@AHP2mintalks: a global community run by AHPs, for AHPs, to make research useful for practice

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Interview with Dr Jenna Breckenridge, co-founder of @AHP2mintalks, Researcher at the University of Dundee and AHP Research Lead for NHS Tayside

Tell us about @AHP2mintalks

@AHP2mintalks is an online twitter community run by AHPs, for AHPs. Its purpose is to help allied health professionals share research knowledge with each other, and to help make research more accessible and useful for practice.

How does it work?

Contributors post a short 2-minute video of themselves summarising a piece of research they have read or been involved in. Most videos are shot on a smart phone; so no fancy technology required! The best talks provide a summary of the research evidence and then offer some critical reflections on (a) its strengths and weaknesses, and (b) its relevance and usefulness for practice.

Where did the idea come from?

In Spring 2019, I led a project funded by the Scottish Universities Insight Institute to develop novel ways of making research useful for practice. I brought together a diverse group of Allied Health Professionals, researchers and creative experts from art, design, technology, comics and creative writing and challenged them to co-design better ways of sharing research knowledge. @AHP2mintalks was one of the outputs from this project. You can read more about the project here, including the final report, a documentary, poetry collection and videos from international experts in health, design and evidence-informed practice: https://www.scottishinsight.ac.uk/Default.aspx?tabid=8389

Why is @AHP2mintalks needed?

Allied Health Professionals know that practice underpinned by good research evidence delivers high quality services, safe and efficient care, improved health and wellbeing outcomes, and better patient and service user satisfaction. Research shows too that practitioners feel more satisfied in their jobs when they know they are working in the most contemporary, evidence-informed ways.

And yet, we hear time and time again that most research evidence fails to make an impact in practice. Research is either implemented patchily or not at all, whilst health and social care organisations undergo frequent change despite limited available evidence.

A common approach to solving this problem is to ‘build capacity and capability’ amongst AHP practitioners. This works on the premise that if we give individual practitioners the skills and confidence to find, read and understand research, they will be more likely to implement evidence in practice.

However, these approaches often ignore the huge structural, organisational, environmental and social barriers that practitioners face when trying to apply evidence in practice. For example, practitioners may lack the time, resources, team culture and managerial support to engage with research.  We also need to recognise that the way researchers share their work is not always helpful for practitioners. Journal articles are the primary means of communicating research findings; but these are difficult to find, time-consuming to read, and not necessarily written with practical application in mind.

For these reasons, we need to work harder at making research more accessible and useful for practitioners. Part of this involves creating communities of knowledge sharing. The time invested by one contributor to @AHP2mintalks, can save time for hundreds of AHPs by providing a concise and accessible summary of up-to-date evidence. Moreover, practitioners often say that blogs and webinars are easier to digest; and @AHP2mintalks endeavours to provide a place for AHPs to share research-based knowledge in ways that suit them.

Why do you think it has been so successful?

Since we launched the account in June 2019, we have gained over 800 followers internationally and the top videos have received thousands of views. Practitioners have told us that they find this a really engaging way to keep up to date with research evidence; in particular the videos introduce them to new research and the short 2 minute precis helps them decide whether or not to read the paper in full. For researchers, @AHP2mintalks is also a really good way to facilitate research impact and gives them a direct line to practitioners. Ultimately, all researchers want their work to be useful!

Finally, I also like that @AHP2mintalks models how we should be talking about research in practice. The talks are short, informal and completely practice oriented; they are a good example of how we should be having daily research-informed conversations in team meetings in practice.

How can I get involved?

Go on, do it! We’d love to have a video from you! Just post your video on twitter with the handle @ahp2mintalks. You can include any relevant hashtags and mention other twitter users who might be interested in watching and sharing your talk. It is also helpful to include the full weblink to the paper you summarise in your video. We welcome videos from anyone, at any time. Our only requirements are that your videos are under 2 minutes long and focus on research that is relevant to any or all of the Allied Health Professions. If you would like some informal support with developing your video, please feel free to contact me, @Jen_Breck or j.breckenrige@dundee.ac.uk.

