Capturing and condensing Life Histories and maintaining personhood for people with dementia on an Acute OPMH ward. Steve Catherall (OT) Lynne Morris (OTTI)
Introduction The Unit is an Acute Older persons mental health unit which includes a functional ward and an organic ward both with 14 beds on each. Psychiatry, Medics, Nursing, Health care support, Activity support workers and Occupational therapy.
Personhood Sacred and unique (Kitwood 1997) Relation driven (Barich 1998) Background Life History Preservation of patient QoL (McKeown et al 2010) Assist in meaningful engagement (Subramaniam et 2013) Personal Reminisce Improved mood/well being (Subramaniam & Woods 2012) Occupational therapy Aims to enable individuals to function and participate in meaningful, purposeful, person centred and stimulating activities that support well being and independence.
Challenges to the In-patient unit Staffing Retention Recruiting Bank/Agency use Activity Understanding interests Providing stimulation/distraction Disease progression Behaviour that challenges Amplified symptoms Carer fatigue
Who I Am acts as a tool to assist in overcoming some of these challenges by providing personal centred approaches to interaction and engagement by all staff members on the ward.
Meet Dennis 82 Admitted from Home Risk of falls We know the names of his: Consultant Key Nurse Social worker CPN Gets agitated Alzheimer's Back Pain Diabetic Requires support with ADLs
Now meet Dennis... Enjoys Used to go Likes Fish Favourite Married song for is 40 listening Admitted on cruises to Reads from the paper at 82 Risk and of Chips, Gimme falls years shelter Favourite the Rolling Home with his breakfast wife Likes to be especially place is Crete stones and children active from his local Likes Has to one be Son and takeaway Only drinks water well one We dressed Used know to drive an Enjoys Daughter Gets or Tea...Milk agitated /No hair names parted Austin of his: Healey Only playing eats darts Sugar! to the Consultant right sandwiches at the pub Was Key in Nurse the Would recognise old for lunch Always armed Social wears forces worker Hates Alzheimer's Football photos of home a shirt for CPN and 15 years Always clean shaved trousers Loved his dogs Toured in Quiet Enjoys but talking about Loves rugby Back Pain Requires Doesn t Cyprus like and Showers approachable his daily old cars and used to Wears glasses support and with ties...reminds Singapore in the morning Diabetic play at scrum a hearing aid ADLs him of work Used to work Stays out of half in the bank the limelight
How do we capture Dennis? By using Who I Am 2 sides of A4 Laminated Placed at front of patient notes Added to observations file Converse with family face to face or via telephone
The Benefits For the patient: Increased potential to be engaged in interactions and distractions based upon personal history and preferences. Improved mood, reduced periods of agitation/anxiety/frustration Linked to Pool Activity levels when providing meaningful and skill matched activity. For the staff: Provides a strategy to use during all interactions in a person centred way, including periods when behaviour is challenging. Easy to read and accessible documentation about the person and not the illness for all members of staff. This has provided reasoning behind some of the patients behaviours It has been invaluable in managing behaviour positively at any time
The Benefits For the family/carer: Knowing that their loved one is being considered as a person and supported accordingly. You have captured him...that s him! I m so pleased that someone wants to know Mum For the unit: Improved levels of engagement with patients. Increased opportunity to engage with family/carers. Added value when transferring to placements by including in handover documentation.
Next Steps 1. Who I am is to be used as an Occupational therapy intervention with all new patients with dementia into the unit. 2. Further research into the effectiveness of interactions with patients. 3. Determining outcome measures and linking to PAL assessment. 4. Expansion of project across the trust.
Thank You for listening.
REFERENCES: Gitlin, L. N., Winter, L., Burke, J., Chernett, N., Dennis, M. P., & Hauck, W. W. (2008). Tailored Activities to Manage Neuropsychiatric Behaviors in Persons with Dementia and Reduce Caregiver Burden: A Randomized Pilot Study. The American Journal of Geriatric Psychiatry, 16(3), 229 239. Kitwood, T. (1997). Dementia Reconsidered. Buckingham: Open University Press. McKeown, J., Clarke, A., Ingleton, C., Ryan, T. and Repper, J. (2010). The use of life story work with people with dementia to enhance person-centred care. International Journal of Older People Nursing, 5: 148 158. NICE (2013) Dementia: independence and wellbeing: Quality standard [QS30] Subramaniam, P., Woods, B., Whitaker, C. (2013). Life review and life story books for people with mild to moderate dementia: A randomised control trial. Aging and Mental Health. Subramaniam, P. & Woods, B.(2012). The impact of individual reminiscence therapy for people with dementia: systematic review. Expert Review of Neurotherapeutics, Vol. 12 (5).