The Registered Nurse s Contribution to Person Centred Care. Our Lady s Hospice & CS on

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1 The Registered Nurse s Contribution to Person Centred Care Linda Kearns, Deputy Director of Nursing, Our Lady s Hospice & CS on Behalf of the All Ireland Gerontological Nurses Association (AIGNA) National Dementia Strategy Roundtable Discussions 9 th April 2013

2 Definition Person-centredness is an approach to practice established through the formation and fostering of therapeutic relationships between all care providers, older people and others significant to them in their lives. It is underpinned by values of respect for persons, individual right to self determination, mutual respect and understanding. It is enabled by cultures of empowerment that foster continuous approaches to practice development. (McCormack et al 2010)

3 Person Centred Organisation Becoming a person centred organisation is all about 'getting it' - excellent dementia care involves creating a culture where the service brings out the best in staff and people living with a dementia. (David Sheard, ml) Jigsaw

4 Person Centred Care Letting older people with dementia live their life Move away from institutionalised task focused care to ensuring older people are living their daily life e.g. getting their work done, activities they are used to doing/enjoy, environment Allowing older people to take risks and ensuring appropriate measures to reduce the risk are in place

5 Person Centred Care Person Centred Care is about working together with residents on the things that are important to them without the restraint of rituals and routines. How can we incorporate this in to the Dementia Strategy? How do we care for people with dementia and not put them in a cocoon?

6 Person-centred Nursing Framework (McCormack & McCance 2010)

7 CARE ENVIRONMENT The context in which care is delivered PREREQUISITES Attributes of the nurse CARE PROCESSES Delivering care through a range of activities OUTCOMES Results of effective person-centred nursing

8 Risk Enablement Nothing Ventured, Nothing Gained : Risk Guidance for People with Dementia (NHS, 2010) Risk Enablement/Positive Risk Management

9 Nothing Ventured- Nothing Gained-Knowledge Sources Knowledge gained by individual people with dementia/their carers from their own experiences Practitioner knowledge, based on the collective experience and judgments of all those working in dementia services Organisational knowledge, including legislation, regulatory standards, organisational policies and procedures Research knowledge Policies based on decisions made nationally/locally including the views of think tanks/lobby groups

10 Nothing Ventured-Nothing Gained Risk enablement is based on the idea that the process of measuring risk involves balancing the positive benefits from taking risks against the negative effects of attempting to avoid risk altogether. For example, the risk of getting lost if a person with dementia goes out unaccompanied needs to be set against the possible risks of boredom and frustration from remaining inside.

11 Nothing Ventured-Nothing Gained Developing systems for enabling and managing risk is one of the most important ways of allowing people with dementia to retain as much control over their lives as possible. Risk enablement recognises the strengths that each person with dementia possesses and builds on the abilities that he or she has retained. Practitioners should identify less restrictive alternatives that cause less disruption and which maximize their independence and freedom, with due attention to the safety of others.

12 Nothing Ventured- Nothing Gained People with dementia s perceptions of risk are likely to be influenced by events and decisions that have occurred during the course of their lives, as well as by the impact of any changes that can be attributed to the effects of dementia. Shared agreement about risk will not always be possible but it is important that everyone involved in reaching decisions about risk reaches a shared understanding of the viewpoints of all those who are affected by decisions involving risk Tailored approach to risk by acknowledging that dementia affects different people in different ways. A more person-centred approach to risk and dementia concentrates upon identifying risky situations for individuals with dementia rather than viewing every person with dementia as being at equal risk.

13 Role of The Gerontological Nurse Leadership Assessment of Risk and Balancing it with Quality Promotion of Independence Contribution to the Development of Person Centred Care Advocate for Person Centred Care Creative Thinker Assessment & Care Planning Life Histories Working with the MDT, the person and their family

14 Education Needs Under-Graduate and Post Graduate Education In-Service Training Training in Dementia and Specific aspects of Dementia Dementia Champions CNS/ANP

15 Examples from Nothing Ventured-Nothing Gained Document Each day brings its own catalogue of risks, some minor and some dangerous. But over time and with forgetting, there is the risk of being put on the sidelines, of being seen as a hindrance, and having control taken away from you, under the guise of it being for your own good. So, while we can, we must challenge the risks People living with a dementia must be allowed to take risks, because if we don t, we are in danger of relaxing into the disease. At times we feel hopeless. At times the hurt we feel is indescribable and we can let it be a barrier to life. But there is a life for us, if we risk it. (Personal account of living with dementia, Morgan, 2009, 28)

16 Examples from Nothing Ventured-Nothing Gained Document Don t get me wrong, carers are the most important people in the world but you can have carers and keepers. The latter try and assume total responsibility for your life prematurely, and there are many of them around. (Peter Ashley, Person with dementia)

17 Examples from Nothing Ventured-Nothing Gained Document We had a younger person with dementia attending our social group but what she really wanted to do was to go back to working in a shop. And there was our charity shop! We thought that she would be able to manage if we gave her some support as it was her anxiety that was really the problem. So a support worker went with her for the first three weeks and that has made all the difference to her confidence. (Chief Executive, Voluntary organisation)

18 Person Centred Care Find ways to minimise/balance risks that prevent older people from carrying out basic activities E.g. Gardening is often cancelled due to the rain- we need to allow older people to go out in the rain, its natural to get wet! Source Volunteers from a variety of backgrounds to facilitate an older person in their trade e.g. a retired builder might enjoy building blocks. Have Workshops such as those for People with intellectual disability

19 Extracts from the Implementation of a Model of Person Centred Care in Older Person Settings (2010) I miss the smell of silage- was part of my life for so long We made cream slices and were barely hot out of the oven before they were eaten I like my own room, and love watching the telly, I am a real telly addict I love to get fresh air every day, if you can assist me to go to the garden

20 Summary & Conclusion Person Centred Care has many elements and there are several frameworks Leadership Assesment and care planning MDT working Risk Enablement Working with the person and their families Education Let s incorporate these into the strategy!!!

21 References McCormack B and McCance T (2010) Person-centred Nursing: Theory, models and methods. Blackwell Publishing, Oxford. Breslin, E, Manning, M., McCormack, B, Dewing, J., Coyne-Nevin, A., Kennedy, K., Peelo-Kilroe, L. and Tobin, C. (2010) Enhancing Care for Older People: A Guide to Practice Development Processes to Support and Enhance Care in Residential Settings for Older People (HSE publication) McCormack, B., Dewing, J., Breslin, L., Coyne-Nevin, A. Kennedy, K., Manning, M., Peelo-Kilroe, L., Tobin, C. (2010) The Implementation of a Model of Person-Centred Practice in Older Person Settings: Final Report. Nothing Ventured, Nothing Gained: Risk Guidance for People with Dementia, DH, Dir SCLGCP, Older People and Dementia, (2010) (David Sheard,