Beyond the Bath: Leading Dementia Care in Long Term Care

Transcription

1 Beyond the Bath: Leading Dementia Care in Long Term Care Wilma Greene MN, CNS Paula Walters, MEd, CNS 1 Define and explain Behavioral and Psychological Symptoms of Dementia (BPSD) Present prevalence of BPSD in LTC Discuss RN leadership Review resident centred dementia care approaches 2 Behavioral and Psychological Symptoms of Dementia (BPSD) Changes in mood and behaviour agitation (physical or verbal), anxiety, disinhibition, delusions, and hallucinations (International Psychogeriatric Association [IPA], 2002) 3 1

2 BPSD Behavioural Repetitive questioning Calling out/screaming Wandering Restlessness Collecting Sexual disinhibition Swearing Physical (Hitting, Kicking, Spitting, pinching etc..) Psychological Anxiety Depression Hallucinations Delusions IPA, Prevalence 80% of residents in LTC have dementia 76% of these show BPSD Buhr & White, Question? Name a clinical intervention that produces a great deal of anxiety/bpsd for residents? Answer: 6 2

3 Question? Name a clinical intervention that produces a great deal of anxiety/bpsd for residents? Answer: Personal care (Bathing, dressing/undressing, toileting) 7 But.. for the most part you don t give the bath or provide the personal care 8 So what is the importance of this topic for RNs? 9 3

4 Why RNs? Need key staff who are clinically well situated to help lead change among co-workers/peers. That is why you are instrumental to help lead change! How to manage? 12 4

5 Philosophy of care Residents are NOT usually aggressive, they are trying to DEFEND and PROTECT themselves. BPSD = Communication Interpret the message so we can respond appropriately Residents at center of care; Resident-first philosophy (AGE Inc., 2010) Brooker, 2007;Kitwood, Informed Practice Non pharmacological interventions first line treatment of BPSD (IPA; ASC; MAREP). Risk of self harm or other harm pharmacological interventions may be indicated in conjunction with nonpharmacological interventions. 14 Strategic Plan! 15 5

6 Wise use of time Crisis Prevention 16 Avoiding Behavioral Escalation Code White Physically Protective Verbally Protective Anxiety Baseline Behavior 17 Emphasizing Behavioral De Escalation Code White Physically Protective Verbally Protective Anxiety Baseline Behavior 18 6

7 Search for Triggers Painful shoulder Annoying noise Invaded personal space Stanger taking off my clothes Loss of independence Too Cold Sad or depressed Cannot go home Bored Hearing aid not used Cannot find bathroom Constipation 19 De escalation Techniques Person centered care (know the resident s likes/dislikes, preferences, past practices and give it to them) Effective communication (verbal and non verbal) Gentle approach (as if it s your mother) Awareness of personal space STOP if necessary; start again if it is ok to do so 20 De escalation techniques Consider the environment for triggers (noise, lighting, alarms, etc.) Validation Therapy & verbal redirection Meaningful recreation and leisure activities. Use humor, rhythm, exercise, pets 21 7

8 Crisis (verbally/physical behavioral escalation) Listen/observe what the resident is communicating Give the person your full attention but keep a safe distance Offer support and assurance Do Not touch the person unless it is necessary (i.e. risk of harm) Remove others from the immediate area/harm 22 Crisis (verbal/physical behavioral escalation) Decrease/remove triggers for BPSD Beware of potentially unsafe objects; remove them if possible Ensure safety for you and others Use physical restraint and medications as LAST resort 23 RN Leadership Knowledge of evidence Assessments Coach Model/inspire/motivate Collaboration/Listen Outcomes TEAM/Relationships 24 8

9 Documentation/Communication Care plan Assessment tools Notes Huddles/Unit conferences Resident care conferences Family 25 Take the Plunge.. 26 Bibliography Advanced Gerontological Education. (2012). Gentle Persuasive Approaches: Responding to persons with challenging behaviours. Ontario Alzheimer Society of Ontario. (2012). Rising Tide. Retrieved from Brooker, D. (2007). Person-centred dementia care: Making services better. Philadelphia, PA: Jessica Kingsley Press. Buhr, G. T., & White, H. K. (2009). Difficult behaviors in patients with dementia. Journal of the American Medical Director s Association, 7(3), doi: /j.jamda Eastern Health. (2009).Therapeutic Crisis Intervention Workshop. St. John s, NL: Program and Policy Development Feil, N. (2002). Validation,The Feil Method: How to help disoriented old-old. Edward Feil Productions 27 9

10 Bibliography International Psychogeriatric Association. (2002). Behavioral and psychological symptoms of dementia (BPSD) educational pack. Retrieved from Kitwood, T. (1997). Dementia Reconsidered: The person comes first. Philadelphia, PA: Open University Press Murray Alzheimer Research and Education Program (MAREP). (2012). Managing and accommodating responsive behaviours in dementia care. Retrieved from P.I.E.C.E.S. (2014). Putting the P.I.E.C.E.S. Together. Retrieved from Rader, J., & Barrick, A. L. [2000]. Ways that work: Bathing without a battle. Alzheimer's Care Quarterly, 1[4],