2.  Families  Environments  Enabling Activities  Risk Management  Teams  Mentoring  Telling the residents story using Case conferencing and Concept mapping  Self care strategies Content- Day 2

4. Families

5. Families: we need them and they need us “... careers of caregivers (family carers) do not stop at the institution’s door, but continue in an altered and still stressful way” Zarit and Witlach (1993

6. Families perceive an important role after placement of a relative is to monitor the standard of care their relative receives Bower 1988; Twigg and Aitkin 1994; Nolan et al 1996 Lack of recognition about families’ specialist expertise about their relative leads family to feel like ‘outsiders’ Buckwalter and Hall, 1987 Families may not ‘adjust to placement’ if there is poor staff- family communication and/or poor emotional, mental state, or behaviour of resident Almberg, 2000

7. Spouses generally want and need more involvement Adult children tend to re-engage with previous life roles How much involvement a family want may depend on the quality of the relationship before care. Case conference – engaging in decision making Support groups

8. Families want to be involved 1. Reduce loss and find new ways of caring 2. Ensure their knowledge about their relative is valued and used 3. Understand the roles of staff and themselves 4. Remain involved and share a fruitful relationship with their relative Kellet (1996)

9. Families give us…… –Information –Words to use and to listen for –Routines to understand and use –Personal history and stories –Interests, passions, likes, dislikes, achievements, disappointments, regrets, loves end more

10. Families give us:  Information  The words, the routines, the stories, the history, the interests and more Families need us to:  Communicate openly and honestly  Recognise their expertise  Provide support, information, respite & self care skills Relating effectively with families

11. Relating effectively with families involves understanding that moving a family member into residential care has impacts on the family: Emotional Social FinancialPractical Physical

12.  Allow families to tell their story  Invite their participation  Be respectful if they refuse  Help families to feel included at a level they are comfortable Families…

13.  The care worker/nurse cannot address all family issues  Referral is essential  A range of organisations provide assistance  Alzheimer’s Australia Helpline 1800 100 500  Look for warning signs of problems and talk to your supervisor Families and you

15. Includes the  Physical environment  Social environment  AND interaction between the two We need to know if the environment is enabling or disabling Environments ‘the totality of surroundings’

16. The environment and the way in which we interact with people living with dementia can enhance their residual abilities or Increase their confusion and disability

18.  Most environments can be improved using 7 key principles  Small and domestic  Close to the community  Reduce stimulation  Highlight needed items  Visual access  Planned wandering  Familiar decor The right environment

19. Exercise: Can you find five horses?

20. Can your resident find the toilet?

21.  Enables individual based activity  Provides independence in functioning  Excludes excessive stimuli  Provides a kitchen/domestic focus  Controls the level of stimulation An enabling social environment :

22.  Small groups and gatherings (avoid the confusion of large groups)  Keep the person in touch with their familiar community  Minimize background noise (trolleys, phones, paging systems, music etc)  Clear signs at eye level for toilets; night lights on in the toilet at night; leave the toilet lid up etc  Manipulate the environment to suit the person’s needs – don’t try to change the person to suit the environment!  Get the person involved in domestic settings and relevant activities Making the most of the environment

24.  They are not always recreational or diversional  They can be part of a normal day’s activities  They should hold meaning and purpose for the resident  They are the responsibility of all staff to facilitate and provide What are enabling activities?

25.  Feel useful and still needed  Maintain skills, health, independence and self esteem  Experience pleasure  Reflect their spiritual and cultural identity  Allow growth, and  Maintain feelings of safety and security Activities should relate to the individual resident and allow them to….

26. Exercise….  Putting on my jumper Meaningful and enabling activities

27.  Task analysis  Prompts, guides and assistance  Knowing the resident  Use the environment Tools to enable people through activities

28.  Break tasks into small steps  Give the least number of prompts to enable the person to do it themselves  Give praise and reward  Allow clients to proceed at their own pace Task analysis…step by step

29. Fully Assist Physical Assistance Modelling required action Directive Prompt Non-Directive Prompt REMEMBER: Make the most of a person’s skills and abilities! Prompts and guidance- graded interventions

30.  Know their disabilities (e.g. visual impairment)  Know their likes and dislikes  Know their passions in life!  Know their personal history and experiences  Know their culture  Develop a life story book together…it is a great activity to involve family as well Know your resident

31.  Set up the environment to enable and encourage residents to be involved in activities  Think of leaving things “half done” to encourage participation  Place a chair looking out on a view or facing an outdoor bird feeder  Leave magazines and recipe books open at inviting pages with pictures  Have dusters, or a basket of washing to be folded, waiting to be ‘found’ Use the environment

32. Risk management

33. Risk is part of everyday life Residents have the right to participate in activities that have an element of risk Risk avoidance or risk management?