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Contributor:

Dr Jenna Breckenridge, Clinical Academic at Dundee University, AHP researcher, NHS Tayside and co-founder of @AHP2mintalks

Allied Health Professionals & #Dementia

“I am an allied health professional and I know I make a difference to people’s lives everyday” by Mark  

Mark shares in 60 seconds how he makes a difference to people’s lives every day when working in the ambulance service #Dementia

Click here to view the video

Mark says

“the part of about my job that I enjoy is being able to help people living with dementia and their families ……..first impressions matter, I treat each person the same……with compassion, dignity and respect at all times….”

To find out more about Scotland’s AHP dementia policy, Connecting People, Connecting Support visit: www.alzscot.org/ahp

Well-being in unprecedented times: Keeping our jugs topped up!

How are you all today? Our thoughts are with you. Whether you have dementia or are supporting someone with dementia, work in health or social care, are an adult or child, stay at home or go out to your work, these days are challenging for us all. This week’s blog is about well-being. It’s something I’ve been thinking about for a while but seems more relevant today than ever…. so today I want us to think about jugs.

Some of you may have been at the Alzheimer Scotland Annual Conference in Edinburgh a couple of years ago and heard Dr Al Power, an American Geriatrician, educator and author, speak. His words struck a definite chord with me and I’d like to share them with you. Dr Power spoke about ‘domains of well-being’, areas of well-being, things I need to keep mentally and physically well and described these as jugs to be filled. He talked about how we have seven jugs, that our jugs can run dry, how we can top them up again and what can happen if we don’t. It’s a brilliantly simple image.

The Seven Domains of Well-being

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There are many theories of well-being and Dr Power’s is based on the work of Fox et al. (the full reference for this and Dr Power’s book is at the bottom of the blog if you’d like to read more). The theory is that each and every one of us has seven domains or areas of psychological need – needs that we must meet, jugs that we must fill, if we are to be at our best. If these needs are not met, these jugs not filled, we experience reduced well-being.

In current climes meeting these needs or keeping these jugs filled when we don’t have access to our usual resources or support network can be challenging. If our needs are not met, our jugs not filled we can feel anything from ‘just not quite ourselves’, to frustrated, angry, stressed, or depressed.

This theory of well-being applies equally to us as individuals and to the people we care for personally and professionally. How do I, given the current situation, top up my own jugs, meet my own needs and stay mentally well??? How can I meet the needs, or top up the jugs of the people I care for, if they can’t do it themselves? How do I know what they need or which jugs are empty?

The seven domains are identity, connectedness, autonomy, security, meaning, growth and joy. These are each vast areas but let’s take a quick overview.

Identity

This is about who I am and my need to be accepted for being me, just as I am. It’s about doing what I have always done, being a father, a teacher, a brother. It’s about being respected, listened to, heard and acknowledged in the small things and the big. If I am continually overruled or my expertise and experience is ignored, if I feel I’m treated as a child, if I am not allowed to do the things I did before, I experience frustration, my jug drains. You top up my identity jug when you honour my space and allow me to say and do what makes me, well me… when you ask me “Can you help me with…?” “Would you like to…?” “I’m worried about… what do you think?” “I hear you, you’re doing a great job, I’m sorry this is hard.” Supporting me to be who I am and do what I like to do fills my identity jug.

Connectedness

Connectedness is about being with, not doing to. Not problem solving but just connecting and being alongside me, letting me be part of the team, not leaving me out, sharing a meaningful moment or just letting me cry to let it all go. It’s about not sweating the small stuff and choosing to connect with me as a person instead of correcting me or trying to improve me. It’s about giving up being right and just being with. Listening and sharing top up my connectedness jug. This jug is often hard to fill … it’s often easier for us to do than to be, to fix than to listen, to just do it ourselves than include another!

