© PROMISE 2016 - All Rights Reserved | Em@il:firstname.lastname@example.org
PROactive Management of Integrated
Services & Environments
Dee Wall, OT, Denbigh Ward, Fulbourn Hospital
I am an Occupational Therapist with a specialism in person-centred dementia care. I currently work on Denbigh Ward, Fulbourn Hospital, which is a purpose built assessment unit for people with dementia.
Since starting on the ward in September 2014, my remit has been to enhance function, promote relationships and social participation, and also to find ways for those with dementia to increase their well-being through involvement in meaningful occupation.
The importance of meaningful occupations for people with dementia is well documented. It can reduce ill-being, counteract feelings of isolation, promote strengths, enhance relationships and communication and reduce behaviours that other people find difficult. However, despite a group programme being implemented on the ward, I considered that more could be done to enrich people’s lives through unplanned moments of engagement and occupation (Hillier and Stokes 2012 )
The most important element of meaningful engagement is to get to know people as individuals, their past interests and lifestyles, their current strengths and to cater for any difficulties such as adapting the environment to suit individual needs.
It is particularly important that the activity should not make the person with dementia more aware of his/her difficulties; it is not therefore always appropriate to invite that person to every group activity as in certain instances using sensory approaches on a 1 : 1 basis may be more meaningful.
Like many others who work in the field of dementia care I have been greatly influenced by the work of Tom Kitwood in person-centred care and the changing culture of care particularly in institutional settings. I quote Tessa Perrin who wrote in the Journal of Dementia Care July/August 2005) ... “there is a myth still prevalent in care settings across the country , that activity provision is the job of the activity co-ordinator and nobody else. Nothing could be further from the truth. Activity is not bingo or knitting. Activity is about living and doing. Activity provision is about sharing that living and doing with the people for whom we have been employed to care. If we are too busy doing in the office/kitchen/potting shed to come out and share that doing with the people we care for, we maybe in the wrong job. The activity
co-ordinator’s job is to co-ordinate the doing, it is everybody else’s to share it.”
In accordance with this approach and with the encouragement of the ward manager on Denbigh Ward, in October 2014 I introduced the ‘Butterfly Approach’ (Sheard 2007) to enhance a good model of the person-centred care already being used on the ward.
Sheard stated “in a busy day, being person-centred is knowing how to touch people’s lives. All of us can live in the moment; all of us can change someone’s day through small things.’
To enable this to happen, I provided a selection of items on “talking tables” in the dayroom which included sensory items, dolls, soft toys, rummage items, art, drawings, colouring pens, fun items, shopping baskets, and musical items.
I also encouraged and coached some of the staff on the ward to increase their level of positive social interaction to make “meaningful moments” the culture of care.
I live by example, so one day, having initiated the daily “talking tables” and introduced meaningful occupation in the dayroom, I noticed general staff interest developing amongst HCAs and nursing staff in what my OTA and I were doing with patients who appeared more settled. They also saw how much fun we all seemed to be having. Within a short period of time I noted that a nurse and an HCA had joined in.
Since that time I have found this new approach and interest has cascaded down amongst the vast majority of staff, and I now discover that whenever an activity commences, an increasing number of staff volunteer or show an interest in participating. Interest has continued to grow and I am delighted to say that I have received numerous positive and encouraging comments from nursing, OTAs and HCAs including:-
“Patients now seem less anxious and more settled”...and
“My work has become more interesting. Through using activities with the patients I’ve seen a more positive side of them. It improves our relationship”
“You have helped to improve the culture of care on this ward “
Enriching people’s lives through unplanned moments of engagement and occupation and implementing the butterfly approach appears to be a win/win situation. Many staff appear more motivated to come to work and are enjoying implementing ideas for engagement with the patients which has provided a more positive and calming atmosphere on the ward.
Most importantly of all the patients with dementia are receiving a more person-centred and positive quality of care.
Kumar Ponnuswamy, Maple 2, Ward Manager
Most or our patients now go off of the ward to eat in the canteen at the Cavell Centre. That’s something the wards initiated because it helps promote independence and health. Previously people used to stay on the ward to eat. Now they can go out for a walk off of the ward to the canteen and choose their meal (depending on mental state and their risk assessment). That’s something we started at the end of September. It’s going really well, people enjoy it and it’s a positive experience.
We recently started to do staff and patient protected time 3 days per week on Maple 2. On Tuesday, Thursday, Friday the office shuts for certain hours in the morning, all staff are on the ward and one of our administrators takes the phone. All the nurses and staff come out and sit with the patient to engage in meaningful activities, such as 1:1 conversation, reassurance, and spending time getting to know patients. All of this does happen at other times of the day too but it’s about protecting that period of time to allow us to focus on engaging with patients. It has been working really well and I’m now planning to extend it to a daily occurrence.
|Values, Vision, Mission|
|Preslude to PROMISE|
|Introduction to PPI|
|Reflections on PPI|
|Open Arts - Navigating Rocky Waters|
|Breaking The Chains|
|Power to Emower|
|Person Centred Care|
|3-3-3 Mulberry Wards|
|3-3-3 Oak Wards|
|Eating Disorder Ward|
|George Mackenzie House|
|Older Adult Wards|
|Learning Disability Wards|
|Reflective Space - No Audit|
|Recovery College East|
|Peer Support Worker|
|Shared Decision Making|
|Mind the Gap|
|Interfaces across Care|
|Road So Far|
|Global Mental Health|
|Breaking the Chains|
|Maintenance - Help or Hindrance|
|Enhanced Primary Care|
|Psychological Wellbeing Service|
|County Council Perspective|
|Caring for Carers|
|Crisis Care Concordat|
|Next Generation Psychiatry|
|New Age Nursing Prospectors|
|Making our services safer|
|Food and Mood|
|Space for Carers|
|Best at Basics|
|ARC: CPFT’s Interface|
|Research in CAMEO|
|PD Pathway Interfaces|
|Affective Disorders Care|