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Providing Resident Centred Care

Providing Resident Centred Care. Kathy Peri School of Nursing Faculty of Medical and Health Science University of Auckland . Patient centred Resident centred is there a difference?. The principals are the same

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Providing Resident Centred Care

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  1. Providing Resident Centred Care Kathy Peri School of Nursing Faculty of Medical and Health Science University of Auckland

  2. Patient centred Resident centred is there a difference? • The principals are the same • Being resident centred defined as older people living in long term care facilities

  3. Literature Review • Quality of life in long term care institutions can be affected by a number of factors including the physical social and health care environments (Kane 2001). • Work force issues in residential care impact on quality of life for residents (Foner 1995). • A number of studies suggest quality care equals improved quality of life and life satisfaction (Tobin 1999). • ADL impairment has a strong influence on the relationship between social engagement and mortality – including mental health (Kempam 1999).

  4. Key Principles • Having a non judgmental acceptance of the uniqueness of each person • Respecting the past experiences and learning of each person • Seeing the whole person with emotional physical and spiritual needs • Focus of a person’s positives – abilities • Staying in communication means being flexible, thinking laterally and listening to the other point of view.

  5. Key Principles • Nourishing attachments – ensuring people feels welcome and included • Creating a sense of community gives us the sense of belonging and knowing where we fit in and what is expected of us • Maximising freedom for people to contribute to their work or care and minimising unnecessary controls • Allowing ourselves to receive from others and valuing what they have to give • Building / maintaining an environment of trust

  6. The International Picture • The Eden Alternative Foundation (Thomas; New York) • Providence Mount St Vincent (Boyd; Seattle) • Wellspring Innovation Solutions (Eastern Wisconsin) • The Pioneer Network (Williams,1997 & Lustbader 2000))

  7. The National Picture • Promoting Independent Living Study(PILS) and the Promoting Independence in residential care study using a goal setting approach to improve quality of life and function (UOA research project) • Adoption of the Eden Model (several individual facilities) • Living Independently and having Fun in Elder Care:LIFE (For profit Chain)

  8. Practical application Is this possible?

  9. Methods • Social Group • Everyday worlds interview x2 • falls surveillance Randomly selected: rest-homes in Christchurch and Auckland Organisational Culture survey, Falls surveillance begun, Baseline Data (Fnc QOL) collected Randomisation (no statification) • Activity Group • PIRC, goal set, functional assessment, PIP to caregiver • falls surveillance • Outcome evaluation • Function, QOL 6m • Organisational culture survey • continued falls surveillance 1yr • (12m all measures)

  10. Intervention • Goal setting with resident • Goal activitiy individualised program devised by research team • Care plan developed and owned by residents • Implementated by caregivers • Goals modified and renewed as required

  11. Goal Domains • Independence day to day functioning (walk to toilet, shower, walk to dining room, walk to craft room) • Social activity (visit relatives, attend opera, play piano, gardening, outings in van, dine out attend church services) • Leisure activity (play snooker, shopping, attend computer classes, dancing)

  12. Outcomes • Improved quality of life; SF36 physical component (PILS) • Improvement of function; functional measure of the late life disability instrument. (PIRC) • Improvement in quality of life; EQUOL(PIRC)

  13. What are the ingredients in order to change care practices in residential care settings?

  14. Resident centre ness Returning locus of control to residents • Assist residents in determining their own daily schedules • Restore choices about eating • Support continence as long as possible • Promote all remaining capacities for self care and mobility

  15. Establishing home like environment • Implement cross training for all staff levels • Include family members in decision making • Promote a sense of community • Create a human habitat • Redesign traditional structures.

  16. Enhancing staff capacity • Flattening a facilities administrative structure • Commit to consistent assignment • Involve nursing assistants in care planing and care conferences • Enable nursing assistants to set their own schedules • Support team development

  17. Strategies for changing the culture in long term care facilities • Encourage frank dialogue • Supporting staff in developing new models of supervision • Communicating a clearly defined alternative to the status quo

  18. Conclusions • Providing those who live in residential care individualized care based on their choice and personal control will provide unlimited opportunities for growth in body, mind and spirit • Acknowledgment to all older people who unconditionally provided me with knowledge and information that supports my presentation today.

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