1. Quality of Everyday Life for vulnerable elderly Reykjavik June 1. 2010 Karin Naldahl, Lecturer, RN,MHH (Master in Humanities in Health) krn@ucn.dk Center of Gerontology, Denmark

2. Vega * Vega: Subinstitution to Center of Gerontology in DK. - produce and share practical knowledge about everyday life - create networks between practical and educational institutions * Vega Colleagues at the congress: Inger-Lise Dyrholm, Center of Gerontology, Cogenhagen, Denmark Anne-Dorthe Rhode, Department of Health, Copenhagen Dorte Grenaa, Department of Health, Copenhagen *

3. Vega Everyday Life focus: VEGA interest: The good life, life quality  Meals and cooking  Outdoor life  Conversations  Evening and night life  ’Traditional' Health Care interest: The healthy body Nutrition Motion Social relations Sleep

4. Investigation question: Is it possible to map and to improve life quality for old people who are depentent on care ?

5. Study objective To map, document and communicate methods whith focus on values in old peoples everyday life (within the four subjects: Meals and cooking, outdorlife, conversations, evening and nightlife) To adjust and modify knowledge of ’best practice’ into a local setting via - continously test of interventions for exchange - exchange of experience and networking

6. Study method: The ’Breakthrough Series’ Collaborative Method. Institute for Healthcare Improvement (IHI), Cambridge, Massachusetts (Sarah Frazer, Thomas W Nolan and others) http://www.ihi.org/ihi/about ……………………………………………………………………………………………………………………………………………………………http://www.ihi.org/ihi/about The Breakthrough method : Evidensbased method for development in health care system The Breakthrough method passes Practical Kvowledge from one practise into another practise. Knowledge from ’practise nr 1’  ’practise nr 2’  knowledge translation Translation of knowledge   new meaning, new types of thinking  knowledge development  care development The Breakthrough Method: A simple tool for rapid, significant improvements in care

7. Phase 1 2007 / 2008 (12 month) Phase 2 2008 / 2009 (18 month) Phase 3 2009 / 2010 (12 month) - -------- Project finished April 2010 Search literature Collect ideas from practice Establish network Test ideas Assess effect: PDSA circle Communicate to others Assess effect Production of cataloques with ideas Experience documentation -pictures -narratives Experience gathering - reports - seminars - video etc., etc.

8. Phase 1: Cataloque of ideas for More Life in Evening and night life 4 Main Subjects: Intimacy Rituals Bodily wellbeing Physical sourroundings

9. Subjects and spesific ideas for evening and night life *Intimacy, fx: a moment of intimacy information about tomorrow say ’goodnight’ *Bodily wellbeing, fx: heat pad footbath foot massage midnight snack

10. Phase 1:Cataloque of ideas for More life in Outdoor-life 2 Main Subjects: - Garden life - Walking Spesific ideas for Garden Life, fx: Country garden Vegetable garden Green care

11. Phase 1 2007 / 2008 (12 month) Phase 2 2008 / 2009 (18 month) Phase 3 2009 / 2010 (12 month) - -------- Project finished April 2010 Search literature Collect ideas from pratcice Establish network Test ideas Assess effect: PDSA circle Communicate to others Assess effect Production of cataloque with ideas Experience documentation -picture -narrativ Experience gathering - reports - seminars - video etc., etc.

12. The Model for Improvement The Plan-Do-Study-Act (PDSA) cycle

13. Our Vega Plan-Do-Study-Act (PDSA) cycle Test period……….………………fx: week 1-2GOAL: Which goal do we have for the resident? 4. ACT What did we learn ? Which changes shall be in focus in the next plan? 1. PLAN Who does: What? When? How ? 3. STUDY Did we reach our expectations? Why / Why not? 2. DO What did we actually do? Which results did we see? How did we see the results?

14. 1. Plan:Who does what – when - how? GOAL: Anna will be more calm, more happy and sleep better at night ……………………………… Shortly after supper Irene or Gitte gives Anna footbath A precise description for Annas footbath is made (look in the green book) Evening and night staff wrights in the handwritten journal how Annas evening and night has gone. Each Wednesday Jonna collects Annas journal papers and asseses the results

15. 2. Do: What did we actually do and which results did we see? Nov. 3.: Footbath according to plan. Anna is happy and smiles during the whole session. Vi talk about ’beeing ticklish’. Feet and ankles becom lotion. Later on we bring Anna tea and biscuits and she is really happy and smiles. Nov. 5., 7., 8., 11.: We follow our plan. Anna is happy and talkative. Allso happy when she goes to bed. Nov. 4., 6. og 10.: Anna is a little ’touchy’ at supper and rather quiet when her footbath starts. During the bath she looses up: Her body is more relaxed, she says ’Mmm………’ * During the period Anna rises from bed x1 each evening She allso rises at night 3 nights x 1, 4 nights x 2. Anna is calm and willingly to go to bed again.

16. 3. Study: Did we reach our expectations? Why – why not? Fx: At the beginning Anna seemed surprised : ”Do you really want to wash my feet’? Now she fully enjoys her footbath – even if she is a little ’touchy’ at the beginning When she is ’touchy’ it is allways around supper Why? Do we ’forget ’her at this time? Does she feel ’outside’ social life at this time - or is she just tired?

17. 4. Act: What did we learn ? Which changes shall be our focus in the next plan? We continue footbath with same procedure next week. It is too early to make changes. We try to be more aware of Anna in the afternoon and around supper. Go to her room, talk with her - or just wave to her if we are busy

18. Two types of projects: Developement of institutional conditions for everyday life. Groups of residents - meals and cooking - outdoor life

19. Two types of projects Developement of everyday life for Individuel residents - conversations - evening and night life

20. Effect and Analysis In 18 (of 24) institutions caregivers succeeded in translating ideas of caregivning into their own practice The 18 institutions developed valuable quality in everyday life for the residents. Cross case Analysis of the improvements using concepts of everyday life showed quality to be: More participation: Activ participation, work-related participation More room to manoeuvre: Owner of your own life again, re-unfolding life Better contact: Spontanously conversation, personal relationship, recognition, intimacy More positiv repetition in daily life: Repetition in days, in weeks

21. Conclusions The breakthrough method is usefull to map and develope quality in everyday life for old vulnerable people if caregivers are able to hold on to the systematics in the method The breakthrough model costs very limited economical resources Side effect: Developing more life quality for residents gives more work quality for caregivers.

22. References *Institute for Healthcare Improvement (IHI), Cambridge, Massachusetts http://www.ihi.org/ihi/about * 10 Powerful Ideas for Improving Patient Care: Book 4 Bisognano M, Conway J, with Schummers D Chicago, Illinois: Health Administration Press with the Institute for Healthcare Improvement; 2008 *Breakthrough method : an evidensbased method for change of practice in health care (2007 Oct 24;298(16):1937-9. The science of large-scale change in global health. McCannon CJMcCannon CJ, Berwick DM, Massoud MR.Berwick DMMassoud MR Institute for Healthcare Improvement, Cambridge, MA 02138, USA. - jmccannon@ihi.orgjmccannon@ihi.org *http://knudramian.pbworks.com/MereLiv *Gode hverdage. Et bidrag til diskussionen om kvalitet i ældreplejen (2010 May,,2(26):17-19. Ramian et al. Gerontologi. Dansk Gerontologisk Institut, København ild@geroninst.dk

23. Thankyou for listening