Induction Manual. Fitzroy Falls Aged Care Facility. J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version 1.0.

Transcription

1 Induction Manual Fitzroy Falls Aged Care Facility J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 1 of 63

2 Induction Manual Challenging Behaviour Behaviours 04 Incident Debriefing 06 Behaviour Descriptions 07 Communication Effective Communication 08 Verbal and Non Verbal Communication 08 Maintaining Effective Relationships 09 Working with Diversity 11 Cultural Awareness 12 Cross Cultural Communication 14 Conflict Resolution 15 Interpreter Service 16 Dementia Person Centred Approach 18 Activity Planning/Development 19 Communication Strategies 20 Dementia 22 Triggers that can Alter Behaviour 23 Documentation Care Plans 24 Completing Care Plans 24 Policies and Procedures 25 Resident Classification Scale 26 Health Terminology Abbreviations 28 Completing Documentation 29 Progress Notes 30 Commitment to Continuous Improvement 31 Materials Safety Data Sheets 32 Health Issues Food and Fluid Thickeners 33 Incontinence 33 Physical Effects of Ageing 34 Stereotypes of Ageing 37 Sexuality and Ageing 38 Grief and Loss 39 Diabetes 40 Healthy Lifestyle and Ageing 41 Swallowing Difficulties/Dysphagia 42 Case Conferences 44 Page 2 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

3 Human Resources Performance Appraisal 46 Performance Appraisal Interview 47 Harassment 48 Medications Medication Administration 51 Medication Effects 52 Medication Administration Responsibilities 53 Blister Pack System 54 Medication Incidents 55 Mobility Mobility 58 Mobility Aids 59 Personal Care Privacy and Dignity 60 Privacy Guidelines 60 Reporting Resident/Client Changing Care Needs 61 Duty of Care 62 J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 3 of 63

4 Challenging Behaviour Behaviours Many factors can increase the likelihood of a resident/client behaving uncharacteristically. This can lead to anger and aggression towards themselves or others around them. Physical, environmental, medical and interpersonal factors can provoke any of the following behaviours: frustration fear misunderstanding discomfort/pain feelings of rejection suspicion intense anxiety. Care workers need to learn what the factors are for each individual resident/client and deal with them positively to prevent an aggressive incident. The following table shows the various triggers that result in challenging behaviours Physical triggers Physical triggers include: pain hunger deafness altered vision altered perception slower reaction time need for toileting or pad change. Environmental triggers Environmental triggers include: noise too hot/cold discomfort (eg position or chair) overcrowding room lighting phobias (eg claustrophobia/agor aphobia) odours new environment rigid routine Inconsistency of care. Medical triggers Medical triggers include: urinary tract infection constipation painful conditions infections dehydration medications psychiatric symptoms (eg delusions, hallucinations) vitamin B 12 deficiency hypothyroidism. Interpersonal triggers Interpersonal triggers include: perceived attitude of carer cultural prejudice frustration at having to wait lack of understanding of what is to happen lack of understanding of expectations bossy or domineering carer/care worker feeling they are being unfairly treated feeling a loss of control embarrassment build up of feelings of rage or anger Page 4 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

5 Changes in the resident's/client's physical appearance (ie hostile facial expression, sustained eye contact, carrying a potential weapon) are all alerts to the fact that they are feeling aggressive. Indications that the resident/client is feeling aggressive can also include changes in their activity level and posture (ie pacing, restlessness, clenching fists and jaw, appearing agitated). The resident's/client's mood will change and they may show signs of being angry, anxious, distressed, irritable and short tempered. The resident/client may speak in a louder voice than normal and may use abusive language or swear. Options to deal with the challenging behaviour include: Back off/leave You should: respond to your gut feelings respond positively don't panic don't get backed into a corner look for an escape route approach the person at a later time. Negotiate You should: make no sudden movements or try to touch the person (this could be interpreted as an attack) wait until the anger has reduced speak in a calm, easy style state the facts be assertive use "I" messages draw up a clear contract of acceptable behaviour state that has contract has been drawn up. Seek back-up You should: use pager, call bell or call out for help don't show panic, anger or fear Use evasive self defence You should stay out of their 'firing line' choose a safe place to stand allow for an escape route move to avoid being hit. Divert attention You should: J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 5 of 63