Autonomy

We all have a need for freedom. If I can’t make choices and decisions, if these are made for me, my autonomy jug runs dry and I get angry or stressed. At the moment we are all being asked to give up some personal autonomy and freedoms. This makes the opportunity to make smaller choices more important, because that helps me feel a little more in control. Having information helps me make these decisions, which is why I can get anxious if I just don’t know what’s going on or feel uninformed. That makes me feel insecure and that’s our next jug.

Security

My security jug is topped up by having my familiar things around me, it’s why new places or new people can discombobulate me or create anxiety. It’s about having a structure and a plan to my day so that I know what’s going on and feel safe. This jug can be drained too when activities are cancelled and my routine is out the window! Not knowing when I can go out, meet that friend, get that appointment, medication or payment, take a break, do what I usually do, makes me feel insecure. Security is also about knowing I am not alone, that I will be heard and my rights respected.

Meaning

This is about making a difference, having a purpose and a reason, that what I am doing has a point. Creating things, giving to others, knowing I make a difference to the lives of others around me, doing something that I enjoy, activity that is meaningful to me helps me top this jug up.

Growth

Learning new things, making new friends, sharing new experiences meet my need to grow and fill up this jug. Too much change can be tricky, but stagnating is just as bad. The delight and sense of achievement when we try a new recipe, use our phone to Facetime or What’s app family for the first time fills this jug. Our physiotherapy colleagues also tell us of the benefits of physically growing, standing or sitting tall, opening up our rib cages and stretching our arms wide, shoulders back, chins up and deep breathing to promote confidence and well-being.

Joy

The temptation is to think of joy as unadulterated fun and pleasure and sometimes that can seem impossible. In this context joy is about simple pleasures, little treats, moments of meaning, laughing through the tears, a kind word, an unexpected call, a warm bath, a cup of tea, a sunrise, a daffodil, a smile. These things bring us joy and fill our jug.

So which of your jugs is running low today?? What do you need today, here and now? To be heard, to connect with friends, to express an opinion, to feel safe, to have something to do that makes you feel good, to feel that you are still growing, to feel a little joy?

Sometimes it’s hard to know what we need, we just need something…. The IDEAS Team at NHS Dumfries & Galloway have created two posters to help identify needs. There is one for Carers and one for people working with those with dementia who are not able to tell us. You might find them useful if you, or someone you care for, is just not feeling themselves and can’t quite work out why. Talking to someone can help. The Alzheimer Scotland Helpline is also here to help.

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Don’t be alone. We can rarely top up all of our jugs by ourselves. It’s ok not to be ok and it’s good to ask for help.

Contributor

Helen Moores-Poole is an Advanced Speech & Language Therapist working in NHS Dumfries & Galloway for the SLT Adult Service and the IDEAS Team (Interventions for Dementia, Education, Assessment & Support). Follow the IDEAS Team on Facebook @IDEASTeamNHS or Helen on Twitter @poole_moores.

The busy month of March

Hello, my name is Nicola Wood and I am the Alzheimer Scotland Dementia Nurse Consultant (ASDNC) and Lead Nurse for Older Adult Mental Heath in NHS Forth Valley.  I am delighted to be bringing you the March blog from our national Nurse Consultant group.

Do you ever go through a period where you have no events coming up then you have 2 that come along at the one time? March is like that for the ASDNC group as World Delirium Awareness Day and the Dementia Champion/Dementia Specialist Improvement Lead (DSIL) graduation day always falls on the same day each year.

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World Delirium Awareness Day

World Delirium Awareness Day is important to us as a group as we know that people with dementia are more likely to develop delirium than those without dementia.  Delirium is a serious condition that is associated with multiple poor outcomes, including death, so it is important to identify and manage delirium effectively.  World Delirium Awareness Day encourages people who are passionate about delirium care to raise awareness either on a local, national or international level about the condition.

