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Dementia Training. Training support • Skills development • Competency • Assessment • Scholarships • Education. Adapting Assessment Techniques. Flo Munro RN. Objective for this session. Promote thought about:

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dementia training

Dementia Training

Training support • Skills development • Competency • Assessment • Scholarships • Education

Training to care for people with dementia

adapting assessment techniques
Adapting Assessment Techniques

Flo Munro RN

Training to care for people with dementia

objective for this session
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
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
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
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
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

disruption to the person s previous functional ability in
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
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

common problems
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 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

slide12
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

slide13
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

kitwoods model
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

slide15
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
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

slide17
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

social environment
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
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
Accommodate the 4 “A”s
  • Amnesia
  • Aphasia
  • Apraxia
  • Agnosia

Training to care for people with dementia

first the obvious
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

physical examination
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
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

10 top tips albany regional hospital dementia resource manual 2006
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

slide25
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
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
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
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
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
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
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
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
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
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
Who is the most difficult to assess?

Training to care for people with dementia