Case study: Researching COVID-19 in care homes

An interview with:

• Caitlyn Burchett – Research Nurse at Solent NHS Trust research and learning team
• Emma Searle – Research Nurse at Solent NHS Trust research and learning team
• Maria Bungaroo - Care home manager at the Braemar Care Home in Southsea, Portsmouth

The NIHR-supported VIVALDI study was established by University College London (UCL) and funded by the Department of Health and Social Care in June 2020, shortly after the first wave of COVID-19. Designed to look at the impact and prevalence of COVID-19 in care homes, the multi-centre study has proved instrumental in helping to shape pandemic protocol and protect vulnerable residents. Here, Caitlin and Emma share their experience of running the study at Solent NHS Trust.

Emma: Both myself and Caitlin began our roles as research nurses early in 2021 and neither of us had any previous experience in research. 

Caitlyn: I’d been qualified as a nurse for three and a half years and had always enjoyed the research part of my training, so when this role came up I was excited to have the opportunity to be involved with research. 

Emma: It was an exciting opportunity for me as well and completely different to what I had been doing previously as part of the older person’s mental health team at Solent and the Queen Alexandra Hospital and the 10 years I had spent in the community. 

Caitlyn: The VIVALDI study involvement came about very early on in our roles. In the Academy of Research and Improvement, we have the Solent Care Home Research Partnership, where we work alongside local care homes in Portsmouth, Southampton and the surrounding areas to offer residents the opportunity to take part in research. The partnership is all about collaboration. We hold quarterly get togethers with the care home managers, giving us the opportunity to discuss ideas for developing the partnership and hear about their experiences of delivering research. We have a partnership with around 25 local care homes, and were keen to get involved in the study as care homes had become such an area of focus during the pandemic. The study involves swabs and blood tests for care home staff and residents to see how prevalent the virus is in care home settings.

Emma: We approached one of the care homes, in our partnership called Braemar Care Home, as they had previous research experience and they agreed to take part in the study. This was great news but we then had to work around the logistics of not being able to go into the care home to deliver and coordinate the study. We had to work really hard to make the study as inclusive as possible, because the care home staff would be recruiting residents and staff into the study and coordinating all the sample taking and sending back to the lab. 

Caitlyn: The study team at UCL created slides that explained all the processes, and we also produced a few simple information sheets to help make everything as straightforward as possible. Some of the processes were a lot of extra work for the care homes - Braemar undertook the whole consenting process as we were not able to enter the care home, and they had to keep a spreadsheet of people with COVID-19 symptoms. They chose to have a private phlebotomist come in to take the blood samples, and they were already doing swabs for both staff and residents as part of the national programme so these results were sent to the VIVALDI study team. We were relying on one member of the administrative team, Kimberley, and the care home manager, Maria, to take on all of this, so it was important we offered as much support as we could to them. 

Emma: UCL created contracts for each individual care home taking part and because this was quite a different way of doing things it took a long time for the study to get off the ground – it was around four to five months before we were able to get going. But being part of a national study meant that once we were up and running, we had fortnightly calls with the study team at UCL and the other teams in local areas. We were able to problem solve together as we were all facing the same challenges and could offer reassurance when it was needed. 

Caitlyn: All together there have been five rounds of bloods at Braemar. We get a monthly newsletter from the central team at UCL which helps us to look at issues and  snapshots of data and pass those on to all the care homes in our region, not just Braemar. We’ve already had feedback from care homes telling us how invaluable they have found it. It is helping them to shape their approach to fighting the disease and get reassurance – one of the most interesting findings we’ve had out of the study so far is that people in care homes who have previously had COVID-19 are unlikely to get infected a second time, but the vaccine offers the best level of protection. 

Emma: It has been a whirlwind time for me starting a new role in research – I’ve hit the ground running. But it’s also presented a lot more challenges. Working from home made it feel like we weren’t having the impact that we could normally and it has been a lot harder to establish a study like this remotely. 

Caitlyn: I’ve definitely learned that a lot of research is about relationship building, which takes time, and is even harder when we’re working remotely and not able to go into the care homes and take the lead. But we’ve been so grateful for the great relationship we’ve cultivated with Braemar and the progress we’ve made.

Emma: We've been involved in other COVID-19 studies too, including various vaccine trials and the SIREN study, which is looking at coronavirus infection in healthcare workers. We’ve both learnt a lot of new skills and been pushed out of our comfort zones. 

Caitlyn: It’s definitely broken down barriers and shown how powerful research can be when we collaborate and diversify. We can achieve so much when we work together. 

We spoke to Maria Bungaroo, Care Home Manager, about her experience of running the VIVALDI study at Braemar Care Home in Southsea, Portsmouth. 

Maria: My husband and I have been managing Braemar since 1989. It started as a very small home with only 13 residents but we’ve grown to now host 35 residents, and have tailored our services to specialise in dementia. 

In 2015, we were approached by what is now the Solent Academy to take part in a research project. We’ve taken part in many studies and research projects over the years, and have been especially involved in social care research studies. I am incredibly proud of our work supporting research, and this pride is shared by our residents, their families, and our team. It helps to motivate us, educate us and refocus our efforts. This is why we value every opportunity to assist in research - it’s an excellent way to contribute to something bigger, as well as progress as a business and as carers. 

As I’m sure is the same across the industry, COVID-19 has been one of the biggest challenges we’ve ever faced. We had to be resourceful to secure the supplies of food, PPE, medication, and other essentials to ensure our residents could remain healthy, stable and safe, and spent a fortune doing so. Our staff worked tirelessly and without any social relief in the midst of the lockdown, some not even sleeping in their family home to keep our residents safe. Despite being cared for, our residents also were subject to the difficulties of lockdown, unable to see their loved ones for months. 

However, we are incredibly lucky in that we have managed to keep COVID out of Braemar. We cannot thank our team enough for working hard to make that happen and the residents and their families for their patience during this difficult time. 

It wasn’t long before we had processes in place for visitation and for people entering the home. For example, even from the moment you step in the home - you have to step on sterilising mats, and we all change from our outside clothes into scrubs before entering the common areas. 

The COVID-19 restrictions meant VIVALDI had to be conducted differently to other studies our residents have taken part in. Caitlin and Emma were always so engaging and very responsive but sadly had to limit their visitation time as much as possible. 

In a way it's made it an easier study to be a part of, in that it’s less disruptive to the working day. Knowing that the VIVALDI study helped to change government policy is also fantastic, we are so proud to have been involved. To see it clearly making a difference to the way the government is tackling their programme is incredibly rewarding, and we hope we can join in any follow up studies to enhance this work.

To find out more about the Solent Care Home Research Partnership, please visit academy.solent.nhs.uk or contact research@solent.nhs.uk