Dementia Training

Dementia Training Training support • Skills development • Competency • Assessment • Scholarships • Education Training to care for people with dementia

Adapting Assessment Techniques Flo Munro RN Training to care for people with dementia

Objective for this session Promote thought about: • how we ensure that the people with dementia in our care receive adequate assessment of health care needs • How we can modify our work practices to improve care for people with dementia Training to care for people with dementia

Health Assessment What we have heard so far: • Person Centred Approach – Geoff Jones • The Language of Behaviour – Virginia Moore THE PERSON living with dementia Vs The DEMENTIA But what if the person is ill with something else? Does PCA support useful assessment? Training to care for people with dementia

Assessment is the First Step • Diagnosis • Treatment choice PWD may present a challenge & a risk Training to care for people with dementia

Patient Safety – Do no Harm • PWD in health care settings experience ill being because of inactivity and isolation • Inadequate Pain Assessment & Management • Inadequate Nutrition & Hydration • Restraint • Inability to reach buzzer • Frequent Falls • Development of pressure ulcers Training to care for people with dementia

Medical Model Vs PCA • Problems with reliability of History • Non-cooperation with physical examination • Non compliance with planned care • Adverse behavioural reactions • Knowledge base of carers and family who usually provide the daily care Training to care for people with dementia

Memory Learning Language Comprehension Abstract thought Calculation Decision making Orientation Perception Patterns of movement Planned activity Motivation Emotional Control Judgement Social behaviour (Adapted from world health organisation definition 1992) Disruption to the person’s previous functional ability in: Training to care for people with dementia

Behavioural and psychological symptoms of Dementia The changes to the person’s previous functional ability mentioned in the WHO definition go a long way to explaining why people with dementia behave in the way they do, and why we find it so difficult to provide care that suits their needs Training to care for people with dementia

Anxiety Fear Depressed mood Paranoia Hallucinations Delusions Aggression Noise Agitation Wandering Social inappropriateness' Constant questioning Cursing Restlessness (From who’s perspective?) Common Problems Training to care for people with dementia

Our Role Our behaviour and attitude, communication style, awareness of what may stress the person, and how we set up the environment will affect the behaviour of people with dementia, And, the process and outcome of any assessment or provision of care that we attempt. Training to care for people with dementia

Gordon’s Functional Health Patterns FrameworkGordon, M. (1987)Nursing diagnosis; process and application (2nd edition) • Profile, Health history, Presenting problem • Nutritional and metabolic health • Elimination • Activity and Exercise • Sleep and Rest • Psychosocial • Cognition and Perception. • Sexuality and Reproductive Health Training to care for people with dementia

Tom Kitwood(1997) suggested that: A person centred approach involves considering the complex interaction of six fundamental factors. These factors together shape the responses and experiences of the person who is being assessed, and will affect the process and outcome of any health assessment. Training to care for people with dementia

Neurological Impairment. Physical, Mental and Sensory health Personality Biography/History Physical and Sensory Environment Social Environment Kitwoods’ Model Training to care for people with dementia

The more we know about a person’s history and background in all the areas of Kitwood’s equation – the better chance we have of predicting their response in given situation. Thus: we can modify our approach accordingly Training to care for people with dementia

Companions • Trusted known person – calm & reassuring • May know the background • “3rd party subjective” • Can inhibit the person from expressing themselves Training to care for people with dementia

Factors affecting us Knowledge & Skill Physical & sensory abilities Personality, prejudice Experience, History Resources, environment Factors affecting the patient NI, cognition Health Personality Experience, history Physical and sensory environment Social environment Training to care for people with dementia

The physical Setting Who is in charge? Does this fit with the persons’ view of themselves? Are we prejudiced against people with dementia? Are we prejudiced against the elderly in general? What about the persons’ rights? Social Environment Training to care for people with dementia

Adequate History • Does the person understand/hear/know why you are asking these questions? • Can the person communicate the answers reliably? • Would someone else know? • Would they be willing to talk about this even if they weren’t affected by dementia? Training to care for people with dementia

Accommodate the 4 “A”s • Amnesia • Aphasia • Apraxia • Agnosia Training to care for people with dementia

First – the obvious • Pain • Conscious state and/or cognition • Depression and/or Delirium • Negative psychosocial environment • Sensory abilities /disabilities • Infection Training to care for people with dementia

In a setting that is comfortable for that person: Inspect Palpate Percuss Ausculate Abdomen, bladder & bowel Lung and thorax Cardio vascular Muscular skeletal Skin, pressure areas Head, neck oral cavity Swallowing Physical Examination Training to care for people with dementia

Considering the Ethic To do or not to do – is that the question? • Consent • Communication • Comfort and safety • Clinical responsibility/obligation Training to care for people with dementia

Stop Smile Go slow Go away Give them space Stand aside Distract Keep it quiet Don’t argue Brainstorm and debrief 10 Top TipsAlbany Regional Hospital – Dementia resource manual 2006 Training to care for people with dementia

Stop Think about what you are about to do and consider the best way to do it. Plan and explain: Who you are, what you want to do, why you want to do it Training to care for people with dementia

Smile The person may take their clue from you and mirror your behaviour Use relaxed, confident, & friendly body language and tone of voice Training to care for people with dementia

Go slow • You have a lot to do and are in a hurry but the person isn’t • The person may react negatively if you rush them Training to care for people with dementia

Go Away If the person is resistive or aggressive but is not causing harm to themselves or others – leave them alone • Give them time to settle and re-approach later (they may be feeling different later and not present the same behaviour, in the meantime supervise unobtrusively) Training to care for people with dementia

Give them Space Any activity that involves invasion of personal space increases the risk of assault and Aggression Every time you provide care for a person you are invading their space Modesty is often very well preserved in the elderly – consider this Training to care for people with dementia

Stand Aside Provide care from the side of the person, not directly in front – especially if they are likely to become aggressive Training to care for people with dementia

Distract them Talk to the person about things they enjoyed in the past Become familiar with their personal profile Give them a face washer or something to hold while you are providing care (They can probably do only one thing at a time!) Training to care for people with dementia

Keep it Quiet Check noise level and reduce it Turn off the TV and radio (Close doors and windows – but - remember to balance privacy, serenity and supervision) Training to care for people with dementia

Don’t Argue They are right and you are wrong! The person with Dementia ‘s brain tells them they can’t be wrong. (remember also, your behaviour is likely to be mirrored) Training to care for people with dementia

Brainstorm and debrief How can you and your team best meet the physical, environmental and psychological needs of the people in your care. Training to care for people with dementia

Who is the most difficult to assess? Training to care for people with dementia

Training to care for people with dementia

Dementia Training