Person-Centred Care in the General Hospital

Transcription

1 Person-Centred Care in the General Hospital Professor Dawn Brooker Association for Dementia Studies University of Worcester The Association for Dementia Studies

2 Who am I? A person with dementia A person with dementia Association for Dementia Studies University of Worcester

3 Person-centred Dementia Care Roots in Martin Buber, Carl Rogers and Tom Kitwood Dementia Reconsidered: the person comes first 1997 Supporting personhood the theory Malignant social psychology & positive person work The enriched model of dementia Association for Dementia Studies 3

4 What s going on here? Bob Green was admitted through A&E and MAU to a orthopaedic ward with a broken NOF 7 days ago. He has had dementia for about seven years. He needs a lot of help with physical care. He lashes out with his fists a lot. Think of as many explanations as possible of why this might be occurring... Association for Dementia Studies University of Worcester

5 D=NI + H + B + P + SP All these effect how a person with dementia [Or any person] behaves, feels and thinks By understanding NI, B & P and optimising H & SP we can help people live well with dementia NI Neurological Impairment H Health B Biography - life story P Personality SP Social Psychology

6 Value us, give us our dignity How you relate to us has a big impact on the course of the disease. You can restore our personhood, and give us a sense of being needed and valued. There is a Zulu saying that is very true. A person is a person through others. Give us reassurance, hugs, support, a meaning in life. Christine Bryden

7 The whole person: The Enriched model Cognitive profile Life story Personality Physical Fitness Positive compassionate communication Photographs of people living with dementia taking part in The Enriched Opportunities Programme

8 Being Competent at Core business? Care homes, health teams and hospitals should provide a good enough quality of person centred care so that the chances of a person with dementia experiencing significant behavioural symptoms are minimal. They should have good support to call on when they are out of their depth. Patient with dementia on acute medical ward, New Cross Hospital 2011 Association for Dementia Studies

9 What does every member of staff need to do with every patient with dementia to improve outcomes: The Care Bundle? Patient with dementia and staff on acute medical ward, New Cross Hospital 2011 Association for Dementia Studies

10 Dementia Care Bundle Knowing key personal information within 24 hours of admission (B & P) Compassionate skilled Communication (NI &SP) Adequate Nutrition & Hydration (H) Safe & Orientating Environment (NI,B,H,SP)

11 The suite of interventions C O M P O S I T E Leadership and top-level commitment to implementing excellence in dementia Dementia friendly physical environment Volunteers Specialist ward Care Bundle Staff development Outreach Integrated dementia pathway from admission to discharge Within the hospital Patients Families Clinicians Liaison Support services Volunteers Catering Estates informatics Local Health and Social Care Commissioners, Local Authority, Primary Care, Community Hospitals, Private and third sector providers of services

12 Skilled person centred care and support in care homes: the evidence General person centred care minimises the escalation of problems into BPSD (Fossey et al, 2006, Ballard et al, 2009; Cohen-Mansfield et al, 2007 & 2010) People with dementia have better mood and quality of life if they are cared for by staff that communicate well (CSCI, 2009). Staff who are trained in person centred care decrease agitation in high dependency care home residents & housing (Chenoweth et al 2009 Brooker et al, 2011)

13 all needs, no mobility, not eating 6 days after admission to a person centred care home... Mrs May Williams, Lady Forester Home

14 all needs, no mobility, not eating 1 month later baking Mrs May Williams, Lady Forester Home

15 all needs, no mobility, not eating 1 month later baking Mrs May Williams, Lady Forester Home

16 all needs, no mobility, not eating 6 weeks later Italian meal...

17 all needs, no mobility, not eating 6 weeks later tea and teddy

18 all needs, no mobility, not eating 2 months later head massage.

19 all needs, no mobility, not eating 2 months later old skills returning...

20 all needs, no mobility, not eating 2 months later silk scarves...

21 all needs, no mobility, not eating 3 months later dancing to music...

22 all needs, no mobility, not eating 3 months later Mexican celebration

23 Interventions to improve quality of life for May Williams Interventions: Person centred care, animals, baking, eating, knitting, teddy, dressing up, silk scarves, head massage, dancing, pain relief Outcomes: Alive, weight gain, happy, active, having fun, no BPSD Association for Dementia Studies

24 We re only just writing the books now for hospital staff... Based on key knowledge set for hospital staff putting person centred care into practice Published April 2013 If every health care professional knew this then there would be radical change

25 Thank you for listening! Professor Dawn Brooker University of Worcester Association for Dementia Studies Photographs of people living with dementia taking part in ExtraCare Charitable Trust Enriched Opportunities Programme