Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the 'right' leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed.KEY WORDS -residential care, nursing homes, culture, quality of care, dementia.

This article is concerned to eliminate a number of possible confusions in egalitarian thought. I begin by showing that the most plausible forms of egalitarianism do not fit straightforwardly on either side of the distinction between Telic and Deontic egalitarianism. I go on to argue that the question of the scope of egalitarian distributive principles cannot be answered in the abstract, but instead depends on giving a prior account of the different ways in which distributive inequality can be bad. I then discuss some misconceptions about the "Levelling Down Objection," and about the relationship between egalitarianism and prioritarianism. In doing so, my aim is to present a more plausible account of what egalitarians should believe.

Objective The research objective was to identify how healthy eating was understood in a disadvantaged community and how barriers to healthy eating might be overcome. Design Participatory action research. Setting Communities in Gurnos, Merthyr Tydfil, one of the most deprived areas in the UK.Method Trainees on a participative methods course undertook handson research, directed by the course leader and local researchers. Respondents were from established local groups, including elderly, carer and toddler and residents' groups. Participants were asked to identify and rank healthy and unhealthy foods and to discuss barriers to healthy eating in their community. Results Participants demonstrated fairly good knowledge of what constituted a healthy diet, but many found that this was difficult to achieve. Barriers included conflicting advice from professionals, lack of time, advertising, community norms and poor quality food available in school. Conclusion In order to be successful, healthy eating initiatives need to embrace the multifaceted nature of this issue in poor communities, including food as an aspect of local culture.

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Evidence-based practice in social care and health is widely promoted. Making it a reality remains challenging, largely because practitioners generally see practice-based knowledge as more relevant than empirical research.<br />A further challenge regarding the creative, contextual use of research and other evidence including lived experience and practice-based knowledge is that practitioners, especially in frontline care services, are often seen not as innovators, but recipients of rules and guidelines or followers of predetermined plans. Likewise, older people are not generally recognised as co-creators of knowledge, learning and development but as passive recipients of care, or objects of research.<br />This paper outlines a participatory action research project which brought together researchers, social care and health practitioners, managers, older people and carers in six sites across Wales and Scotland. Working collaboratively, and using a dialogic storytelling approach, they explored and addressed seven already published research-based ‘Challenges’ regarding what matters most to older people with high-support needs.<br />Taking a participatory, caring and emergent approach, participants discovered and addressed five elements required in developing evidence-enriched practice: the creation of supportive and relationship-centred research and practice environments; the valuing of diverse types of evidence; the use of engaging narratives to capture and share evidence; the use of dialogue-based approaches to learning and development; and the recognition and resolution of systemic barriers to development. Although existing literature covers each element, this project was novel in collectively exploring and addressing all five elements together, and in its use of multiple forms of story, which engaged hearts and minds.<br /><br />Key messages<br /><ul><li>People meaningfully engage with research evidence if they feel valued and have agency to lead their own learning</li><br /><li>People engage with research evidence when they can relate it to their own knowledge and experience</li><br /><li>Research evidence presented in story format is accessible and can act as a catalyst for dialogue-learning</li><br /><li>Dialogue-learning, stimulated by stories, supports the co-creation of knowledge and policy</li></ul>