The organisers this year asked people who were involved to think about the following actions:-

  • Commit to using the term ‘delirium’
  • Screen your patients for delirium
  • Listen to patient and family stories about the experience of delirium
  • Engage your leadership in a discussion for delirium
  • Educate health professionals about delirium

As professionals we approach this day in many different ways.  Some areas have information stalls, share information regarding delirium electronically via social media and some staff go as far as dressing as delirium super heroes to catch people’s attention!  Something that our team in Forth Valley have worked very hard on in recent years is the first point above – encouraging the use of the term ‘delirium’ and we have managed to make some major improvements.  It is important to use the correct terminology for delirium as this is recognised as a medical emergency as opposed to terminology like ‘more confused’ which is a symptom, not a condition.

I would encourage everyone who may come in contact with people with delirium to be vigilant of the symptoms which may include:-

  • Suddenly becoming more confused, which can vary throughout the day
  • Disorientation
  • Drowsiness
  • Restlessness
  • Poor sleep pattern
  • Hallucinations
  • Paranoia
  • Mood changes

If you do notice these symptoms in yourself or another person, please discuss with a Doctor straight away.  Advise them of the symptoms but also tell them that you suspect this is a presentation of delirium to ensure the appropriate response is given.  Early identification and management really goes a long way to supporting recovery and reducing the chances of poor outcomes.

Dementia Champion/Dementia Specialist Improvement Lead graduation

We as a group always look forward to the Dementia Champion and Dementia Specialist Improvement Lead graduation as it is a real celebration event.  This year was extra special, particularly in terms of the Dementia Champions, as it marked the 10th cohort and took the number of Champions who have graduated in Scotland to over 1000, an amazing achievement.

The Champions and DSILs lead on improving systems, approaches and ultimately the care that people with dementia experience if they come into hospital, whether this be to an acute ward or a specialist dementia unit.  They are a huge resource across the country and a fountain of knowledge about all things dementia (including delirium) in their areas.  If you do find yourself in a hospital setting and wish to find out more about what is happening locally, or access additional support, ask the area if they have a Dementia Champion that you can speak to.

The event itself was a huge success and a privilege to be a part of as always.  On behalf of all of the ASDNCs, a huge congratulations to all of the Champions and DSILs who graduated this year, very well deserved after all of your hard work.

Contributor Nicola Wood, Alzheimer Scotland Dementia Nurse Consultant and Lead Nurse for Older Adult Mental Health, NHS Forth Valley.

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How do we protect the rights of drivers with dementia as they navigate the assessment process?

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Receiving a diagnosis of dementia does not automatically mean the person must stop driving. There are legal requirements to adhere to in informing the DVLA and insurance company, however often a driver with early stage dementia is able to carry on driving.

The challenge for clinicians is ensuring the best decisions are made at an appropriate time with the driver and their family,  which empowers the decision making processes and enables the person to drive for as long as is safe.

In 1985 Michon described three levels of driving skill which remain relevant today:

  1. Operational skill – controlling the car
  2. Tactical skill – manoeuvring and judgement
  3. Strategic skill – planning and organising.

There are compensatory strategies which can help a driver manage difficulty at a strategic level, however risks for safe driving begin to occur when a person’s cognition impacts their ability at a tactical level. Operational driving skill is overlearned, meaning that a person may well be able to operate the car, however be less aware of having any difficulties at the higher skill levels.

There will come a time where a decision to stop driving is inevitable as the dementia progresses.

So how do we ensure that assessments take place at the right time for the person with dementia?

Historically fitness to drive decisions were a subjective decision made by a physician. This resulted in some people being told to stop driving at the point of diagnosis, or conversely the physician did not address driving at all. Neither approach was useful or rights based and failed to allow the person or their carer the right to be involved in the decision making process. In addition, it resulted in people stopping driving earlier or later than appropriate, with subsequent impact on many aspects of their daily life, or indeed an increased risk to themselves or other road users.

In Perth and Kinross we began to receive referrals around 8 years ago from clinicians seeking an objective evidence base for the decision making process. As this clinical practice has grown over the years, so has the accompanying debate, and we find ourselves increasingly advocating on behalf of the people who are referred for assessment.

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How do we ensure that the assessment process is fair, objective and equitable?

