“A small change can make a BIG difference”

An Interview with an AHP Dementia Champion

My name is Tracey Stronach and I’m an Occupational Therapist working in a large acute hospital in Edinburgh.

1. What do you enjoy most about being an occupational therapist?

 

I’ve always enjoyed working with elderly people and for a number of years have specialised working with this group of people in both acute and rehabilitation hospital settings. When people ask me what I most enjoy about being an Occupational Therapist, I think it’s the difference I can make by identifying the impact of acute and chronic illness on function and safety  and by pro-actively trying to reduce or manage this impact.   My training has enabled me to always see the “bigger picture” and appreciate the effects of the environment and social situation as well as the physical and psychological impact of illness and disability.

2. Why did you decide to become a dementia champion?

Within dementia care I particularly enjoy using my occupational therapy knowledge to support both the person in hospital and their families and carers at a time when admission to acute care can be distressing. This is especially relevant for a long term condition like dementia, where outcomes are improved with the right environment and a compassionate approach. My role involves identifying services, equipment and adaptations that will improve the quality of life for the person living with dementia and their carer too with the ultimate goal to enable the person to return home.

I was delighted to gain a place on the Dementia Champions programme in 2014, and thoroughly enjoyed my training with colleagues from all over Scotland. Before the course I had read stories of people with dementia who did not experience a good patient journey in acute hospital care.  Gaining skills to help improve the experience of such people was a main driver for me applying.  I was also keen to make sure I knew as much as possible about identifying, and helping reduce, stressed and distressed behaviour in the acute hospital environment.

3. What aspect of the dementia champion education did you enjoy the most?

As well as the taught sessions, I really enjoyed my community placement, where I joined an afternoon singing group in a local church. It was such a positive way to meet people living well with dementia and their families and carers.  The community setting was a real contrast to my work environment, where I tend to meet people in a crisis situation. It helped put things in perspective and reinforced the impact that the environment has on the person with dementia. This welcoming atmosphere was very respectful and the volunteers treated those attending in a very inclusive, caring and compassionate way. My assignments helped me to reflect on what I had learnt and identified what ideas and learning I could take back to my workplace.

4. What has been your proudest moment integrating your new learning as a dementia champion in you day job?

At the same time as becoming a Dementia Champion I took part in a course focussing on learning skills to train others in Dementia Awareness.

Working with other Occupational Therapists, and using the Dementia Skilled – Improving Practice resource, we have run some training sessions for the support staff in our occupational therapy department. The feedback has been very positive and the sessions have generated discussion, reflection and the sharing of ideas.  I think my proudest moments come when I can see that someone has used the information taught to make a positive change in caring for someone with dementia. This could be a practical skill; using more sensitive or up to date terminology; or altering a perception or belief.  The change needn’t be huge – even a small change can make a big difference!

5. What would you say to your colleagues to encourage them to be a dementia champion too?

I feel very privileged to have completed two major programmes of learning in the field of dementia care. I would recommend anyone to take up the opportunity of training – the more Dementia Champions we have, the better care we can provide for people living with dementia – and their families and carers. I’m sure this is the highest priority for all those who work with people living with dementia.

Final thoughts……

I’d be interested to hear how other Dementia Champions are putting their training into practice.

• What’s been working well?

• How do we demonstrate we make a difference to the lives of those with dementia?

 

Tracey Stronach

Specialist Occupational Therapist – Mobile Medicine of the Elderly Team

@TherapyLimpet

I’m an Occupational Therapist working in a large acute hospital in Edinburgh. I’m part of a mobile Medicine of the Elderly team which involves working with people being treated on non-Medicine of the Elderly wards within our hospital. This brings equity of care to this often vulnerable group of people.