6 use teamwork if possible other (ie another person can step in with a reassuring message) change subject to a favourite topic validate feelings and re-direct to another subject/task Incident Debriefing Any sudden event which occurs at Fitzroy Falls Aged Care Facility has the potential to cause distress to residents, staff or visitors. This distress can result in difficulties in coping, adapting and recovering from the physical and mental upset that the incident may have caused. An incident debriefing meeting assists people, particularly staff, to overcome the effects of the incident by: talking about what happened expressing how they feel as a result of the incident identifying any individual stress reactions (ie physical, emotional, thinking, behavioural) identifying some ways of dealing with stress reactions. Incident debriefing meetings are designed to reduce the possibility of any physical, emotional, thinking or behavioural reactions. The meetings provide an important opportunity for early identification of staff who have had an adverse reaction to an incident and who may require further professional assistance. The meetings are intended to be a normal operational procedure for managing challenging/difficult behaviour incidents and identifying suitable strategies for responding to these incidents. It is important to note that incident debriefing meetings can be used for any sudden distressing event at Fitzroy Falls Aged Care Facility. An incident debriefing meeting is conducted in such a way that, the people attending the meeting, share their understanding of the following: the sequence of events leading up to, during and after the incident the causes of the incident the effects of the incident on all the people involved, including the resident other work related issues that had an impact on the incident previous incidents that occurred the way each individual has reacted to the incident including the resident the external professional assistance that can be accessed, if required. Incident debriefing meetings should always use a systematic approach to gain a thorough idea of the event and the reactions of everyone involved. Page 6 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

7 Behaviour Descriptions The following is a list of behaviour that you may observe while monitoring your client: Abusive: verbal and physical abuse towards staff and other clients Agitation: general distress, restless, unable to settle Anger: perceived threat to others, facial expression Anxiety: a state of uneasiness and uncertainty Bewilderment: puzzled, perplexed, overwhelmed by a situation Combative: aggressive behaviour in which physical contact is made (eg hitting, biting, scratching, hair pulling, kicking, pinching) Confused: poor memory and recall unable to remember events and tasks asked of them Danger to self: history of falls, reduced insight into own safety needs, safety comprised by confusion, smoker Disorientation: confused to time, place, person and events Dependency on family: seeking out family Depression: feeling of sadness, hopelessness, bouts of crying, this may be a diagnosed history Destructive: damaging objects Frustration: inability to cope and express feelings Hallucinations: often visual, auditory very real to the client experiencing them Noisy/verbally disruptive: causing disruption to others (eg yelling, calling out, screaming, shouting, singing loudly, chanting, banging, dragging furniture, raising volume of TV or radio) Pacing: walking faster than normal, usually within a confined space. Perseveration: repeating same behaviour, action or speech over and over, may or may not be disruptive Tearful: shedding tears, weepy, emotional J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 7 of 63

8 Communication Effective Communication Communication is a two way process involving both listening and talking. Communication begins with the first face to face contact between residents or clients and carers. Observation of body language contributes to the total message. The aim of effective communication is to correctly interpret the whole message sent by other people both by listening to the words used (the verbal) and gaining an overall impression from their body language (the nonverbal). Active listening is the key to effective communication. Actively use the ears, the eyes and intuition to understand what the speakers intend, not just what the speakers say. Listen first and then respond. Check to be sure that you have received the right message, by providing feedback. When you are speaking, the same principles apply. Be aware of the total impression you are creating by choosing your words carefully and using appropriate body language. Also be aware of barriers to effective communication. These may be physical or emotional. Possible physical barriers: noise and interruptions sensory loss, for example hearing and vision, or other disabilities such as difficulty with comprehension furniture (a table or desk can easily be perceived as a barrier) gender age height tiredness pain. Possible emotional barriers anger, fear, frustration, anxiety over-excited state lack of confidence, low self-esteem comparison to others culture. Verbal and Non Verbal Communication In your job as a care worker, you will be communicating with a variety of people every day. A lot of this communication will occur face-to-face. For example, you may chat to the residents or clients in your care, or talk to other staff members. Effective face-to-face communication requires good verbal and non-verbal communication skills. Page 8 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

