Fact Sheet June 2010 Gentle Persuasive Approaches in Dementia Care Gentle Persuasive Approaches (GPA) in Dementia Care, is an innovative education curriculum that is currently being offered to care organizations throughout Ontario. We also have coaches in Prince Edward Island, Newfoundland, Saskatchewan, British Columbia and Nevada State. To date, approximately 42,000 staff members have been trained in Gentle Persuasive Approaches by 700 certified coaches. Many front-line staff in health care have little or no training in the management of challenging behaviour associated with dementia. Staff consistently report feeling vulnerable and at risk of injury if they have not been trained in respectful, non-violent, self-protection techniques. The GPA curriculum addresses these needs and is designed for delivery to interdisciplinary groups from all departments within various care settings, including, health care aides, dietary aides, and housekeeping staff. The curriculum is delivered in a 7.5 hour day and is case-based, interactive, and practical. It reframes challenging behaviour to be interpreted as self-protective or responsive behaviour that occurs as a result of unmet needs, thus encouraging staff to assess the meaning of the behaviour and work alongside the resident/patient/ client. • A third-party evaluation of the curriculum was completed in 2009 at an Ontario hospital. Results from the evaluation showed how this program improved staff’s response to challenging behaviours and learning strategies to respond to challenging behaviours. • Physical aggression rates declined 50% 3 months post-GPA training • 90% of respondents stated that the training helped them learn strategies to respond to challenging behaviour Curriculum Objectives • More specifically, as a result of participating • in this curriculum, staff will be able to: • Strengthen their understanding that the person with dementia is a unique human being who is capable of interacting with the outside world. • Use a holistic perspective to explain the relationship between the disease process and the person’s behavioural response. • Apply emotional, environmental, and interpersonal communication strategies that diffuse challenging behaviours. • Demonstrate the suitable and respectful protective techniques to use in response to catastrophic behaviour. The curriculum is targeted to all levels of staff and departments in care organizations who work with older adults. Involvement in this curriculum will provide staff with invaluable education and the opportunity to develop skills to manage those responsive behaviours staff experience as highly catastrophic in an effective manner. The overall goal of the GPA curriculum is to educate staff on how to use a person-centred, compassionate and gentle persuasive approach and to respond respectfully, with confidence and skill to challenging behaviours associated with dementia.
Course Content Course Delivery Module 1 – Overview of the principles of person-centred care, and the meaning behind responsive, self-protective behaviours of persons with dementia. The course is delivered through a 7 ½ hour, day-long workshop, involving multiple educational strategies to meet the various learning styles of front-line, point-of-care staff. Course content is implemented via role plays, focus groups, didactic mini-lectures, experiential exercises, case studies, and videos. It is the intent of the curriculum to be delivered by Certified Coaches so that point-of-care staff can continue to be coached in their application of key competencies. The project’s interdisciplinary curriculum development team designed this literature-based product and evaluated its effectiveness by measuring impact on participants’ self perceived competency, knowledge acquisition and clinical application. Module 2 – Introduction to the impact of dementia on the brain. Discussion centres on the A’s of dementia (anosognosia, amnesia, aphasia, agnosia, apraxia, altered perception, attentional deficits, and apathy), the relationship of each of these to responsive behaviours in dementia, and care implications. Interested? If you are interested in obtaining more information about this curriculum or to find a GPA Certified Coach in your region, please go to http://cgec.rgpc.ca/ or contact the CGEC: Paula DiLoreto CGEC/GPA Coordinator St. Peter’s Hospital 88 Maplewood Avenue Hamilton, Ontario L8W 1M9 (905) 777-3837 x 12506 firstname.lastname@example.org Module 3 – Overview of emotional, environmental and interpersonal aspects of communication strategies that assist front-line staff to respond effectively to escalating behaviours. Module 4 – Overview of physical intervention principles that when respectfully used in the clinical setting can assist staff to de-escalate the person with dementia, particularly when the behavioural profile includes physical acting-out. Staff learn how to protect themselves. They also learn respectful escort techniques, both individual and team versions that can be used to manage catastrophic behaviours. Staff have an opportunity to apply the techniques in role play situations. What are people saying about GPA? “[GPA] is very applicable for healthcare workers as we sometimes forget it’s the disease not the patient causing these behaviours “I feel it is very appropriate to the unit we work on and the patients we work with. These situations are not rare and the way we dealt with them previously could be improved using these techniques.”” “This class should be mandatory, so that staff can work together on the same level [to provide] better, consistent care.” “Provided very important information and helpful safe techniques. Made me more aware of this patient population.” “I now have a better understanding of how to deal with restless or agitated patients.” “The course was excellent. We need more courses like this.” “I think all healthcare professionals should take this course.” Acknowledgements The GPA curriculum was developed with the assistance of a research grant from the Regional Geriatric Program central (RGPc). The ongoing development and delivery of this curriculum is organized through the Continuing Gerontological Education Cooperative (CGEC).