Background: There are very few robust studies in the literature that explore the correlation between transformational leadership and effective nursing care in long term care facilities for older people. Working from the premise that transformational leadership is situational leadership enacted within a person-centred framework, this study develops a composite model of situational lead~rship in residential care by connecting and synthesising concepts of person-centred theory with situational leadership theory within the person-centred nursin~ framework. This model subsequently forms the theoretical basis for this overall study. Aims of the research study: To use the model of situational leadership in residential care as the premise for developing and facilitating a leadership intervention programme for leaders and, using an action research approach, test three actionable hypotheses that were developed from the theoretical model. Approach and methods: The data came from several sources: the Leadership Practices Inventory (LPI); non-participatory observation using the Workplace Culture Critical Analysis Tool (WCCAT); critical and reflective dialogues with participants; narratives from residents at time 1 and time 2 of the study; focus groups with staff at time 2 and my reflective field notes. Different approaches to analyse the data were adopted for the different data sources. In the final stage the overall results of the thematic analysis were brought together using cognitive mapping to answer the study's actionable hypotheses and create a visual representation of the study. Findings: A 'Person-Centred Situational Leadership (PCSL) Framework' emerges that captures seven core themes of 'the being of person-centredness'. These specific attributes enhance the leader's ability to continuously role model a person-centred way of being for followers so that person-centredness "is consistently brought into practice on a day-to-day basis. Conclusions and implications: A main recommendation from the study is the utilization of the PCSL Framework to underpin the: delivery of a leadership development programme focusing on the development of 'the being of personcentredness in leaders.

This study has been conducted in response to policy initiatives that have aimed to model residential care upon a homely or domesticated ideal. This objective is consolidated by the publications of Home Life (1984) and A Better Home Life (1996) that maintained that older people have rights to receive care in `homely' environments. A major concern of the study has been to contribute to research that has examined the topic of residential care within a domesticated framework. The study intends to integrate these topics in order to further knowledge about the way in which the notion of home can be related to the residential care setting. The study uses the method of participant observation and investigates constructions of home and homeliness in two residential settings. The aim of the research has been to examine, to what extent, the two settings utilise the concept of home within the respective environments with regard to the realities of everyday life, the nature of social relationships and the philosophy of care for residents. The study provides a discussion of how the construction of homeliness is either enhanced or inhibited by the environments and accompanying routines that shape the everyday life experiences of residents. Results indicate that it is factors associated with the structure of routines, the use of space and the consequences of disability that are particularly instrumental in influencing feelings of homelinessThe study makes recommendations for the development of further research to focus on comparisons between people receiving care in their own homes and people receiving care in other special settings. It is considered that this will broaden knowledge about how feelings of homeliness for older people are influenced and determined by the different environments that people inhabit as they grow older

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This thesis examines the emotion work of care staff working with older people living in care homes, by integrating both sociological and psychological perspectives relating to emotions. By exploring both the empathy and emotional labour undertaken 3y care assistants from their own perspective, this thesis provides insights into the emotional demands of care work that are of both theoretical and practical relevance. The thesis examines how care staff respond to many emotional challenges in their daily work, which require both emotional skills and labour in order to provide emotional support for the residents.

Relationships are an integral part of living, working and visiting in care homes. However, few studies have considered relationships as their main focus of enquiry, and there has been a relative dearth of work that has included the perspectives of residents, staff and families. This study sought to redress this imbalance. Using a constructivist approach the nature and types of relationships between residents, staff and families were explored in three homes through a combination of methods including participation, observation, interviews and focus groups. Data collection and analysis occurred concurrently and three types of relationships were identified: pragmatic relationships, which had as their primary focus the instrumental aspects of care; personal and responsive relationships that engaged more fully with the wider needs of individual residents; and reciprocal relationships that sought to recognise the contribution of residents, staff and families to creating a sense of community within the homes. More detailed analysis revealed a number of factors that helped to shape the relationships with each home including: the personal motivations and values of staff; leadership style; teamwork, and the input of residents and families. Findings from the thesis enhance our understanding of the importance of, and dynamics contributing to, relationships within a care home setting. These insights are considered with reference to current notions of person centred and relationship centred care and a framework for promoting a relationship centred approach is ii presented. Implications for policy, practice and education are considered and recommendations made.

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The health and social care needs of older people are varied and complex and often require the involvement and expertise of a number of professionais. Practitioners who provide services for older people have skills that have been historically defined by different training and professional pathways and often work for different health and social care agencies. There is significant interest in interprofessional working. However, its development has been shown to be a process that can be easily complicated when structural and professional factors are not considered or understood. As a result, further research on the factors that underpin effective interprofessional working will be central to this approach.

In the year 2000, the United Kingdom government produced a report called "Organisation With a Memory" in response to the problem of safety in the healthcare sector and committed to reduce the number of serious medication errors. Whilst patient safety research in other healthcare settings such as the primary and secondary care has been under way for the past two decades, patient safety research in care homes has largely been neglected. This thesis presents the findings of the first large-scale epidemiological study of the prevalence and types of medication errors in England that was conducted as part of a wider study.

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