Topics of Personcentered Care (PCC) Psychological needs of Persons with dementia Dementia Care Mapping

Transcription

1 Topics of Personcentered Care (PCC) Psychological needs of Persons with dementia Dementia Care Mapping

2 Topics of PCC Several things about PCC you have to know The psychological needs of persons with dementie Dementia Care Mapping But first..mariette

3 Mariette What s going good? What s going less good? What s going not good? How you shall do? Why they do it so? Other remarques?

4 Several things about PCC you have to know What is PCC? Treatment and care provided by health services (that) places the person at the centre of their own care and considers the needs of the older person s care (Victoria Department of Human Services, Australia, 2003) a recognition of, and connection with, the person, a focus on the person s strengths and goals, an interdisciplinary approach, and recognition of the centrality of relationships. (Nay, Bird, Edvarsson, Fleming & Hill, 2009)

5 Several things about PCC you have to know Why should we provide PCC? What the virtuous caregiver should do Promote the person s holistic well-being Support a person s values and preferences Involve a person in decisions about their care It respects the rights of the older person Leads to desirable outcomes

6 Several things about PCC you have to know Why should we provide PCC? What the virtuous caregiver should do It respects the rights of the older person Residents have a right to be treated and accepted as individuals and to have their individual preferences into account and treated with respect Leads to desirable outcomes

7 Several things about PCC you have to know Why should we provide PCC? What the virtuous caregiver should do It respects the rights of the older person Leads to desirable outcomes Chenoweth et al, 2009: PCC reduced agitation in people with dementia in residential care Hoeffer et al, 2006; Sloane et al, 2004: PCC-intervention for showering and bathing residents found that discomfort, agitation and agression declined significantly Fossey et al, 2006: PCC leads to significantly less neuroleptic medications

8 Several things about PCC you have to know Objectives of PCC: maintaining personhood in dementia Kitwood, 2001: Personhood = a standing or status is bestowed upon one human being by others, in teh context of relationship and social being. It implies recognition, respect and trust.

9 CLOSE YOUR EYES

10 Several things about PCC you have to know Maintaining personhood in dementia Security feeling safe in the living environment Continuity experiencing links between past, present and the future achievements and goals Belonging having a place of my own, being accepted Fulfilment getting somewhere/doing something meaningful Significance feeling I matter, my life has been/is important

11 Several things about PCC you have to know How personhood becomes impaired in dementia Multitude losses are occuring-cognitive, emotional, social, physical, eg. impacts of past traumas, Loss is characterised by disconnectedness in self-perception, awareness and response Loss of self-perception can lead to disorientation, apprehension, distress, anxiety, depression, ambivalence, elation, withdrawal The person s behaviour is labelled as a Behavioural and Psychological Symptoms of Dementia (BPSD) The person s Quality of Life (QoL) suffers if the BPSD label dominates staff thinking and negatively influences care and therapy delivery

12 The psychological needs of persons with dementia

13 The psychological needs of persons with dementia COMFORT Warmth, tenderness, closeness and soothing Promotes security and relaxation and decreased anxiety

14 The psychological needs of persons with dementia IDENTITY Relates to knowing who one is and to having a sense of continuity with the past Life story Others know about you

15 The psychological needs of persons with dementia ATTACHEMENT Relates to bonding, connection, nurture, trust and relatioship Also relates to security in relationships

16 The psychological needs of persons with dementia OCCUPATION Relates to being involved in activity in a way that is personally meaningful Feeling of having some control over one s private world

17 The psychological needs of persons with dementia INCLUSION About being in, or brought into, a social world Relates to facilitating engagement where there would otherwise be none Making a person feel part of a social group

18 Personal Detractions/Enhancers PD= staff behaviours that have the potential to undermine the personhood of people with dementia PD lead to malignant social psychology PE= actions who re aimed to satisfy the needs of persons with dementia and leads to higher levels of well-being

19 EXAMPLES OF MALIGNANT SOCIAL PSYCHOLOGY ARE IDENTIFIED AND RECORDED AS PERSONAL DETRACTORS (PD s). Eg Two care workers sit in the lounge chatting. Jack s wife arrive and asks then how he is. They reply He is fine, he s been in a good mood this morning. No trouble at all EXAMPLES OF POSITIVE PERSON WORK ARE RECORDED AS PERSONAL ENHANCERS (PE s). Eg Two care workers sit in the lounge chatting to the participants.jack s wife arrives and asks then how he is. One of the care workers replies He is fine this morning. Aren t you Jack. You ve had a good breakfast and you ve been doing some exercises. She makes a clear effort to include Jack in the conversation.

20 Dementia Care Mapping DCM = a genuine attempt to take the standpoint of the person with dementia using a combination of empathy and observational skill (Kitwood, 1997) DCM = tool & process What DCM observes? People with dementia: Behaviour, mood and engagement (wellbeing of illbeing) Caregivers(staff): PD s and PE s

21 % of Time Sample group behaviour profile Group Behaviour Profile Aim: To increase the variety and percentage involvement in behaviours that support a high potential for well-being To completely reduce occurrence of low potential behaviour categories To reduce occurrence of medium potential categories A B C D E F G I J K L N O P R S T U V W X Y Z Behaviour Categories

22 % of Time Sample patient well-being profile ### b#c###j###ˆ'p########### Mood & Engagement Values Aim to 'shift' patients' well-being to the positive end of the mood and engagement scale Aim to reduce completely -3 ME values and reduce significantly -1 ME values

23 Effectivity of PCC on agitation (systematic review, KD, 2013)

24 DCM is a responsive tool that provides rich data describing the patient experience Data is quantitative and qualitative and can be used in many ways to measure progress in identified areas of care Used correctly, DCM can be a positive and constructive process for all involved in providing patient care and can improve the overall care experience for the patient with dementia