McDonald, T. A. (ACKNOWLEDGE Thompson, R. (CEO) & Kwok, C. (DCEO)), 2008
Better Practice Conference, Sydney
What is the better practice initiative?
The use of life-story approaches to pleasantly distract confused residents is widespread in Australia. Evidence has shown that following the episode of distraction, there is little if any ongoing positive outcome for residents. This project extends the concept of life story work in dementia care and focuses upon the building of genuine links between staff and residents; as well, the special needs of veterans who served in a range of wars are able to be acknowledged respectfully and incorporated into their daily conversations with staff.
What was the trigger for this initiative?
Older adults in residential dementia-care units, face difficulty being recognised for who they are because their dominant morbidity tends to overshadow the perceptions others may have of them. For those who have served in defence of Australia, their bravery and selfless contribution can be overlooked in such an aged care context if special efforts are not made.
Since receiving Special Needs status under the Aged Care Act in 2001, veterans needs have been recognised in various ways that acknowledge the special bonds that develop among service personnel. The situation is less apparent for residents who are mentally confused and who may not be thought sufficiently aware to have their service contributions mentioned. But RSL Village staff and management are continually conscious of their need to be included in veteran cultural and other ex-service activities in the village and local community. In 2005 veterans’ experiences were incorporated as part of the Positive Connections program at the Veterans’ Retirement Village, Narrabeen.
What aspects of this better practice initiative makes it unique?
Life story work is being used in a number of health and social care settings, including those catering to residents with dementia. It has been defined as a biographical approach in health and social care that gives people the opportunity to talk about their past experiences. Life story work becoming widely known, and many aged care operators have introduced elements of social histories and photographic representations of the person at an earlier time of their life. The usual approaches to collecting social histories and having nostalgic photographs in residents’ rooms, go some way toward establishing their identity and to providing staff with a means of distracting their attention when agitated – but the information contained in case files is often not easy to read, especially if care staff also have to overcome difficulties with English.
In the Positive Connections strategy, developed by Dr T. McDonald Professor of Ageing, existing social history material has been augmented through family interviews about stories emerging from their war service as well as other related stories about residents’ participation in Returned Service League activities after the war. The story of their service activities is written within the context of their overall lives and placed on the front of case files and used to orient all staff to the unit. The information is not on general display; nor is it used to distract attention – it is there to inform staff or details before they approach the resident to have a genuine, face-to-face conversation about the person’s accomplishments. Its uniqueness is that the information is used to promote staff respect and enhance non-trivial conversations that acknowledge the veteran’s past.
What results and evidence support your initiative?
Prior to implementing the Positive Connections program staff attitudes and perceptions were tested on the themes of (i) giving individualised quality care; (ii) knowing and catering to personal preferences of confused residents; (iii) Accessing background information about residents; and (iv) team and family expectations of staff. Three months following implementation staff testing plus interviews were again undertaken and revealed changes such as (i) greater understanding and respect of residents and their value systems; (ii) feeling less intimidated by residents who exhibit challenging behaviours as a result of war service and dementia; (iii) confidence that individualised care is possible for each resident; (iv) better understanding and management of topics that prompt positive or negative recollections about war service; (v) job satisfaction derived from improving beyond ‘good care’ for people with special needs.
What are the key success factors to making this initiative work?
The major success factors in this program are:
What were the challenges and how were they overcome?
Staff involved in the project needed to overcome certain barriers such as (i) most have English as a second language and have diverse cultural backgrounds; (ii) Literacy levels among staff are poor restricting the delivery of information about residents in their care; (iii) entrenched perceptions of residents with dementia as representing workload rather than as unique people. Families involved in the gathering of war service information ranged from being well-informed or ignorant of details. Some were quite emotional and grateful to have this aspect of their loved one’s lives acknowledged.
Staff testing and explanations of the approach were provided in writing and verbally in groups and individual coaching to overcome language difficulty. Registered nurses and researchers demonstrated the use of the background information with small groups of staff observing and then they were encouraged to enter into conversation with residents, while being supervised from a discreet distance, and then de-briefed. Families were provided with drafts of the plain-English stories and follow-up discussions with extended family members were undertaken as indicated.
Outline the strategies involved in implementing this initiative.
Essentially the strategies involved (i) motivation to provide something ‘extra’ to veterans who have dementia symptoms; (ii) thoroughly reviewing the research literature on life-story work and evaluating the outcomes as a basis for consideration; (iii) constructing a project that goes beyond life-story work and which focuses on particular residents’ needs; (iv) involving families in the writing of accessible stories about residents; (v) pre and post-testing of staff implementing the program; and (vi) evaluating the benefits of this program for special needs residents. In this way, the Positive Connections project acknowledges existing research around effects of dementia on relationships, and also effects on health, of diminished opportunities to relate as individuals with others of similar backgrounds, in meaningful ways.
CITATION McDonald, T. A. (2008) Ensuring that mealtimes for people with dementia are relaxing and enjoyable. Better Practice Conference. National Aged Care Standards and Accreditation Agency, Sydney