9 So, what is verbal and non-verbal communication? 'Verbal' means 'spoken'. So, verbal communication is the messages you send with words. It's what you actually say. Non-verbal communication is the messages you send with your body. Some people call it your body language. For example: facial expressions - smiling, frowning, raising eyebrows, eye contact gestures - waving your hand, pointing your finger, crossing your arms posture - the way you stand or sit. Non-verbal communication also includes the tone and pitch of your voice. So, verbal communication is the words. But non-verbal communication is how you say the words. Non-verbal communication is an important part of the communication process. Up to two-thirds of the meaning of a message can come from non-verbal communication. So, it's very important that you are aware of it. A facial expression or simple hand gesture can show: how we feel what we like or dislike if we care or not. Sometimes a person's non-verbal communication may not match their verbal communication. For example, a person may be saying nice things, but have crossed arms and a frown on their face. When this happens, the message can be very confusing. Is the person being friendly, or are they a little bit angry? Effective communication occurs when your verbal and non-verbal communication skills send the same message. Maintaining Effective Relationships Communication is a process of passing information from one person to another, or others, to gain understanding. Principles for building and maintaining relationships Research has shown that there are three fundamental skills to making effective relationships. These can best be described under three headings- Respect, Empathy, and Genuineness. Respect Empathy Genuineness Try and see it from their point of view Live in such a way as to make others feel important Be yourself and share yourself appropriately J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 9 of 63

10 Respect Behaviour which conveys to others that they are worthwhile, unique and valuable. It involves a commitment to live in such a way as to make other people feel important. Respect is conveyed by - Giving positive attention Active Listening Giving your time Remembering the person's name Introducing yourself-greeting people Basic courtesies-offering a chair, saying 'please' and 'thank you' Asking questions Checking out assumptions you have made about the other person Not interrupting or talking over the other person Being thoughtful e.g.: remembering concerns a person my have and inquiring as to how that is going Showing concern Remembering something they have told you before and reminding them of it Asking for assistance or support Being complimentary Giving positive and correct feedback Listening from where a person is speaking Asking the other person for their opinion or idea Offering rewards Expressing appreciation Apologising when wrong Involving others in decisions Showing trust Delegating responsibility Being assertive rather than aggressive Talking in terms of the other persons interests Empathy Behaviour which shows that you understand the other persons world as they are experiencing it. In other words, "You see it their way", or "put yourself in the other person's shoes". Page 10 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

11 Empathy is conveyed by - Reflecting back to the other person feelings you are picking up - "you must have felt very angry" "you sound very happy". Sharing related experiences of your own Smiling when the other person smiles, frowning when the other frowns, etcbehavioural mirroring Trying to understand why a person 'did what they did', or 'said what they said' Asking questions to gather information-making enquiries, in a genuine manner, to understand more where the person is coming from Recalling what it is like to be in that situation yourself Genuineness Behaviour which conveys to others that you are real, trustworthy, not hiding behind roles or facades, spontaneous and open about yourself in an appropriate manner. 'Coming across as being real - not phoney.' It involves being yourself and sharing yourself appropriately. Working with Diversity Your skills in developing effective interpersonal relationships in the workplace needs to incorporate methods that show you have considered the individual and cultural differences of the people you will have daily interactions with. These people will include the residents/clients, their relatives, staff, unpaid workers, your supervisors and managers. While working as a care worker you are sure to come across people from the following diverse backgrounds: People from non-english speaking backgrounds (NESB). Migration to all states and territories of Australia has been predominantly from Western European Countries such as Italy, Greece, Portugal, Yugoslavia, Holland and Germany. Towards the last quarter of the twentieth century migrants have come from India, south-east Asia, Africa and form South American countries. This has brought a whole new range of languages and cultures to our predominantly English speaking communities. People, for whom English is a second language, will be your residents and team members. It is important that workers at Fitzroy Falls Aged Care Facility become culturally aware and receive some education concerning the cultural diversity of the residents and staff. Aboriginal and Torres Strait Islanders. The majority of Aboriginal people today have been born into a westernised culture without the in depth understanding of how it works and why it works the way it does. Aboriginal people for a long time were not recognised and have been excluded from decision making in Australian society. All Aboriginals deserve to have their culture and traditions understood and respected just as much as the migrant dominant cultures in Australia. J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 11 of 63

