'Actively engaging psychiatric and dementia nursing patients: Practical lessons from a year in an NHS nursing home'

Transcription

1 'Actively engaging psychiatric and dementia nursing patients: Practical lessons from a year in an NHS nursing home' Marcus Yorke Occupational Therapist Margaret Butterworth Care Home Forum

2 Aims Background of the NHS care home Activity provision and increasing engagement OT interventions What was learnt Group discussion

3 Rationale NICE Quality Standard (December 2013) Mental wellbeing of older people in care homes 1. Participation in meaningful activity 2. Personal identity 3. Recognition of mental health conditions 4. Recognition of sensory impairment 5. Recognition of physical problems 6. Access to healthcare services

4 Alzheimer s Society Staying involved and active Keeping active Maintaining everyday skills Finding suitable activities Information about working with people with dementia

5 About the care home 19 bed over two floors Psychiatric nursing/dementia nursing Complex physical health needs (80% severely restricted mobility) In 2015 CQC visited and found it required improvement Change to manager and new activity coordinator appointed. Existing staff shuffled. Re-organised MDT input; Consultant geriatrician, GP, pharmacist, manager, nurse from each floor and sometimes nutritionist meet on bi-monthly basis Aim of MDT is to review each patient at least every 12 months. Needs ledphysical/mental health, meds compliance, hospital admission.

6 Activity Provision 271 group session (involving between 5-15 residents) 212 one to one sessions 11 tea parties or picnics 8 excursions (including RAF museum, London Zoo, carol concert) 12 visits to the Rio Cinema (dementia friendly screenings)

7 External input Music therapist (1 day per week) Monthly Kissing it Better sessions 9 Music in Hospital sessions Weekly visit from therapy dog Introductory visit from local nursery school 4 regular local volunteers Regular nursing and OT students Islington library services Friends and family

8 Why OTs in care homes? Professional concern and curiosity around occupation Use of assessment to determine functioning Life story work Group facilitation COT recently published updated Care Home Toolkit- Living well through activity in care homes

9 OT Student Interventions 3 MSc Pg Dip occupational therapy students on consecutive placements Each placement lasted 7 or 8 weeks Interventions incorporated group and 1-1 work Use of evidence-based practice Supported in each group session by a qualified OT unit staff Focus of planning was around trying to involve all service users

10 Student Project 1- Gardening Used principals of cognitive stimulation therapy and POOL Activity Level to grade the activities to the right level. Each began with a song to warm up followed by 2-3 components (including working with herbs, potting flowers, planting seeds). Groups ended with reading a poem. Focus on encouraging group interaction, reminiscence, motor skills, learn/maintain skills, getting outside, improving levels of alertness and attention, improving mood. Group risk assessment completed

11 Week 1 Example of gardening session plan Activity Description Time allocated Poem/song Read/sing as a group 5 mins Play sounds from nature CD/playlist Sensory stimulation herbs Potting mint Take handfuls of fragrant herbs and help participants to smell, feel (and taste) these, passing them around to facilitate communication between group members Propagate mint by dividing larger mint plants into smaller sections and re-potting these. Participants assisted by staff to participate as much as they are able. Steps: - Remove mint from pot - Divide up sections from roots - Add compost to flowerpots - Place mint in flowerpots - Top up with compost - Water and place in sunlight Exploratory level: concentrate on the experience of doing the task rather than the end result. Sensory level: guide to carry out single step activities, and enable to experience the effect of the activity on the senses Reflex level: direct sensory stimulation can increase awareness of self and others, can make reflex responses to direct sensory stimulation 5 mins 20 mins Mint tea Pour hot water over mint cuttings; add cold to ensure tea is a safe temperature. Give drink to participants and encourage smelling and tasting. 10 mins Poem/song Repeat poem/song used in opening read/sing this as a group 5 mins

12 Student Project 2&3- Creativity and Namaste Creativity group primarily focused on art therapy techniques, sensory and reminiscence techniques. Beginning of each group involved gentle exercise activity Involved more of the unit staff Namaste sessions were run in groups and 1-1 Based on the Namaste Care Program designed for end of life care Worked with a range of service users- especially some of the hard to reach

13 Student 1-1 Work Resident selected due to her low engagement with group activities and behaviours that challenge POOL activity level used to complete personal history profile. POOL level revealed that she was at the exploratory level Scrapbooking and life history work was found to be a way to engage. Using themes like clothing styles and images of royal family as well as resident s personal history. Book was effective in aiding communication, use as a therapeutic tool and reduced resident s anxiety be re-focusing her attention. QUALID assessment (Quality of life in later stage dementia) by keyworker. Jane scored 36.5/55 which suggested scope for improvement.

14 Challenges Time frame- short time to get to know residents and plan the groups. Ability to chart changes in residents in any formal way Environmental challenges in the home- space to facilitate activities Having to move multiple patients from different places Ensuring activity was graded in such a way that all participants were engaged Buy-in from unit staff

15 Positive outcomes from student projects 6 session plans per student which can be used again by unit staff Groups were cheap to run Activity worker was able to refine and improve how she works with the residents (including grading activities, being time limited etc) Involving other members of the team helped them to learn more about their patients, interact with the residents in non-task based activities. Grading the activity to residents level of functioning successful 1-1 sessions involved hard to reach patients

16 Legacy CQC rating good in summer 2016 CQC said there was a feeling that the staff were happy Instances of behaviours that challenge have dropped significantly Stable staff team (good management, training, good basic pay for auxiliary staff) Activity worker won staff award Two of the students are using their experience as basis for their MSc dissertations School project to become regular from February 2017 (with research element) This work has prompted wider work with activity workers/care home managers throughout Islington Business case for OT input around activity provision and meaningful engagement?