1. The MORE LIFE Project – More Life in everyday life for weak old people Karin Naldahl, Senior Lecturer, RN, MHH (Master in Humanities in Health) krn@ucn.dk Brussels February 28th 2012

2. Presentation 1) Why this case story? 2) Participation in the More Life project 3) Project - aim, method and stages 4) Sub-project - evening and night life 5) Sub- project - outdoor life 6) Project results and conclusions 7) How can the More Life project enhance the delivery of adult learning in my region – and in the EU?

3. Why this case story? 1) * The increasing amount of ageing people worldwide * Many old people are going to be very old * The decreasing amount of children and young people in the EU fewer social- and healthcare persons 2) * The need for care, support and solidarity between the generations will still exist 3) * A need for education programs which can move health care staff towards a more positive attitude towards old people

4. Participation in the More Life project * Mealtimes and cooking Social- and Healthcare School, Herning (basic level) * Out-door Life School of Occupational Therapy, University College of Northern Denmark (UCN) (BA level) * Conversations Social- and Healthcare School, Randers (basic level) * Evenings and Night life School of Occupational Therapy and Nursing School, University College Northern Denmark (UCN), (BA level) * 24 Nursing Homes and Day Care operations ind North and Mid Jutland * VEGA

5. Study Objective * To map, document and communicate methods whith focus on values in old people’s everyday lives (within the four sub-projects; Meals and cooking, Out-door life, Conversations, Evenings and Nightlife) * To adjust and modify knowledge of ’best practice’ into a local setting through - continous tests of interventions for exchange - exchange of experience and networking

6. Study method: The ’Breakthrough Series’ Collaborative Method. Institute for Healthcare Improvement (IHI), Massachusetts (Sarah Frazer, Thomas W Nolan and others) http://www.ihi.org/ihi/about ……………………………………………………………………………………………………………………………………………………………http://www.ihi.org/ihi/about The Breakthrough Method – An evidence based method for development in the health care system The Breakthrough method passes practical knowledge from one practice into another practice. Knowledge from ’practice no 1’  ’practice no 2’  knowledge translation Translation of knowledge   new meaning, new types of thinking  knowledge development  care development

7. Stage 1 2007 / 2008 (12 months) Stage 2 2008 / 2009 (18 months) Stage 3 2009 / 2010 (12 months) Search literature Collect ideas from eldercare institutions Establish network Test ideas Assess effect PDSA circle Bring out conclusions Communicate to new eldercare institutions Produce cataloques with ideas Collect experience (data) - pictures - narratives Document experience - reports - seminars - video etc., etc.

8. Stage 1 Cataloque of ideas for More Life in Evening and Night life 4 Main Subjects; Intimacy Rituals Bodily wellbeing Physical sourroundings

9. Subjects and specific ideas for Evening and Night life *Intimacy; a moment of intimacy information about tomorrow say ’goodnight’ etc *Bodily wellbeing; heat pad footbath foot massage midnight snack etc.

10. Stage 1:Cataloque of ideas for More life in Outdoor-life 2 Main Subjects; - Garden life - Walking Specific ideas for Garden Life; Country garden Vegetable garden Green care

11. Stage 1 2007 / 2008 (12 months) Stage 2 2008 / 2009 (18 months) Stage 3 2009 / 2010 (12 months) Search literature Collect ideas from eldercare institutions Establish network Test ideas Assess effect PDSA circle Bring out conclusions Communicate to new eldercare institutions Produce cataloques with ideas Collect experience (data) - pictures - narratives Document experience - reports - seminars - video etc., etc.

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

13. The Plan-Do-Study-Act (PDSA) cycle Test period……….……………… week numberGOAL: Which goal do we have for the resident? 4. ACT What did we learn ? Which changes will 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 will give Anna a footbath * A precise description for Anna’s footbath is made (look in the green book) * The evening and night staff will write in the handwritten journal how Anna’s evening and night have been * Each Wednesday Joanna will collect Anna’s journal papers and assess the results

15. 2. Do: What did we actually do and which results did we see? -------------------------------------------------------------------------- * Nov. The 3; Footbath according to the plan. Anna is happy and smiles during the session. Vi talk about ’beeing ticklish’. Feet and ankles get lotion. Later on we bring Anna tea and biscuits and she is really happy and smiles. * Nov. The 5., 7., 8., 11.; we follow our plan. Anna is happy and talkative. Also happy when she goes to bed. * Nov. The 4., 6. og 10.; Anna is a little ’touchy’ at supper and quiet when her footbath starts. During the bath she loosens up; Her body is more relaxed, she says ’Mmm………’ * During the period Anna only rises from bed once each evening. At night Anna rises; three nights one time, four nights two times. Anna is calm and willing to go to bed again.

16. 3. Study; Did we reach our expectations? Why – why not? -------------------------------------------------------------------------- For example; * At the beginning Anna seems 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 always around supper * Why? Do we ’forget ’her at this time? Does she feel ’outside’ social life in the nursing home at this time - or is she just tired?

17. 4. Act; What did we learn ? Which changes will 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. Stage 1 2007 / 2008 (12 months) Stage 2 2008 / 2009 (18 months) Stage 3 2009 / 2010 (12 months) Search literature Collect ideas from eldercare institutions Establish network Test ideas Assess effect PDSA circle Bring out conclusions Communicate to new eldercare institutions Produce cataloques with ideas Collect experience (data) - pictures - narratives Document experience - reports - seminars - video etc., etc.

19. Results and Conclusions In 18 (of 24) institutions, caregivers succeeded in translating ideas of caregiving into their own practice The 18 institutions developed valuable quality in everyday lives for the residents (more participation, better social contact, life re-blossoming, etc) The Breakthrough Method is useful to map and develop quality in everyday life for old vulnerable people if caregivers are able to hold on to the systematics of the method The Breakthrough Method costs very limited economical resources Project side effects: The development of more life quality for residents gives more work quality to caregivers and enhance their competences.

20. How can the More Life projects’ SIDE EFFECTS enhance the delivery of adult learning in my region – and in the EU ? --------------------------------------------------------------------- * Enhance staff members’ positive attitudes towards weak, old people * Give; - learning possibilities within different qualifications and levels of education - multidiciplinary learning possibilities - possibilities for community and civic participation - possibilities for further development of the More Life project and design

21. How can the More Life projects’ SIDE EFFECTS enhance the delivery of adult learning in my region – and in the EU ? --------------------------------------------------------------------- * Bridge the gap between practice and theory * Turn tacit knowledge into explicit knowledge * Address the philosophy of Lifelong Learning * Underline; - adults learn what is meaningfull for them to learn - meaningfull learning gives self-esteem, identity and recognition

22. Thank you for your attention

23. 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 evidence based 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