What do you get when you combine a Speech and Language Therapist, an improvement project and a very accommodating charge nurse? Thankfully, a positive outcome!
Why did we bother?
As food is fundamental to health and wellbeing, mealtimes are extremely important. They also offer the opportunity to promote social interaction and the potential for enjoying one of the remaining pleasures for many people with significant cognitive impairment. Clinical research supports the use of relaxing music played during mealtimes to exert a calming effect and decrease stress and distress. As a speech and language therapist, I regularly require to undertake assessments during lunchtimes. I also have a personal interest in music. Having the opportunity to undertake Quality Improvement training allowed me, after a fair bit of background reading around the subject, to use these skills to seriously develop my initial project idea. Combine all of the above ingredients plus approachable Charge Nurse Lainey McLeod and I was good to go.
Marchburn Ward, in the local community of East Ayrshire, provides care to people living with dementia with who have complex care needs. Stress and distress symptoms of dementia are a significant problem that impacts on clinical care and overall life quality. The sensory stimulation and increased demand for social interaction required when dining can create uncertainty and anxiety which is often expressed in various forms of disruptive behaviour. Mealtimes, particularly the midday meal, were identified to be stressful for both patients and staff resulting in increased stress and distress behaviours.
What we aimed for
It was hoped that through introducing specific changes to the usual lunchtime there would be a 10% reduction in symptoms of stress and distress exhibited. 10% improvement in staff perception of the lunchtime environment was an additional goal.
How did we do it?
By adopting a quality improvement approach, change ideas were explored and undertaken.
- Introducing relaxing classical music during lunchtime.
- Increasing staff awareness of the current evidence regarding achieving an optimal mealtime experience.
- Ensuring staff consistently initiated appropriate interaction with patients, providing information/comments on their meal e.g. taste, smell.
- Minimising noise and conversation unrelated to the dining experience.
- Establishing a consistent lunchtime routine.
Following months’ of planning and paperwork, staff training and burning of CDs with classical music of a particular style and speed, we started making changes. This required tallying various behaviours observed at lunchtime, noting staff experiences and much gnashing of teeth over excel spread sheets and run charts………. The results however indicated it was worth it.
What did we achieve?
- Stress and Distress – Classical music reduced overall stress and distress behaviours. Positive interactions adopted by the staff helped stabilise stress and distress behaviours at a lower level.
- Lunchtime Environment- Staff were asked ‘How relaxed and harmonious did lunchtime feel? 1(not at all)-7(very) scale. There was 20% perceived improvement. Even better than was hoped- result!
‘One patient sat for the longest spell I have ever witnessed her doing during lunch’
‘Calm today, patients’ content’
‘Music helping, less behaviour’
What did we learn?
- Levels of stress and distress behaviour were higher at lunchtime than dinner time. We tested this out and at the evening meal the levels of behaviour were much lower overall and no significant change was made.
- Optimum staffing levels directly impacted on level of patient stress and distress. Fewer staff led to increased negative behaviours.
- Continuity of staff was important. Stable/predictable staffing ensured appropriate use of positive interaction training and knowledgeable management of individual patient needs.
- Changes within the typical lunchtime routine negatively affected behaviour. The timing of music to the arrival of the meal was vital. One day when the trolley was delayed by ten minutes stress/distress behaviours reduced when the music began and then increased above the usual levels.
- Patient stress/distress affected other patients and staff, influencing their behaviour.
- On a personal note, the project improved my skills and confidence in quality improvement, providing an opportunity to lead a project. I also developed knowledge in producing a poster including the importance of presenting the information in an accessible format.
NB. Specific pieces of music with contrasting dynamics are not a good idea unless someone stands beside the volume control……….
The addition of classical music and intentional positive interaction between staff and patients created a calming lunchtime environment with positive benefits for both staff and patients.
Speech and Language Therapist