Tag Archives: Dementia

Half way through my first placement

This is the second guest post from Kate Hopley (first post here) who recently commenced a course here at BCU. Kate has also started a BCU mental health nurse student area on Facebook

I am now more than half way through my first placement, and I have had many new experiences since writing my last entry. I have been involved in all of the day to day nursing duties: meds round; ward round; helping residents to wash and dress; assisting residents with eating meals; completing all the relevant paperwork and, most enjoyably, getting to know each of the residents by spending time with them. 

A difficult time

I had a difficult couple of days a week or so ago, in the midst of several deaths. Over the week following the deaths I noticed how stories of those who had died were told over and over again in the staff room, alongside stories of other deaths which had been experienced. I reflected that the communal processing of grief was important for nurses, because fitting our experiences together and telling and re-telling them led to an acceptance of death and to moving on. We knew that we had done our very best to care for our patients during their stay at the unit, and in the end I felt honoured to have cared for them at the end of their lives, and no longer sad. 

Advocacy

Another subject which struck me forcefully over the past weeks is the need for nurses to act as advocates for people suffering with dementia, and especially for those who are in the stages of the disease where they may have lost the ability to communicate verbally. Most of the residents at my placement are not able to choose from a menu prepared to their liking – they rely upon the nursing staff to make informed choices on their behalf to ensure that they eat a varied and balanced diet. Many of the residents cannot walk about unaided, and so cannot choose whether to sit in a sunny window or right next to the television or who to sit by. Nursing staff must consider what they know of the person’s history alongside non-verbal clues as to what mood or preferences are being expressed on that day, and then make an informed choice. 

A good environment?

I have also spent some time reflecting on the physical and sensory state of the healthcare environment for those who are inpatients with dementia. If the rooms are moved around every day this may be confusing for the person with dementia; if different and unfamiliar staff help residents to wash each morning this may be confusing and frightening; if someone starts to offer food on a spoon without first explaining what they are going to do this could be frightening. If music is played or interesting sensory objects are available and nursing staff spend time talking to or sitting with the residents, then this creates a space for the residents to engage with the world around them and to express themselves. I have spent a lot of time getting to know the residents better, and over time I have learned to understand what they are saying to me better, and finding that it is indeed possible to have a conversation, one side of which consists solely of an array of meaningful facial expressions and gestures. 

I am absolutely loving my placement and I will be really sad to leave. Every day something happens that puts smile on my face, and every interactive response from a resident, be it a belly laugh or simply the raising of an eyebrow, makes placement feel nothing like a job at all, and everything like a satisfying vocation.

Kate

Guest post SCEPrE Fellowship : Trevor Adams

This is a guest post from Trevor Adams from the University of Surrey. Trevor is very well known for his work in the area of Dementia care and has been widely published. As ever, we are delighted to feature guest posters – so if you think you have something you want to say then please get in touch.

I have recently received a SCEPrE Fellowship (see http://www.surrey.ac.uk/sceptre/) from my own University, the University of Surrey. The award offers funding to undertake a project that will ‘promote excellence in Professional Training (placement learning) and enhance students’ experiences through enquiry-rich approaches to learning’. Over the last few years I have developed with others, the idea that there are three agencies involved in dementia care, people with dementia, family carers, and care staff. This is often called ‘relationship centred care’. This work has not just focused on ideas and theories associated with working alongside people with dementia and their carers, but has also described various strategies and skills that may be used to promote their well-being.  

My main aim within the Fellowship is to develop four films, each about 20 minutes long for publication on YouTube. This will make the films accessible to all and will hopefully, help nurses and other care staff develop worthwhile and effective skills in promoting the well-being of people with dementia and their family carers. The films will draw on relationship centred approaches, but will also include positive person-work that was developed by Tom Kitwood.  One of the films will concern the experience of care staff and will draw on the idea of emotional labour.

At the moment you can buy various teaching packages on dementia care, and I am sure they are very good. But they often cost a lot and I suspect, frequently lie unused on office shelves. I want to develop a package that was freely available and open to all. One reason for this is that teaching is changing. When I first became a nurse teacher I used to spend hours and hours preparing acetates. Now it is different and I have increasingly used films from YouTube in my teaching.  It is really good to hear Dr Niles Crane from Channel 4’s ‘Frasier’ talk about how Alzheimer’s disease affects the brain (sorry if you are not a Frasier fan! ):

These films offer students a really great learning experience and are a easy way of listening to experts, whether they are staff, carers, or patients.  I now want to use YouTube to help nursing students and others learn skills associated with dementia care.

As part of the Fellowship, I will be completing a wiki. As the Fellowship continues, I will be adding to this and sharing more about its progress. If you want to keep in touch, the wiki will be available here.

Photos Flickr creative commons

1. University of Surrey by Kai Hendry

2. Hand by Pamelaadam

The Dementia Care Strategy

In my blog I’m going to write about dementia, this is because that was my main speciality in practice, and because I have a module launching in a couple of weeks that focuses on dementia and so it is uppermost in my mind.

Leonardo DaVinci
Old Man with Water Studies: Leonardo DaVinci

Last year I was thrilled (yes, I really was but didn’t let it show) that the Government was planning to release a Dementia Care Strategy and got quite excited that suddenly my ‘poor relation’ interest was going to be top of the news and lead to better funding and public attention, and also give me lots of new material to boost lessons and discussions in class. It was like as a child waiting for a particular present which isn’t exactly promised, but you feel there’s a good chance it will turn up. As you may know, the Strategy wasn’t published before Christmas, perhaps the Government had other things to deal with, but from my perspective, and others in the field and those who have Dementia, and their families, it was a disappointment.

We do know roughly what the Strategy might contain, because there’s been a draft, and the themes are likely to be raising public awareness, early recognition and improved care. One of the things the strategy was criticised for was a certain vagueness about any money to support the recommendations. Now I’m getting anxious that not only I won’t get the present, but that if I do it won’t have any batteries.

This is just a little corner of the world, and it’s not just about being a spoilt brat when there are so many other pressing concerns – older people, at risk of dementia, or who already have it, don’t usually have high expectations, but maybe this time it will be their turn (and with them all the nurses and other staff involved in their support) to beam with pleasure when they unwrap the parcel. We’ll have to wait and see.