12 Cultural Awareness People with disabilities. These may be physical, intellectual or psychiatric disabilities. These disabilities may effect how a person functions in society. Whatever the disability a person has, the person should be recognised as a complete person and not as someone in a wheelchair or someone with impaired mental function. Varying religious/spiritual beliefs and practices. It is not necessary for you to agree with everyone's beliefs and practices. It is however, essential that you accept varying beliefs and practices and the individual's right to hold differing beliefs and practices. You need to do this if you want to establish and develop an effective working and caring relationships with someone. People who have varying skill levels. Varying skill levels may be related to varying levels of literacy and numeracy. Low levels of literacy and numeracy may result from a person being from a non English speaking background or may result from the person not completing more than the basic requirements of formal schooling. On the other hand some residents may have very high levels of literacy and numeracy but are in Fitzroy Falls Aged Care Facility because of other problems in their lives. Important points to keep in mind include: All staff, relatives and residents/clients are working to achieve the same goal, the empowerment and maintenance of health of residents. Any workplace is made up of individuals with diverse backgrounds, these individuals will see right and wrong from their own perspective. The potential for conflict must be recognised and agreeable solutions to issues be found so that the workplace does not lose its cohesiveness Successful communication involves both verbal and non-verbal interaction. That is, to get our message across to others and to understand them, we need to speak and gesture effectively. As many of our care recipients are born in another country or speak more than one language, we need to know information about them to ensure their care needs are met. As people age, it is common for language use to go back to their first learnt language. It is very important that we recognise this is happening and follow clear steps to support the person. The following are some tips to help you communicate effectively across cultures; Speak slowly and clearly The care recipient or client needs time to understand your words. Pronounce your words clearly? not loudly. We all have an accent? check to see if your resident or client understands yours. Take care not to talk down to the person. Clarify by writing down words. Don't use slang words or jargon (like medical terms and initials). Explain your role to the care recipient It is important to explain your role in words that is understood by your resident or client. Listen and observe Page 12 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

13 Words are only one part of communication. The majority of our communication involves many other cues. The way someone is dressed, their stance, the tone of voice, the pitch, body gestures, the use of silence. Be aware of your body language and learn about the body language of your care recipient's culture. In some cultures it is respectful to maintain eye contact yet in another it is respectful NOT to have eye contact. Lack of understanding and awareness can lead to misinterpretation and lack of respect. Take time to listen Extra time taken to listen can enable you to clarify what is needed. This will save a lot of time for all staff later and prevent the care recipient becoming frustrated or withdrawn. Take care not to approach the resident or client when you know you really haven't got the time to talk it through thoroughly. Rather, make sure you have the time to discuss any issue with patience and respect. People express feelings in many different ways Emotions and feelings are open to a lot of misunderstanding when translating from one language to another. Remain respectful of people's different ways. One person may cry and sob to express their grief and another may not show any signs of emotion at all. Care workers need to remain non-judgemental. Everyone has their right to express their feelings their own way. What may be proper behaviour for one group of people may be disrespectful for another. Rules of communication All cultures have unspoken rules of communication. These rules include things like - what is the right thing to talk about and in what setting. What tone of voice we use, the speed we speak and the emphasis we place on words, are all factors to be considered when we speak with people of another culture. Differences in word meanings Some words have different meanings in different cultures. "Yes" does not always mean the person understands, it may be their custom to say "yes" to be polite. It is better to have the person let you know that they "understand" what you have said rather than accept a simple "yes" for an answer. Beliefs and attitudes must be respected Care recipients have developed certain beliefs about illness and ageing over their lifetime. We need to ask for more information about what they believe rather than discount them. It is more respectful to ask them to tell you more about what they believe and how they would be cared for in their former country. Let the resident or client know you are interested to know more about them. Do not assume that a care recipient's level of English will always be correct As a care recipient translates from one language to another, the structure of their sentences can become confused. This can occur if a person is distressed or excited. Co-workers Another group of people we need to consider in our workplace are our working partners and colleagues. Many of our co-workers also have a diverse cultural background. To promote a better workplace, take time to find out about your co-workers? without being J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 13 of 63

14 too nosy! The more we know about people the easier it is to understand them and work with them. Acknowledgement: Cultural Assessment Tool Understanding Cultural Diversity in Mental Health 2002 Commonwealth Department of Health and Ageing and Multicultural Mental Health Australia Cross Cultural Communication Many people are born and live in a variety of countries during the course of their life. To give the best care possible we need to gather detailed information about our resident or client. We need to know about their language skills and their culture. One word written on a document, such as Vietnamese, does not give very true and accurate information about how that person lives, speaks, thinks and what they believe. The following may give you some ideas on things we need to know about our resident or client: Family may be extremely important. It may be a specific requirement that family are involved with all decisions about treatment and care. The structure of the family may be very different from what you are familiar with. The care recipient may suffer extra stresses related to a change in their role and financial dependency because of their cultural beliefs. Different cultures have different values. Some resident/clients may be proud. Independence and self-control are important to them. Another culture may value co-operation. Yet another may be brave. We need to be careful not to be judgemental about a resident/client's outward personality. It takes a lifetime to get to truly know a person. The care recipient may use other types of healing. They may use folk medicine methods with or without Western treatments. Other cultures may look more at the whole person for healing. Their thoughts, feelings, spirituality, family, environment, diet and physical self are a key to their health. There may be issues related to the resident or client being male or female. Some cultures have rules about what gender may treat and care for them. The care recipient may have lived through incredible suffering for example if they have been a refugee or prisoner of war. Some cultures feel shame to express their feelings about a trauma or loss. Some cultures use terms like "hot", "cold", "wind, "nerves" to describe symptoms. To assist you to gather useful information about your resident or client consider the following points: Where was the person born and how long have they been in Australia? What is the person's first language and other languages spoken? What are their reading and writing skills like in each of these languages? What is their style of communication non-verbally? Page 14 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

