Walking in Another s Shoes.

Transcription

1 Walking in Another s Shoes. Steps Towards Positive Well-Being in Dementia Care Background Recent Government led initiatives aimed at enhancing the quality of care being provided for individuals with dementia in a residential setting. Lewis (2002) identified a number of essential components that are required to ensure quality care. Symposium

2 Components Include Staff who are well trained, highly skilled and well supported by management. Promotion of individual rights and choice. Individualised care plans. Non-use of physical and chemical restraint. Appropriate living environments. A person-centred approach. The Dementia Educator Initiative Aims To Complement and work alongside existing education programmes. Enhance the quality of care being delivered to individuals with dementia. Increase the level of job satisfaction experienced by staff working in the area. Symposium

3 Objectives of Programme. To provide opportunity for health workers to develop their skills, knowledge and confidence in the delivery of care for individuals with dementia. To ensure the ongoing provision of a quality person-centred service. To promote concepts of Well Being Quality of Life Dignity Respect. Symposium

4 To develop a support network for staff working in residential services. To enable improved staff recruitment and retention in the area of dementia care. To maintain open lines of communication between Psychiatric Services for the Elderly and Residential settings. Walking in Another s Shoes Care-Giver/Diversional Therapy Programme. Symposium

5 This Programme. Delivers 8 workshops that run in a sequential manner over a period of approximately 8 10 months. Maintains continuity and develops support networks between dementia rest-homes and hospitals. Provides clinical support to all staff members at their work-place. Ensures ongoing evaluation and review through the use of outcome measures. Symposium

6 The Programme Enables Staff to engage in learning with hands-on facilitators. A training forum that provides staff with the opportunity to reflect on their attitudes and practices. Training that is practical and combines factual information with experiential learning. Provides an experience of a supportive group to empower and encourage staff. As recommended by Loveday (1998) Workshop One Overcoming The Challenges. Symposium

7 Learning Objectives. Participants will have the opportunity to Explore individual attitudes and beliefs related to cognitive impairment and ageing. Develop increased understanding and empathy towards people with dementia. Identify 5 unmet emotional needs in a person with dementia and consider ways of meeting these in a dementia setting. Identify a minimum of 3 strategies to assist in communicating with a person with dementia. Workshop Two Detecting Dementia. Symposium

8 Learning Objectives. Participants will have the opportunity to Develop an increased understanding of the brain and the impact dementia has on it s functioning. Identify at least 3 ways dementia impacts on an individual. Identify 2 risks associated with alcohol and dementia. Recognise signs and symptoms associated with a minimum of 2 types of dementia. Identify a minimum of 3 signs and symptoms of acute confusion/delirium and identify at least 3 strategies to deal with this. Identify a minimum of 3 signs and symptoms of depression in people with dementia. Workshop Three Considering Culture. Symposium

9 Learning Objectives. Participants will have the opportunity to Develop knowledge and understanding of workplace culture with a focus on person centred care. Develop knowledge and understanding of bi-cultural practice, in relation to meeting the needs of Maori in a residential setting. Develop knowledge and understanding of restraint minimisation standards and transfer this knowledge into the workplace. Develop awareness of issues related to sexuality and the elderly and explore individual attitudes and beliefs related to this. Workshop Four Caring for the Carers. Symposium

10 Learning Objectives. Participants will have the opportunity to Develop awareness of the impact of dementia on families and carers. Recognise signs and symptoms of carer stress and identify how this may effect families and oneself. Develop skills in dealing with conflict when working with families. Develop increased understanding of the effects of stress and identify strategies for managing stress in the workplace. Identify at least 2 strategies that aid relaxation Workshop Five Environmental Influences. Symposium

11 Learning Objectives Participants will have the opportunity to Identify at least 2 methods of adapting activities of daily living to ensure a successful outcome for the client. Identify at least 2 ways of enhancing the senses to improve well being in people with dementia. Develop an increased understanding of the impact of environmental factors when working with people with dementia and identify 3 factors within own workplace. Identify 3 ways of modifying the workplace environment to ensure positive outcomes for people with dementia. Workshop Six Team Work in Dementia Care. Symposium

12 Learning Objectives. Participants will have the opportunity to Develop skills in conflict resolution with a focus on positive team work. Develop knowledge and understanding of assertive communication and identify 2 ways of incorporating this into the work place. Develop knowledge and understanding of the role of the Speech Language Therapist in Dementia Care and identify 2 strategies to support safe and independent swallowing for people with dementia. Develop knowledge and understanding of the effects of at least two commonly used medications with people with dementia. Workshop Seven Let s Get Physical. Symposium

