1. The Value of PIE Jane Buswell Consultant Nurse for Older Adults Clinical lead for dementia care

2. How did we do it? Attended a training day- then undertook 2 trial observations as part of research phase Attended second training day with other senior clinical staff – matron/ward sisters to learn the methodology Repeated Observation on the three wards identified that participated in the earlier enhanced phase of National Audit of Dementia

3. What exactly did that entail Deciding on a suitable date for ward and observers! Issuing prior Information for staff and patients /briefing for staff 10-15 mins gathering information about what may impact on patient care ( staff shortage-clinical demands) 10 mins asking staff what they knew about the patient Initial observation of 30 mins. Then correlate observations (another 10 mins) Area then observed for 2 x two hours periods- one of which had to be over a meal time

4. What did we find? Some individual practitioners demonstrated a person centred approach and excellent communication skills Where interaction takes place it was kind and patient Boredom factor – on every ward – long periods of time where absolutely nothing happened for that individual

5. How did it feel to us Initial time management daunting Very rare to have the opportunity to sit and observe for a significant length of time Difficult not to get distracted and watch other things Emotional impact-

6. The hidden costs? In practice it’s a whole day out by the time you've completed all stages Other work that the observation generates not directly connected with PIE (documentation) To follow through the action plans and ensure they are carried out To debrief the observers as well as the staff When do you do decide to do it again

7. Surprises on the way? Research –what research? Becoming a principal investigator by default Learning R&D process overnight Getting consent –what a challenge! Listening to the humour and wisdom form people with dementia

8. Additional Observer attributes Ability to think fast and adapt (ward communications issues) Ability to sit quietly and not intervene unless patient at risk of harm or malpractice Ability to not lose your cool when something is blindingly obvious doesn’t happen Ability to be creative when trying to find things to put in the “area for celebration” box

9. π =C 2 Using PIE can enable Care and Compassion to be at the heart of everything we do