15 What is the person's religion and how important is this to them in their daily life? Which ethnic group does the person see themselves linked closest to? Who are the resident's or client's main support persons? A small conversation with your resident/client can find out a lot of information that will be useful for all care workers and most of all for benefit of that person. Another group of people we need to consider in our workplace are our working partners and colleagues. Many of our co-workers also have a diverse cultural background. To promote a better workplace, take time to find out about your co-workers? without being too nosy! The more we know about people the easier it is to understand them and work with them. Acknowledgement: Cultural Assessment Tool Understanding Cultural Diversity in Mental Health 2002 West Commonwealth Department of Health and Ageing and Multicultural Mental Health Australia Conflict Resolution The word conflict means different things to different people. What may be a lively discussion for one person, may be a major conflict for another. Conflict levels can be looked at in a similar way to stress levels. A certain amount is good for us to function effectively and to keep us open to new ideas and ways of doing things. Often, as a result of conflict, an improvement in relationships can take place. Positive effects of conflict can include: A creative approach to problem solving. This can shake you out of lethargy. An increase in group and organisational unity. This can help team members identify and make clear their points of view. Conflict can stimulate team members to find different methods of approaching situations by exposing them to new ideas. Negative effects of conflict can include: Violence, particularly where there is inadequate ability to put feelings and needs into words. This can result in relationship breakdown. Breakdown in collaboration, because the purpose or agreement about how to work together is no longer shared. Opposing views from which people can't back down. Changes in the work or home environment which produce and reflect anger and anxiety. Emotional devastation, because feelings are ignored, put down or misdirected. J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 15 of 63

16 Interpreter Service There are five main ways of dealing with conflict. These are: accommodate (ie to bring harmony to the situation by agreeing with the other person) avoid compromise collaborate compete. In situations of conflict you will be looking for options which satisfy both sides. When you are both upset it is difficult to relate to each other. To think, speak and listen clearly is a challenge and if you are not used to being assertive this will create added pressure. It is important not to blame the other person for the situation and aggressively argue the point, equality it is important that one person doesn't back off and feel like a martyr. These types of behaviour can make things worse. To be assertive is to deal with your own feelings and avoid blaming others. It can be wise to: Take time out. To do this you can count to ten drop your shoulders, postpone the situation or go for a walk. Check your thoughts, if they are unrealistic or inappropriate change them. You are the rider as well, not just the horse. Reveal your feelings and acknowledge them. This eases the tension and gives you space to think. You then have a better opportunity to deal with the situation assertively. If it seems too difficult to deal with feelings, it may be of benefit to seek a third person to act as a mediator. There are a large number of interpreting and translation services, provided by the Government, private organisations and community networks. Some interpreter services also provide information on cultural factors and appropriate ways to communicate with people of culturally and linguistically diverse backgrounds. Services may include: skilled interpreters on site professional interpreter service. Offer the assistance of translating and interpreting to care recipients and/or their representatives, as appropriate. The Translating and Interpreting Service (TIS) of the Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) is a large government interpreter service. TIS provides a national 24 hour a day, seven days a week telephone Page 16 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

17 interpreting service on a national telephone number TIS services are provided in more than 100 languages and dialects. Each interpreter and translator is contractually obliged to conform to the Australian Institute of Interpreters and Translators professional Code of Ethics. Providing care recipients from non-english speaking backgrounds with interpreters ensures their care and right of equal access to the full range of public health care services. Relatives and friends of patients should not be used as interpreters for medico-legal reasons. In some cultures, gender issues are particularly relevant and you may need an interpreter who is of the same gender as your care recipient. When using the services of an interpreter: Brief the interpreter, if possible, about relevant words and concepts prior to the interview. If your care recipient does not understand what you are saying, it is your responsibility (not the interpreter's) to explain it more simply. Speak directly to the care recipient, eg 'How can I help you?'. Do not say (to the interpreter): 'Ask the client or resident how I can help them?'. Sometimes it may take more or fewer words than those you have spoken to convey the message in another language. Do not let the interpreter's presence change your role in the interview. You need to conduct the interview. When working with interpreters by phone: Describe the telephone equipment you are using (eg conference or single phone) and where you are (eg residential home or private residence). Make allowances for possible clarification by the interpreter because he/she has no visual cues (eg body language) to assist in interpreting. Ensure that all required information is collected from and provided to the care recipient while the interpreter is on the line there will be no chance to speak directly to your care recipient after the interpreter hangs up. J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 17 of 63

