., described their large-scale, self-funded research project into why gardens around care settings were not more actively used. Here they explain their findings in more detail and the innovative way they presented this information for care home staff and designers
Prior to the research project, we had no direct experience of working in a care setting. We were therefore neutral observers when we stepped across the threshold to capture what we saw going on inside the care settings we visited. Our first site visit proved to be transformative for us both and challenged many deeply held assumptions about how a care setting garden should look from a designer perspective.
We saw a magical interaction take place between a member of staff and a resident living with dementia in a very modest garden that had clearly not been designed. There were weeds and bare patches, a washing line and a general feeling of untidiness. And yet, what made this garden work for this resident was connected to the skills and sensitivity of the member of staff who accompanied her.
She knew her resident very well and the garden visit proceeded to use the weeds, which they had told us they kept deliberately to support some residents, the watering can and other features within this domestic-scale garden to help calm and lift the resident in her care.
What made this garden successful was not its design but the attention and skill of the person the resident was with. It had to do with the care culture in operation at this home that enabled this deeper engagement with the resident and with the outside space. This was earth-shattering for us. We had to acknowledge that if we had been invited to redesign this garden we would have removed the very things that had made it successful! What we had witnessed on this visit showed us that we needed to widen our research project’s remit and follow the trail of evidence wherever it led. From that visit on, we spent as much time inside the care setting as we did outside, finding out as much as possible about the care culture in operation as well as what took place outdoors.
During all the remaining site visits (we made 20 in total), we noticed that the way care was delivered (the care culture, effectively) varied widely across the homes and a ‘spectrum’ of care cultures emerged. Without knowing that some terms already existed, we started to plot a range of care cultures with our own descriptions along this spectrum. We placed ‘task-oriented’ care at the lower end and ‘relationship-centred’ care at the higher end. Around midway we placed what we observed to be ‘person-centred’ care.
The challenge for us was how to explain this subtle and complex process in an easy to grasp, practical way so that care staff could engage more confidently and more actively with their gardens, based on better knowledge of their care culture practices. We also wanted to show ‘how’ care homes can progress along the spectrum towards more advanced forms of care cultures where the outside space is being used more actively, whether or not the garden has already been designed.
During our data analysis phase we scribbled and drew sketches to describe the patterns and themes we had identified. The spectrum of care practices developed into an arrangement of columns and boxes. With the aid of a graphic designer, we developed this diagram into a poster-sized, graphic tool to show the care culture spectrum in an easy-to-grasp and practical way. The ‘Care Culture Map’ diagnostic tool effectively became our academic paper showing visually the complex and subtle relationship between care culture and engagement levels with the outdoors.
We had identified information that could help care settings address their fears, inhibitions and concerns about using the garden and also that would help designers (and other outside specialists) to match their services to the type of care culture in operation at their client’s setting, and make more appropriate and cost effective interventions as a result. It is in the Care Culture of the setting where the answer lies to activating the outside space: in the interactions with staff, the procedures and beliefs that determine what is permitted and what is not, what is valued and what is not, and what is encouraged and what is not. All of this information was arranged on our Map to be interpreted by care staff and designers alike, along a wide spectrum of care practices.
At our first presentation of the Map tool to 14 Care Home managers, we were stopped 10 minutes into our presentation. A manager stated, with some incredulity, ‘so you have basically carried out an audit of care culture across the UK.’ We looked at each other for a moment, unsure how to respond. We had set out to answer a simple question and thought we would find the answers in the garden. Until that moment, we hadn’t fully realised that our colourful and engaging diagnostic tool was just that: an audit of Care Culture.
Our Map was like a mirror being held up to the care home managers in the room that day.
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