Interventions for Dementia: Education, Assessment and Support

AHPs join forces with other disciplines

They say if you have a good idea for a project, give it a memorable name. The IDEAS team in Dumfries and Galloway took this on board when they put in a successful bid for “Putting you First” money to launch a rolling programme delivering dementia training to care homes. The prize winning two year project finished in August 2014 with an array of great outcomes across the region’s care homes– a dramatic reduction in the use of anti-psychotic medication and benzodiazepines, much better staff morale with consequent lower rates of staff sickness, improvements in environmental design and in meaningful activity, with an impact on stress and distressed behaviour. A “train the trainers” component ensured homes could continue to deliver the modules to new staff after the end of the project.

The team is a multi-disciplinary task force co-ordinated by Lorraine Haining,  Advanced Mental Health Nurse Practitioner, and overseen by Gladys Haining, (@gbhaining) Alzheimer Scotland Dementia Nurse Consultant (no relation!) For the Phase 1 two-year project, Lorraine was joined by a specialist from Psychology, and AHP input was provided by members of the Occupational Therapy Mental Health team.

Making a difference in acute sector

After this success in care homes, Lorraine was asked to provide a 6 month programme to deliver training in the acute sector. This is in line with the 10 Dementia Care Actions in Acute Hospitals from the National Dementia Strategy 2013 -16. A scoping exercise identified Capacity and Consent, and also Communication, as key issues, so for Phase 2 the two other members of the team were Frances Thielen, a Mental Health Officer from social work, and me, a Speech and Language Therapist. Both of us are Dementia Champions.

Foundation training is for any staff and covers common types of dementia and symptoms, and why ordinary everyday circumstances can cause alarm or confusion in a person with dementia.  Practical exercises give participants the opportunity to experience some of the difficulties of living with dementia. We look at ways to offer effective person centred care to help reduce stress and distress.

Intermediate training is for clinical staff and has been delivered in three parts. The first focuses on delirium, as it is a medical emergency which often goes unrecognised.  The team is recommending a new screening tool which facilitates identification of delirium and outlines a management plan.

Another vital part of intermediate training is the session on capacity and consent. It is against the law to make decisions on somebody else’s behalf unless legal authorisation is in place, and there are simple steps to take on the ward to ensure that a person’s rights are not being violated. The final element of training is on communication, and how important it is to adapt our interactions and the environment to compensate for the effects of dementia. This is difficult in a busy hospital and there are no fool proof answers, but we have some suggestions, and there are opportunities to talk through examples. We have also devised a component for dieticians, who have asked for training relevant to their role.

Results?

Well over 400 staff have been trained in total, though in some areas the limited availability of staff for training is an issue that has not been resolved. Questionnaires show attitudes and knowledge have improved and comments have been extremely positive. For the first time, domestic staff have attended clinical training, and they are keen to do more. They feel their improved understanding of dementia will help them enormously on the wards.

From the AHP point of view?

It has been great working in a wider multi-disciplinary environment and learning from different professions. We now have a much greater understanding of each other’s roles and where they differ, complement or overlap. This has potential to increase efficiency and effectiveness. For example, the dementia care mapping done by Lorraine ties in very closely with what I as a speech and language therapist do in analysing communication breakdown as a cause of distressed behaviour. I can contribute to strategies to compensate for communication difficulties, but can use her thorough observation rather than carry out another assessment. Similarly, Frances’ expertise in considering capacity issues dovetails well with speech and language therapy knowledge of communication techniques. She is suggesting that all mental health officers should have access to the communication training from the IDEAS programme, and I have taken back many of her useful documents to my team.

Together, we feel able to deliver a targeted training package which a range of staff can relate to. It is a model which fits well with the integration of health and social care, and allows different disciplines to share and build on each other’s knowledge. I’m only sad the project was so short! I can’t wait to see what the IDEAS team will do next.

What are your suggestions?

 

Rebecca Kellett, Speech and Language Therapist (SLT), Dumfries and Galloway Royal Infirmary until April 2015.

@SLT_DG

I work in the community with adults with acquired neurological problems, including dementia, and I’m a member of the Alzheimer Scotland AHP dementia expert group. I’m starting a new job with a specialist speech and language therapy team in Lothian working with people with dementia.