18 Dementia Person Centred Approach A person, whose mental abilities are failing, due to dementia, needs to be treated as a person in their own right. Caring for these residents/clients requires you and other staff to provide a positive social environment that focuses on the person and not on their disease. This type of environment can be provided by using a person centred approach to dementia care. The person centred approach to dementia care is recognised as being a 'best practice' standard. Using this type of approach requires you to take on values and ways of thinking that will promote the residents/clients physical, emotional and intellectual well being. With this type of approach it is also essential to take into account each of the resident's/client's unique desires, tastes, abilities, difficulties and fears. Remember that these things may change as time passes. When using the person centred approach you need to know as much as possible about the person living with dementia. It is important that you have some information about the following: knowledge of their husband/wife, brothers, sisters, children, grandchildren and other family members family background significant people or situations in their lives (past or present) type of work they did likes and dislikes proud moments in their lives values religious beliefs or connection with religious groups past and present interests (eg leisure time activities) involvement in politics major illnesses and hospitalisation recent health problems home situation before you got to know them how they have coped with difficulties in the past how the resident's/client's family is coping with the situation now. To be able to provide a person centred approach to dementia care, you should adapt, as far as possible, your work routine to that of the resident/client so that you can meet their individual needs. To be an effective care worker you will also need to accept and respect each individual resident's/client's reality, rather than putting forward your own views. Page 18 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

19 Activity Planning/Development People with memory failure such as dementia sufferers often can't do many of the things they were able to do before. In planning and developing an activity for a dementia sufferer it is important to recognise and use the abilities that the person does have. In planning an activity for a group it is important to recognise each person's abilities, special interests and physical capabilities. By recognising the abilities these residents/clients do have, the care worker can fill in the bits of the activity the resident/client can't do. When designing an activity it is necessary to consider the following: Will the activity give the resident/client a sense of achievement? Will the activity improve the resident's/client's self-esteem (ie improve their feelings about themselves)? Does the activity provide natural contact with other people? Is it a type of social contact that the resident/client is used to (ie listening to music or playing bingo)? Will the activity increase the resident's/client's trust and ability to cooperate? Does the resident/client see the activity as meaningful? Will the activity promote the resident's/client's sense of physical wellbeing? The table below may be helpful when you are planning an activity. The tablet details the mental abilities of dementia sufferers. The first column gives suggestions for an activity that are related to the abilities of a dementia sufferer. The second column lists the particular memory abilities that are failing in a resident/client living with dementia. J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 19 of 63

20 Residents/clients with dementia can... (suggested activity is listed in brackets) Remember the past (Activity about reminiscing) Feel emotions (Activity to help the residents/clients express their emotions) React to a 'threat' and react to their feelings: (Activity to meet resident's/client's needs in a non threatening environment) Feel secure with familiar faces familiar people familiar routines. (Activity to meet resident's/client's needs using skills they are familiar with) Know what they don't want (Activity to help residents/clients express their feelings) Indicate their approval/disapproval of your choice for them (Activity to be meaningful for resident's/clients) Do familiar and simple things (Activity that doesn't have too many unfamiliar steps) Follow your lead or demonstration (Activity to contain specific simple steps that allows the client to follow your lead) Enjoy sociable company (Activity to give the resident/client the opportunity to socialise with residents/clients who have similar interests/backgrounds/cultures) Do things one step at a time (Activity that is broken down into a series of steps that are easy to follow) People with dementia find it difficult to... Remember the present, particularly details Express their emotions verbally or rationally Make sense of the 'threat' or their feelings Adapt to: new people new places new routines Know what they want, and tell people what they want Choose or make a decision for themselves Do complicated tasks and learn new ways of doing things Follow instructions Interpret crowded or busy situations and appreciate satire Do several things in a hurry Communication Strategies Communicating with a resident/client living with dementia needs you to use good observation and listening skills. When communicating, the most important thing is for you to treat the resident/client as an individual and for you to look at the world from their perspective. The resident's/client's critical physical environment is a one metre circle, with them at the centre. The qualities of being able to negotiate and collaborate with the resident/client in planning their care will help you and others to enter this space. Using these skills will help to improve the resident's/client's well being and care. Observing the resident's/client's reactions to their environment and using active listening skills will also allow a closer relationship to develop. Observation skills Observing the resident/client in their environment and in their interactions with their family, friends and visitors needs more than just looking. You need to observe their: facial expression eye contact and gaze Page 20 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

