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Assessment Tool for Occupation and Social Engagement (ATOSE)

Assessment Tool for Occupation and Social Engagement (ATOSE). within a nursing home environment Mark Morgan-Brown Dympna Manley HSE, Cavan, Ireland. Household Model Principles. Each household is a person’s home The kitchen becomes the focus Residents participate in meal preparation.

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Assessment Tool for Occupation and Social Engagement (ATOSE)

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  1. Assessment Tool for Occupation and Social Engagement(ATOSE) within a nursing home environment Mark Morgan-Brown Dympna Manley HSE, Cavan, Ireland

  2. Household Model Principles • Each household is a person’s home • The kitchen becomes the focus • Residents participate in meal preparation

  3. N. Home S MMSE scores 0-17 MMSE mean 8.6 Dependency 68% N. Home W MMSE scores 0-12 MMSE mean 6.4 Dependency 94% Resident Population

  4. the observational toolRationale Proximal Factors Aging and Mental Health: 2001 (5) Supp. 1: Zarit & Leitsch; Schulz; Beck EnvironmentalDisengagement T. Perrin, J. of Adv. Nursing 1997 Alz. Care Quarterly 2000

  5. ASSESSMENT TOOL for OCCUPATION & SOCIAL ENGAGEMENT (ATOSE) SEGMENT SEQUENCE NO: SEGMENT START OBS TIME DATE of OBS RESIDENTS VISITORS STAFF Active Social Engagement Social Engagement Social Engagement x R . x R. x R. x V. x V. x V. x S . x S. x S. mixed mixed mixed non-verbal non-verbal non-verbal Welcome Welcome Welcome Activity Activity Activity kit. / dom. - I. kit. / dom. - I. kit. / dom. - I. kit. / dom. - R. kit. / dom. - R. kit. / dom. - R. kit. / dom. - V. kit. / dom. - V. kit. / dom. - V. kit. / dom. - S. kit. / dom. - S. kit. / dom. - S. rec. - I. rec. - I. rec. - I. rec. - R. rec. - R. rec. - R. rec. - V. Rec. - V. rec. - V. rec. - S. rec. - S. rec. - S. rec. group - I. rec. group - I. rec. group - I. rec. group - R. rec. group - R. rec. group - R. rec. group - V. rec. group - V. rec. group - V. rec. group - S. rec. group - S. rec. group - S. Passive Engagement with Surroundings Passive Engagement with Surroundings Passive Engagement with Surroundings non / A. non / A. non / A. Receiving Care Care tasks Care tasks P.care - R. P.care - R. P. Care Prof. care Other Work tasks Passive / Agitated Behaviours Partnership prof. tasks eyes closed meal / snack dom. agitated cater. self-stimulation

  6. ADVANTAGES • Analysis of time use • Observable Q of L indicator • Identifies areas of need • Compares environments • Good inter-rater reliability • Fairly unobtrusive

  7. Disadvantages • Time intensive (cost) • Location specific • 5 minute interval recording • Doesn’t seek to evaluate care task quality

  8. Results

  9. Preliminary Conclusions The physical environment encourages apathy • Immobilization caused by: • Sitting around the wall • TV and DVD • Lack of casual social contact opportunities • Barren environment for occupational opportunities

  10. Conclusions Residents • Residents participate only when encouraged by staff • Only a few residents participate in structured activities • Activities oriented towards female middle class residents • Some residents shut their eyes to avoid structured activities

  11. Conclusions - Staff • Most of the time there are no staff (or visitors) in the room • Staff interaction tends to be based around care tasks • No strategies for encouraging interaction and activity

  12. Conclusions - Visitors • Few visitors, short times • Visitor interaction is based around talking or walking (even for residents with severe language or mobility problems) • Lack of alternative interaction strategies for visitors • Lost resource

  13. Conclusion: The ATOSE serves its purpose….. • Rates and compares levels of occupation and social engagement in environments • Will evaluate the change to the Household Model of care (Q of L, cost effectiveness)

  14. Mark Brown, Occupational Therapy Specialist in Inclusive Design for People with DementiaCavan, Irelandmark.brown@hse.ie

  15. The authors thank the Managements of the Moorehall Lodge, Ardee, Co. Louth and Castleross Nursing & Convalescent Centre, Carrickmacross, Co. Monaghan. Their commitment to exploring the possibility of improving quality of life for their residents and undertaking the relevant renovations and culture change were the genesis of this research project. It is directly through their facilitation and support that the investigations detailed in this paper are able to be carried out. The authors also wish to acknowledge the openness of the Residents to the research, and the continuing commitment of the Staff and Visitors to the observation stages and the gift of their time and thoughts in the interview processes.

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