35. Risk Assessment  Is the risk of harm occurrence potentially high, medium or low?  Is the harm impact likely to be fatal, serious or minor?  What are the risks to the resident if they are prevented or restrained from doing what they wish?  What good things may result if the client engages in the activity?  What bad things may result for others?  Can we lower the potential or impact of the risk by implementing, modifying or eliminating something to control it?  If so, by what, by whom, and when, where and how?  Agree on a risk reduction/elimination action plan and regularly review the plan to keep it effective. When assessing risk, consider:

36. Together Everyone Achieves More

37. Team communication is the key to solving problems Who is on the team?

38.  Supports an effective team- where members feel listened to and valued.  Is safe and supportive – members feel supported and learn from their experiences, feel confident to speak up and to suggest new approaches. Good communication ‘oils the engine of care’

39.  Be respectful of others’ opinions, even if you do not agree  Present your point of view calmly  Do not interrupt others  Do not speak over the top of others  Respect confidentiality Ground rules for team communication

40.  Team problem-solving has been found to:  Be effective for team learning;  Be good for some forms of organisational knowledge transfer;  Improve members task allocation, coordination and trust; and  Promote attitudinal change including combating subtle, unacknowledged racism and ageism. Team Problem - Identification

42.  A care plan is:  Collaborative  Person-centred  Potentially a legal document  A care plan contains:  A statement of the problem based on assessment information or progress notes  A statement of the desirable goal for the client  The actions or interventions the staff will use to achieve the goal  An evaluation of the success, partial success or failure of the plan Care Planning

43.  Document by exception, remember to look for the positive as well as the negative.  Tell about the resident’s responses to care delivery, not what you did today.  Must be written by the person delivering the care.  Extended periods without writing infers no one is observing and care is sliding,  Every day has the potential to be exceptional!  Remember this is the resident’s story – not yours. Progress Notes

46. What is Case Conferencing? …“a collaborative process of team brainstorming, aimed at reviewing the needs of individual residents” Case Conferencing

47. ...is a team approach to care planning that results in the delivery of individually tailored care in consultation with families and clients Good communication is essential between  Staff & Residents  Staff & Family Members  Staff & other Staff  Residents & Family Members Case Conferencing

48.  Improved consistency and quality of care  Improved care planning  Increased positive family involvement (to the degree sought by family)  Improved staff responses to behaviours of concern  Improved staff involvement and morale, reduced burnout and improved attitudes  Improved team approach  If the behavioural symptoms are reduced the resident’s functional levels may increase Advantages of team approaches to case conferencing

49.  Improved QOL for resident and family  Helps staff and family understand reasons behind the behaviour  Helps with reflection & learning from incidents  Helps staff to be proactive rather than reactive.  Helps transfer knowledge and experience  Helps embed education / training into practice  Reduces “fault finding” mentality  All feel part of the team and HAVE A VOICE Advantages continued

50.  Set a time and ensure all relevant staff are invited  Review all the notes and documentation  Have the documentation with you during the meeting & take notes  Ensure family have been invited  Invite the resident’s GP  Provide comfort & amenities  Ensure no interruptions  Ensure Follow-up afterwards How to set up and run a case conference

51.  Needs organisation and management support  Must have mutual respect, trust and a safe psychosocial environment – able to discuss feelings openly.  Requires a competent & educated leader – to lead the team  Takes time Mentoring and Case Conferencing

52.  M - Monitor the knowledge, skills and attitudes of staff  E - Enthusiasm, experience and expertise  N - Negotiating improvements  T - Teach but don’t preach  O - Organise opportunities for staff to meet  R - Review team progress continually, relationships  I – Inquiry, and look to improve  N – Need to care for yourself as well as others  G – Go looking to learn from others Mentoring

53.  Concept maps are tools for assessments, care planning and evaluation.  Concept maps are drawings or visual representations of ideas or facts.  Constructing a map as a team can communicate what is known, identify gaps in knowledge and allow us to come to new understandings of the resident. Concept Mapping

54.  In concept mapping the emphasis is on uncovering the facts.  But to find the facts we need to talk about feelings.  Feelings are important and give us clues as to what may be causing problems or distress, not only for the resident but also for ourselves as we try to do our best at work. Concept Mapping

55. Impact of psychosocial environment Identity and story –culture, family, beliefs, interests etc. Health and well-being Health and well-being Impact of physical environment Task, activities or ADLs: enabling or disabling Task, activities or ADLs: enabling or disabling Dementia type, progression and effect Dementia type, progression and effect Resident

56.  Exercise: case study Putting it all together

57.  Fatigue / Exhaustion  Self – neglect  Stress & anxiety  Other risks?????? Physical Emotional Social

58. Develop your own stress reduction techniques: –Take time out –Learn –Talk to others –Let your feelings out –Look after YOUR health –Take annual leave when due

59. Be as generous with yourself as you are to others. Do not be your own worst enemy, be your best friend.