Good WorkA dementia learning and

development framework for Wales

Nick Andrews, Research & Practice Development Officer, School for Social Care Research, Swansea University

Background – the Developing Evidence-Enriched Practice (DEEP) project

• An appreciative action research project;

• in health and social care services for older people;

• across six sites – five in Wales and one in Scotland;

• exploring research and other contextual evidence and using it in service and workforce development;

• To promote well-being and address the Seven Challenges of the JRF programme A Better Life.

The five elements of the Developing Evidence-Enriched Practice (DEEP)

approachValue and empower

peopleValue and use

a range of evidence

Present evidence well

Sort things that get in

the way

Talk and think together well

The importance of narrative in getting people to engage with research

The importance of talking together about research and other evidence

• Does not come as naturally as we would hope

• Use the elephant metaphor of reality

• Use dialogue techniques, e.g. Exploratory Talk and Community of Enquiry

Vision for the Dementia L&D Framework

People with dementia, carers and staff who support them will all experience fulfilled lives within supportive

communities

Who is this framework for?

People with dementia

Carers

The social care & health

workforce

‘What do we mean by ‘good work’?

The three Es of ‘good work’:

• Ethics – values based and getting to the heart of ‘what matters’ (compassionate practice)

• Excellence – technically competent and ‘fit for purpose’ (competent practice)

• Engagement - personally engaging and contextualised (wise practice)

1. Ethics – to support compassionate practice

• Everyone matters

• Everyone has something to contribute

• Everyone is different

• Everything matters – including the little things

• We need to use positive and strengths based words

Everyone matters and have a right to experience well-being

Within enriched environments of learning and practice (Nolan et al 2006), everyone experiences a sense of:• Security – to feel safe and secure, not just physically but also

psychologically• Continuity – to feel that what we are doing in the present has links

with our past• Belonging – to feel ‘part of things’, maintaining existing

relationships and forming new ones• Purpose – to have valued goals to aim for and a feeling of ‘I have a

contribution to make’• Achievement - being able to achieve goals and to feel satisfied with

your efforts• Significance – to feel that you ‘matter’, that your life has

importance, and that other people recognise and value who you are.

Sense of: Declaration of Rights for Older People in Wales

Security I have a right to safety, security and justice

Continuity I have a right to be who I am

Belonging I have the right to decide where I live, how I live

and with whom I live

Purpose I have free will and the right to make decisions

about my life

Achievement I have the right to work, develop, participate and

contribute

Significance I have the right to be valued

This recognises an interdependentapproach to well-being

Well-being of service users

Well-being of carers

Well-being of

staff

… which requires negotiation and compromise

Everyone has something to contribute

People in the local

neighbourhood

Carers

People with dementia

Frontline staff

Specialised staff

Service managers

Commissioners and regulators

Researchers

Everyone is different

• This requires an individualised approach that recognises difference, not standardised responses

• The example of short breaks – one carer’s difficulty is another’s satisfaction

Everything matters and the ‘normal’ and the ‘ordinary’ are important

• ‘Often it is the simple things that bring the most pleasure (and the lack of them can bring a sense of sadness and loss) and services do not always seem to be very good at delivering “the ordinary”’. (Blood, I. 2013 p13)

We must use positive and strengths based terminology

Negative and deficit based terminology Positive and strengths based

terminology

The frail elderly Older people with high support needs

Elderly Mentally Infirm (EMI) People with dementia

People suffering with dementia People living with dementia

People afflicted by dementia

Wandering Walking

Dements People with dementia

Feeders People who need help with eating

36 (i.e. naming a care home resident by

their room number)

Never a number!

Senile Old

Not there Still here

An empty shell A person

2. Excellence – to support competent practice

• Taking an outcomes focused approach

• Thinking carefully about categorising people –non hierarchical

• Broadly identifying three types of people –informed, skilled and influencer

• Key learning and development topics for each group and suggested learning outcomes

Informed person

Learning and development topics – linked to Dementia Friends work in Wales:

• Dementia is not a natural part of ageing

• Dementia is caused by brain diseases

• Dementia is not just about losing your memory

• It is possible to live well with dementia

• There is more to the person than dementia

• Effective communication is important to people with dementia

Skilled person

More complex – 48 learning and development topics mapped to the National Outcomes Framework covering:

• Rights and entitlements

• Physical and mental health

• Safeguarding

• Meaningful living

• Meaningful relationships

• Community inclusion and contribution

• Social and economic well-being

• Physical environment

For example…

Each outcome category has 6 L&D topics.

For example - Meaningful living:

• Life story work

• Identifying the strengths of people with dementia and their ability to do

• Creative and meaningful activities

• Sensory stimulation

• Experiencing positive transitions

• Meaningful short breaks

Influencer

Learning and development topics linked to organisational leadership and development:• Drivers, policy and research• Ensuring effective service mapping• Collaborative and integrated working• Promoting congruent values, ethics and culture• Involving people in creating and owning a clear and

shared vision• Delivering the vision• Quality assurance and improvement• Safeguarding

3. Engagement – to support wise practice

Engaged people are compassionate and technically competent, but also feel good about what they do and work within systems that are empowering, enabling them to make wise decisions about how they support people with dementia, carers and staff within the context of their daily lives

‘Don't get me wrong. We need rules! Jazz musicians need some notes… but too many rules prevent accomplished jazz musicians from improvising, and as as a result, they lose their gifts, or worse, they stop playing altogether’. Barry Schwartz

A whole system approach

Good leadership within organisations

• ‘Our role as leaders is to set the stage, not perform on it’ Linda Hill.

Robust and meaningful quality assurance

• Owned by everyone –not done to them

• Experience not tick-box focused

• Supported by helpful not burdensome paperwork

• Identifying and building on strengths, e.g. ‘Magic Moments’ work

Effective approaches to individualisedand collective learning

For example – the DEEP approach that has been developed in Wales which draws on:

• Appreciative Inquiry

• Communities of Practice

• Community of Enquiry

• Exploratory Talk

• Caring Conversations

• Experience-Based Co-Design

• Collaborative Action Learning

Learning and Development topics for Influencers

• Drivers, polices and research• Effective service mapping and co-ordinated

delivery• Collaborative and integrated working• Shared values• Creating and owning a clear and shared vision• Delivering excellence• Creative approaches• Quality assurance and improvement• Complaints and whistle-blowing• Safeguarding

Resources

• Good reading – suggested books

• Helpful Welsh and national organisations

• Free web-based resources

Further information

n.d.andrews@swansea.ac.uk