13 Learning Objectives. Participants will have the opportunity to Develop increased understanding of how to physically care for people with dementia, and know what to recognise and report. Develop increased understanding of at least 4 physical health problems which can occur in people with dementia and identify suitable interventions to apply within a residential setting. Identify a minimum of 3 signs and symptoms of constipation, UTI s, and decreased fluid intake in people with dementia. Develop knowledge and understanding of skin assessment and management. Identify a minimum of 2 strategies that reduce the risk of pressure areas for people with dementia. Identify a minimum of 2 strategies that reduce the risk of falls for people with dementia. Develop knowledge and understanding of the assessment and management of pain in dementia care and identify 2 ways that a person may communicate pain to others. Symposium

14 Workshop Eight Walking the Talk. Learning Objectives Participants will have the opportunity to Demonstrate key learning's from the programme through case study presentation and discussion. Share ideas and resources with other participants and consider additional ways of implementing knowledge gained back into the work place. Symposium

15 Case Study Staff Member A and Resident B Staff Member A Activities Assistant 3.5 years experience Previous Qualification: National Certificate in the Older Person. Identified Learning Objective: To develop strategies that assist in understanding and dealing with challenging behaviour of resident B. Symposium

16 Resident B. Female Diagnosis: Dementia Alzheimer's Type Length of Time in Residential Facility: 2 years Challenging Behaviours as Identified by Staff Member A: Negative Comments toward staff and other residents. Monopolising one particular chair in the environment. Refusal to engage in activities. Resistant to cares. Attention-Seeking Behaviour. Symposium

17 Step One The Detective Work (Appreciative Enquiry): Who is Resident B? What lies behind her behaviour? How else could we describe her? What s the view from her chair? Whose problem is it? Step Two The Relationship A daily greeting. An invitation. The Just Right Challenge. Use of rituals rather than mundane routines. Meeting emotional needs. Symposium

18 Step Three Celebrating Positive Change Increased attendance and enjoyment of activities. Accepting help from Staff Member A. Remembering Staff Member A s name. Evidence of empathy, increased understanding and new ideas. Positive feedback from management. Step Four Sharing the Knowledge Sunshine Book Liaison with staff Case Study Symposium

19 Qualitative Outcomes What do participants say about the programme? The Programme has helped me Look outside the square. To reiterate the importance of stepping back and looking at the person as a whole and putting yourself in their shoes. Take into consideration residents individual needs and life history. Have more understanding of the why or how. Learn to cope with stress better. Realise the importance of exercise and activity for residents. Symposium

20 It has also Extended knowledge. Provided good ideas and strategies for dealing with residents especially challenging behaviours. Increased tolerance Improved my confidence with residents. Made me think a lot more before I do something. Confirmed my love of the job. What Do Managers Say about the programme? Symposium

21 The Programme Is Making a real difference to patient care. Resulting in a significant, positive shift in the way staff think and practice. Proving to be highly beneficial for the facility and also for staff s professional development. Resulting in staff coming back with great ideas to overcome some of the challenges they have been presented with. Future Directions Symposium

22 Important steps forward 2010 funding approved by Ministry of Health for Regional Dementia role Road Shows around South Island to promote programme Trainers employed in West Coast and South Canterbury. Home Based Support Trainer employed in CDHB. Recruitment in process in Nelson/Marlborough. Position being developed for Southern DHB. References ALZHEIMERS NEW ZEALAND National Dementia Strategy COLE, R.P; SCOTT, S and SKELTON-ROBINSON, M. The Effect of Challenging Behaviour and Staff support, on the Psychological Wellbeing of Staff Working with Older Adults, Aging & Mental Health 2000:4(4): Symposium

23 References LEWIS, H. Dementia in New Zealand: improving quality in residential care: A report to the Disability Issues Directorate Ministry of Health January LOVEDAY, B. Training to Promote Person Centred Care, Journal of Dementia Care March/April 1998: NEW ZEALAND COUNCIL OF CHRISTIAN SOCIAL SERVICES Working Together We Can Respond To Dementia: Future Directions for Services. September Acknowledgements Jane Verity Dementia Care Australia Linda Fourie Facility Manager Radius St Winifred s Hospital. Margaret Sutherland Charge Nurse Manager Tuarangi Home. Symposium