Youth health NP LOU ROEBUCK and Professor JENNY CARRYER, patron of youth one-stop shop, WAVES, ask why a popular health service helping thousands of young people can’t get funding.
“I’m not going to change. I’ve been nursing 35 years and …” Some nurses find change harder than most. Sydney nursing professor, Lynn Chenoweth, shared some of her knowledge and research in aged care nursing at the recent symposium, including the EN-ABLE project about implementing person-centred care in residential aged care facilities.
The collaborative project involved researchers from three universities working with six residential care providers across three states of Australia to trial a toolkit for a person-centred approach to dementia-related behaviours. The person-centred approach to dementia care was developed by British psychologist, Tom Kitwood, and is focused on meeting a person’s psychological and social needs including the need to feel secure, have purpose, and to belong.
The project’s aim was to work directly with managers and staff at the facilities using a team approach to empower and upskill staff to respond in person-centred ways when faced with “needs-driven” behaviours by people with dementia – for example, wandering, aggression, or withdrawal.
“We asked what are the most important things we need to do to support the care of the older person and how can we work together as a team to bring about that change,” says Chenoweth.
“We [were wanting] to make staff more person-centred in their approach, not just for the residents but also for their team to treat each other with respect and support each other.”
As to be expected, they came across a small number of nurses unwilling to come on board. “Those nurses who say things like, “I’ve been nursing for 35 years and I’m don’t care what they say, I’m not going to change…’.”
“There are always groups of people resistant to change, small groups open to change, and the large majority sit in the middle and can vacillate either way depending on whether you put forward a good case for change,” says Chenoweth. “The idea is to bring that middle group along so the others follow or leave…”
To encourage people to change, staff had their job descriptions rewritten to include a person-centred approach to their work. Their manager also set down what behaviours they needed to change and included strategies to help meet set goals. A review was held every six months and staff members who had not achieved their goals in the first six months were given more support. If at 12 months they were still resistant and their behaviour unchanged, they were “counseled” to leave.
“Within 12 months, we changed the service around – quality of care and attitude of staff.”
She said the new job descriptions had moved from task-focused work to identifying the needs of the residents they are caring for. “So rather than coming on duty and being told you have to shower five people … [it moved] away from task-focused care to focusing on meeting the person’s needs that day.”
Staff were asked to build a relationship with the people they cared with so they knew more about their past and interests and started the day finding out how a resident felt rather than heading straight for the shower.
At the six-monthly review, their supervisor would sit down with them, and if they were having difficulties with one particular goal, then new strategies would be tried to help them. For example, if it was difficulty communicating with patients and families, the manager may buddy them up with a role model to help them learn and practise skills, or be sent off to a course on communicating with people with dementia, or to work side-by-side with their supervisor to get feedback on where they were effective or not. Other goals examples were being competent in moving patients – e.g. from bed-to-chair or chair-to-standing in a person-centred, respectful, and safe way.
Those staff members who after 12 months had not changed or continued with negative behaviour were “counseled”.
“The director would talk to them and say this is the type of attitude and behaviour we expect of our staff. We have given you an opportunity to make the change to our new model, and it’s clear that you are not able or willing to work with this model. Therefore, we believe you aren’t suited to this type of work or for our organisation’.”
She said the same approach had been used in her PerCEN (Person-centred environment and care for residents with dementia) study, which had been rolled out to 38 providers across New South Wales.
Lynn Chenoweth, Professor of Aged & Extended Care Nursing at the University of Technology Sydney, was keynote speaker at the College of Nurses’ Baby boomers & beyond: transforming aged care symposium in Christchurch in mid-October.
Major concerns of older health consumers
• Poor staff knowledge of age-related changes.
• Focus on acute illness (ignoring psycho- social needs, co-morbidities).
• Poor staff communication skills with older people.
• Intolerance of older peoples’ needs (questions, complaints, distress).
• Task-oriented care (driven by schedules).
• Use of restraint, including verbal (and chemical).
• Insufficient risk-prevention systems (i.e. falls, delirium).
Distinguishing features of a ‘person-centred’ older person’s health service
• Managers and staff promote and adopt appropriate attitudes towards the older person and their family.
• Staff develop a sound knowledge base.
• Staff develop skills for aged care work.
• Staff reflect on and improve their practice.
• Staff lower their defence barriers when families and managers question their care practices, or distress in the older person.
• Staff grow in practical morality regarding their work.