A Moment in Time: Reflections on the Development and Evaluation of a Dementia Support Service in an Acute Inpatient Setting presented by: Liz Yaxley (Dementia Services Manager at Norfolk and Norwich University Hospital) Dr Sarah Housden (Senior Lecturer, School of Health Sciences, UEA)
Presentation Outline The role of Dementia Support Workers at NNUH What is Dementia Care Mapping (DCM )? Reflections on DCM (Dementia Care Mapping) as an approach to evaluation Further tools for evaluation carer and staff questionnaires Current project developments and advances in evaluation.
The Original Role of Dementia Support Workers at NNUH Complete This is Me booklets and share with ward teams Engage patients in 1:1 meaningful activities and emotional support to help wellbeing Offer support and advice to carers Signpost patients and carers to services for ongoing advice and support Support through procedures as required e.g. phlebotomy, scanning
What is Dementia Care Mapping (DCM ) An established observational method for evaluating the quality of person centred care delivery in formal care settings. DCM is designed to empower staff teams to engage in evidencebased critical reflection in order to improve the quality of care. It was chosen due to being highly regarded as a tool/process for evaluating the impact of person-centred care on individuals living with dementia in receipt of care services. Individual and group summaries for six patients living with dementia were used for the purposes of briefing and feedback of the DSW team.
Findings of the DCM evaluation i. DSWs are involved in role modelling best practice on the ward. ii. The positive effects on well-being resulting from DSW s interactions with patients were not limited to individuals, as meaningful activities carried out with one patient led to engagement of others. iii. Well-being was sustained beyond the DSW s visit. iv. Vulnerable people living with dementia were supported and periods of ill-being were avoided. v. DSWs helped to create a relaxed and socially inclusive atmosphere. vi. There were a number of occasions where well-being increased from +1 (neutral) to +3/+5 (considerable signs of well-being).
Reflections on DCM as an evaluation tool Strengths 1. The immediate effect of specific interactions can be analysed and reported with reasonable objectivity and reliability. 2. The DCM process gives opportunity for reflection and service improvement. 3. Individual care staff are not identified, thus avoiding a sense of blame or scapegoating for poor practice. Limitations 1. The DCM report only captures a moment in time without exploring cause and effect in detail. 2. This moment in time offers no explanation of the broader context in which care interactions are taking place. 3. Nor does it tend to provide insight into why the things which enhance quality of care, do so.
Further tools for evaluation Carer Questionnaires (N=19) Helpfulness of DSWs (9.74) Positive impact on patient s quality of life (9.39) Usefulness of information provided by DSWs (9) DSW s awareness of patient needs (9.39) Likelihood of recommending DSW team (9.83) Staff Questionnaires (N=23) Improving quality of life Preventing and reducing distressed behaviour Supporting patients in distress during clinical procedures Completing This is Me booklets Supporting carers through admission Providing information and support to carers Saving staff time Staff feeling supported Providing ideas to help care Assisting 1:1 carers Providing information about individuals to assist decisionmaking about discharge Providing evidence to help care-planning (All the above scored an average of >80% agreement)
Further Reflections on Evaluations While the additional evaluation materials obtained from staff and carer questionnaires, supported the view that the DSW team were doing a good job which was appreciated by staff and visitors alike, there was still no firm evidence of: Cost effectiveness i.e. we need to know whether the cost of employing DSWs can be covered by savings from, for example, reduced use of 1:1 support Statistically demonstrable shortened stays for people living with dementia Lasting impact on quality of life.
The Dementia Support Team NNUH: The Vision Needs assessment for all patients in relation to dementia Support during transitions of care as required care as soon as possible from time of admission Interventions to de-escalate and prevent patients in Completion of This is Me booklets as early as possible distress and actively shared with ward teams Timely referral to specialist services e.g. mental health Engagement of patients in 1:1 meaningful activities and liaison emotional support to promote wellbeing Advice, support and resources for staff offering 1:1 care Support and advice offered to all carers Engagement in and contribution to evidence for Production of individualised care plans for patients with CHC/discharge assessments complex needs and those under DoLS, engaging with staff family carers where possible Production of person-centred care advice for patients being discharged to new care environments to assist Active engagement of the whole team and family carers transition in carrying out care plans e.g. prevention and management of distress, communicating effectively Signposting patients and carers to services for ongoing advice and support Dementia care mapping for complex cases to assist care planning Practice development opportunities Support through procedures as required e.g. Aspire to a trustwide, seamless pathway from admission phlebotomy, scanning to discharge
Advances in Evaluation Impact on patients Dementia Care Mapping. Staff and carer questionnaires Impact on staff - Multi-disciplinary/agency staff questionnaires Impact on Carers Carers questionnaire Use of 1:1 carers Data from ward manager Use of security Data from ward manager Length of stay Data request Number of MHA assessments requested Data from ward manager MHL involvement Data collection. Staff questionnaire Incidents reported for patients with dementia - DATIX e.g. falls, harm to self/other patients/staff - data from ward manager/datix team Discharge destination types data collection DoLS applications Number. Staff survey Dementia Support team activity data
Conclusion: Evaluation of the DSW service at NNUH is an evolving process that has moved from capturing A Moment in Time to a much broader and deeper process of data collection and analysis.
Thank you for listening! Any questions? S.Housden@uea.ac.uk ELIZABETH.YAXLEY@nnuh.nhs.uk