21 gestures and movement posture and appearance smell inappropriate use of objects (eg using a pencil to cut paper) sound and tone of voice use of touch signs of physical comfort or discomfort. Listening skills Listening is an active process that requires your participation. To fully understand the meaning of what is being communicated you usually have to ask questions and respond. Then in the give and take of the communication that follows you get a fuller appreciation of what is being said. By using this process you have gone beyond just absorbing the words and now you should then be able to work in partnership with the person in the communication process. Listening is an essential skill for making and keeping relationships. Listening is a commitment to understanding how other people feel and how they see their world. Listening is also a compliment because it says "I care about what's happening to you". Real listening is based on the intention to do one of four things. These are: understand someone enjoy someone learn something give help. Benefits of real listening to a resident/client can include: the resident/client appreciates being heard stops escalating anger and cools down a crisis or reduces tension stops misinterpretations/errors helps you to remember what was said. Effective strategies in talking and listening to a resident/client living with dementia include: Facing the resident/client and not invading their personal space without warning. Having an open posture (ie arms not folded and legs not crossed). Leaning towards the resident/client. Keeping good eye contact (ie looking at the resident/client without staring). Being relaxed. Adopting a running commentary (ie you can say what has happened and what is about to happen). Ask who, what, where, when and how questions. Never ask why? Why questions can make a resident/client anxious, angry or agitated. Avoid should, must, ought to, don't and no. They can make the resident/client feel they are being spoken to as a child and can make them angry or aggressive. J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 21 of 63

22 Never ask "Do you remember?" This can cause distress. Begin your sentences with "May I offer you...", "I would like to invite you...", "Today, is it going to be... or...?". When you present a choice, always accept the decision and do not argue with the resident/client. Dementia Dementia refers to a group of illnesses that are characterised by changes in the brain that lead to a decline in the person's mental functioning. Dementia brings about changes of personality and can alter relationships within a family. This results in changes in the quality of life of the dementia sufferer and leads to social isolation and loneliness. Dementia is not a part of normal ageing. People with dementia undergo psychological changes and progress through a series of stages that include memory loss, disorientation, verbal communication problems and personality changes. Dementia is a most distressing and serious illness. The causes of dementia are unknown, but can be affected by issues such as poor diet, side-effects of medication, vitamin and hormone deficiencies and depression. The majority of cases, however, fall in to the category of incurable illness. This includes: Alzheimer's Disease vascular dementia (where the brain is damaged from a series of small strokes) mixed dementia which is a combination of Alzheimer's Disease and vascular dementia Parkinson's Disease Huntington's Disease alcohol related dementia (Korsakoff's syndrome). The main symptoms of dementia are: Poor short term memory. The sufferer finds it hard to remember recent events, but can remember incidents from their past, even as far back as their childhood, with complete clarity. Loss of contact with reality. The sufferer begins to lose their hold on reality. They may not know who they are (disorientation in person), who others are, where they are (disorientation in place) or what time of day it is (disorientation in time). This causes them to feel frightened and insecure. If they don't know what time of day it is, the sufferer may get up in the middle of the night believing it is day time. It can increase the sufferers distress if, in the early stages they are aware that something is not quite right but they can't do anything to change it. As time goes by they lose that insight. Changes in behaviour. This is perhaps the most concerning symptom. The sufferer can become quite agitated and restless. Their surroundings, whether at home or in residential care, becomes a place of uncertainty and bewilderment. They no longer feel secure and safe. It becomes more difficult to cope with the varied demands of their life and they reach Page 22 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