Firstly we had to source a suitable assessment to use which was evidence based and suitable for using with people living with dementia. Our assessment of choice was the Rookwood Driving Battery (McKenna P, 2009) which is a simple office based standardised screen for the core neuropsychological skills needed for driving amongst the neurological population. The score indicates whether a person is likely to pass or fail on road. The responsible doctor would then use this result in conjunction with other information to facilitate the best decision around the next steps; to continue driving and review at a later date; to attend for an on-road medical driving assessment; or, that there would be no benefit  in perusing any further testing.

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As this aspect of clinical practice grew, we then became increasingly aware of the need to ensure that all requests for assessment were fully justified and minimise the risk of harm through unnecessary assessment…. But how best to do this? Based on what evidence?  This has lead to some challenging conversations with referrers at times.

Referral on for the full medical Driving assessment and on road test is itself an area for debate in terms of being fair and equitable. Given that there is only one location for the whole of Scotland, referral for people living rurally can mean added expense and the stress of going to Edinburgh. Furthermore some people will have very little experience of city driving, or will have modified their driving habits. This will no doubt influence the assessment. In the Rookwood Hospital in Wales, research has highlighted that older adults and also people with dementia perform less well during assessment and as a result they introduced an on-road test route for older adults which involves less city driving but still meets the DVLA requirements. (Rees et al., 2008)

How do we ensure that the person and their carers are fully supported?

Involving the person and their family/ carers throughout the assessment and decision making process is a vital part of them feeling empowered and listened to. Often the person themselves is keen to be assessed in order to prove their skill, and, if the result of the Rookwood Driving Battery indicates a very high chance of failing on road, but the person still wishes to be tested on road, we will respect their wishes for that referral. It may be that an on road test is the most relevant part of the whole process for some drivers and families.

How has asking all these questions impacted our local clinical practice in Perth and Kinross?

We realised that in order to have a voice to represent the rights of drivers with dementia during assessment and decision making – we needed clear answers and an evidence base for our local practice. Completion of a literature review during 2018 brought us to the point of seeking these answers from our own practice and the hope that this could lead to us producing some very clear guidelines for referrers.  The need for more data regarding the use of the Rookwood Driving Battery with drivers with dementia has also been highlighted from previous research. (McKenna and Bell, 2007; Vella and Linclon 2014).

What started out as an audit proposal was soon classed as research and we began the process of seeking all the necessary approvals during 2019.

In January 2020 we have now begun the research process itself and we will be collecting retrospective data from our own practice going back as far as 2015. In 2021 we plan to analyse  and publish our results as well as to use these locally.

You can read more about our research at :

https://www.researchregistry.com/browse-the-registry#home/registrationdetails/5e0f505d55470e001602531b/

In January I was also very pleased to find out that we had been awarded the Royal College of Occupational Therapists Constance Owen’s Early Researcher Award for 2020 which will help us fund back-fill clinical cover during the data collection phase.

Contributor

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Hazel Douglas, Occupational Therapy Team lead, Perth and Kinross Psychiatry of Old Age Occupational Therapy Team, Murray Royal Hospital, Muirhall Road, Perth hazeldouglas@nhs.net

References:

McKENNA, P., 2009 The Rookwood Driving Battery Manual. London: Pearson Assessment.

McKENNA, P. and BELL, V., 2007. Fitness to drive following cerebral pathology: The Rookwood Driving Battery as a tool for predicting on-road driving performance. Journal of Neuropsychology. vol. 1, pp. 85–100.

MICHON, J., 1985. A critical view of driver behavior models: what do we know, what should we do? Human behavior and traffic safety. pp. 485–520.

REES, J., McKENNA, P., BELL, V., SKUCEK, E., NICHOLS, E. and FISHER, p., 2008. The Rookwood Driving Battery: normative older adult performance. British Journal of Clinical Psychology. vol. 47, no. 2, pp. 139–151.

VELLA, K. and LINCOLN, N. B., 2014. Comparison of assessments of fitness to drive for people with dementia. Neuropsychological Rehabilitation. vol. 24, no. 5, pp. 770–783.