23 a point that they are unable to handle situations at all. They may become more emotional or weepy which may be quite uncharacteristic of their previous behaviour. This is known as a catastrophe reaction where a simple problem such as putting on an article of clothing becomes too much of a challenge. Communication problems. Dementia affects speech as well as behaviour. Sufferers with severe dementia are often unable to communicate, as they would do normally. Their speech becomes incoherent, they may babble like a baby, and the sounds and groups of words they use are without any apparent meaning. In the early stages they may forget common words and use other words to describe what they are talking about. Such as, knowing they are going for a shower and using the word "umbrella..going in the rain " but use the actions of washing their face and body. The association between water falling in the shower and rain is not distinguished. Their actions are not the same as they would use for putting up an umbrella. The name of common objects may be forgotten but they will try to get the message across using other descriptions. Being aware of failing communication in the early stages of dementia can make the sufferer extremely frustrated. Triggers that can Alter Behaviour There are a number of different types of triggers that can alter behaviour in a person living with dementia. These triggers can be divided into the three categories listed in the table below. Client triggers (these triggers can be identified from the care plan and progress notes) Client triggers include: Cultural background/values/language Social history Impact of changes to work roles (eg retired from work) Sleeping problems Feelings such as frustration, sadness, anger, grief Effects of dementia Triggers that can alter behaviour Communication triggers (these triggers can be identified in the care plan and progress notes) Communication triggers include: Poor verbal communication (ie speaking too fast, mumbling) Hostile body language Inappropriate nonverbal cues Changes to routine Unfamiliar carers/care workers Preferred language not used Feelings of client not considered Location triggers (these triggers can be identified by observing the client in their own environment) Location triggers include: Unfamiliar surroundings Too much noise (eg radio, building sounds) Visual distractions (eg patterned carpet) Decor and fittings confusing (eg can't recognise what room they are in) Too much clutter Visual prompts that cue unwanted behaviour (eg items usually associated with outside activities in immediate inside space) J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 23 of 63

24 Documentation Care Plans Every resident or client in your care will have a number of documents and records about their care requirements. The most important document you will work with is the 'care plan'. A care plan gives all staff, including yourself, detailed information about the person in your care and their specific care needs. This ensures everybody works together in a consistent way, to provide the best quality care. Care plans are legal documents. You must consult the care plan before completing any task with a resident or client. This ensures the resident or client, your team members and yourself remain safe. So, what information will you find in a care plan? A care plan will include information about the following: Care needs. These are problems or issues that have been determined through formal assessment. For example, a hearing impairment. Goals and outcomes. In other words, what level of support is needed. For example, the goal for a person who is hearing impaired may be to maintain effective two-way communication. Interventions and actions. These are directions on what you need to do to help the resident or client achieve or maintain goals and outcomes. For example, you may be required to clean and check the batteries in a resident's or client's hearing aid every day. The information in a care plan comes from detailed assessments that are carried out from the time of entering care. These assessments are completed by nurses, physiotherapists, occupational therapists, social workers and doctors. Care workers are also involved. A care plan is a 'dynamic' document. This means it is reviewed and updated regularly, to meet changing needs. All staff, including yourself, will be responsible for maintaining the care plans for people in your care. Therefore, it is part of your role to report changes to your supervisor and seek guidance on how to update the care plans in your workplace. Different workplaces will have different ways of presenting information in a care plan. You need to know how to access and read the care plans in your workplace. They will help you plan your daily work with each resident or client. Completing Care Plans To ensure the best possible care is provided it is important to complete the care plan thoroughly. Page 24 of 63 Fitzroy Falls Aged Care Facility - Induction Manual Version J.N. Bailey 2009

25 Firstly, ensure the resident's/client's details label is adhered to at the top of each page of the care plan. As this is a legal document every page of the care plan must identify the care recipient. Care alerts must be written clearly in red. This section must include any known allergies or information that could seriously affect the resident's/client's health or well-being. The care needs prompt is where you write a particular care issue that requires attention. The goal (or expected outcome) states what we want to achieve. For example: Care needs - Hearing and visual impairment Goal - To maintain effective two-way communication Each section of the care plan has a box of prompts that you may select as needed. To alert other carers to do this task you highlight the instruction with a highlighter. On a computer the highlighter function is on the formatting toolbar. If the instruction you require is not already listed, write the instruction or information into the space for "Other". There is room at the end of the document for additional comments if needed. The care plan must be evaluated three monthly or before if there is a change in the care recipient's status. The document must be signed and dated when created and each time it is reviewed or changed. Policies and Procedures Policies and procedures are important documents in any workplace. Their purpose is to record, in detail, how a workplace is to operate. Policies and procedures can be categorised into three (3) main areas: 1. Policies and procedures that outline how your workplace will comply with Federal and State/Territory laws, such as Occupational Health and Safety. 2. Policies and procedures that outline the standards your workplace expects. For example, customer service standards. 3. Policies and procedures that outline the day-to-day functioning of the workplace. For example, what staff need to do when applying for leave. So, what are policies and procedures? A policy is a statement of intent. In other words, it's a written aim of the workplace. For example: J.N. Bailey 2009 Fitzroy Falls Aged Care Facility Induction Manual Version Page 25 of 63