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Unit Standard 23921 Dementia - Person Centred Care Script Contents Segment 1 - What Is dementia?..................................................... 2 Segment 2 – Supporting a person living with dementia..............................5 Segment 3 – Person-centred Care................................................... 7 Segment 4 - Holistic approach..................................................... 9 Segment 5 - Individualised care and support......................................12 Segment 6 – Personal plan index..................................................15 Segment 7 – Using a personal plan................................................17 Segment 8 – What is a life story?................................................20 Segment 9 – Features of a life story.............................................22 Segment 10 – Features of a life story – continued................................25 Segment 11 – Supportive interactions.............................................28 Segment 12 – Assistance with daily living activities.............................31 Segment 13 - Observing and carrying out clinical tasks...........................34 Segment 14 - Strategies for responding to changes................................37 Segment 15 – Barriers to communication...........................................40 Segment 16 – Communication skills................................................43 1
Transcript
Page 1: Segment 1 - What Is dementia? - caretrainingonline.com  · Web viewDementia is an umbrella term used to describe varying chronic or persistent disorders of mental functioning caused

Unit Standard 23921

Dementia - Person Centred Care

Script

ContentsSegment 1 - What Is dementia?........................................................................................................................................ 2

Segment 2 – Supporting a person living with dementia.....................................................................................................5

Segment 3 – Person-centred Care..................................................................................................................................... 7

Segment 4 - Holistic approach.......................................................................................................................................... 9

Segment 5 - Individualised care and support................................................................................................................... 12

Segment 6 – Personal plan index.................................................................................................................................... 15

Segment 7 – Using a personal plan.................................................................................................................................. 17

Segment 8 – What is a life story?.................................................................................................................................... 20

Segment 9 – Features of a life story................................................................................................................................ 22

Segment 10 – Features of a life story – continued........................................................................................................... 25

Segment 11 – Supportive interactions............................................................................................................................. 28

Segment 12 – Assistance with daily living activities......................................................................................................... 31

Segment 13 - Observing and carrying out clinical tasks....................................................................................................34

Segment 14 - Strategies for responding to changes......................................................................................................... 37

Segment 15 – Barriers to communication........................................................................................................................ 40

Segment 16 – Communication skills................................................................................................................................ 43

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Segment 1 - What Is dementia ? Slide 2: Index

In this topic you will learn how to give person-centred care and support to people living with dementia. Firstly, you need to know what dementia is. This segment will cover what dementia is, what changes will occur, and the conditions that come under the term dementia

Slide 3: What Is Dementia?

Dementia is an umbrella term used to describe varying chronic or persistent disorders of mental functioning caused by physical changes in the brain as a result of disease or injury. Dementia is associated with the loss of cognitive functioning. When these physical changes occur, they can lead to a loss of the functions controlled by the part of the brain that is affected, for example losing the ability to recognise the urge to urinate.

Slide 4: What do these changes involve?

These changes involve memory such as not being able to remember the names of objects such as fork, or not being able to remember how to get home once out. Thinking such as understanding information that is given to them and behaviour such as loss of inhibitions or a general change to the persons normal way of behaving.

Slide 5: What do these changes involve?

Other changes that you might see in someone who has dementia is a change in emotions, such as getting angry easily. I know a lady who had dementia, she had always been a very placid and gentle person, so it was quite a shock for the family to see angry outbursts from her. The other change that can be noticed is physical functioning. There is a variety of physical symptoms associated with the decline in cognition that impacts a persons’ ability to perform tasks they used to achieve every day. For example, forgetting how to use the oven when previously they had cooked for themselves.

Slide 6: Can dementia be treated?

Yes, some dementia can be described as reversable while others are non-reversable.

Certain conditions can cause reversible dementias. The effect of these problems is usually reversed when the cause is removed. Reversable dementia is often short term. It is important that these conditions are identified early and treated appropriately so that symptoms can be improved.

Slide 7: What can cause reversable dementia?

There are many factors that can cause reversable dementia. For example, medication interactions, where two medications are given but not compatible with each other, this also includes medical interactions as a result of excess alcohol consumption, effects of particular medications, or illicit drugs and smoking. Sometimes significant mental health issues can impact the brain causing cognitive issues, for example prolonged high stress levels, sleep deprivation or significant depression. Physical health issues can also create short term dementia such as vitamin deficiencies or imbalances, thyroid abnormalities, infections and inflammation, lung problems or metabolic disease or abnormalities.

Slide 8: What causes non-reversable dementia?

The irreversible dementias are known as degenerative dementias which means there is a progressive and irreversible decline of cognitive functioning. This can be caused by different illness, such as Alzheimer’s or an illness that causes a blockage of blood to the brain such as a stroke or Transient ischemic attacks (TIA) which is a mini stroke. These are very short episodes where a person loses consciousness temporarily. Each time they have one of these, the area in the brain affected dies. Over time this will result in loss of memory and can also lead to a major stroke. These can result in a decline in the persons’ ability to think, reason and remember, changing the way they behave and function.

Slide 9: What is Alzheimer’s disease?

Alzheimer’s disease is the most common of these conditions, accounting for 50-60% of all diagnoses. It is a neurological disorder that is irreversible and causes nerve cell death and tissue loss throughout the brain. It usually occurs in older age but can happen to people that are middle age, very occasionally a younger person

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will experience Alzheimer’s. If you have worked with people who have Alzheimer’s you will have experienced the continued decline in ability, a person might be confused about what clothes to put on where, then require help to get dressed until they are completely unable to dress themselves.

Slide 10: What happens during Alzheimer’s disease?

The brain of people living with Alzheimer’s disease has fewer nerve cells and connections than a healthy brain does. Over time, the brain shrinks dramatically, affecting nearly all its functions. As a result, people lose functional nerve cells in the areas of the brain that deal with thinking and memory. This is what causes the decline in cognitive skills as the disease progresses. They also experience a build-up of abnormal proteins in some brain cells.

Slide 11: What causes dementia?

Currently, we do not clearly understand what causes dementia, this means research, examinations and scans have not shown a definitive cause of dementia. Research has however, shown it appears likely that there is a link between age, as most people experiencing dementia are over the age of 65. Currently in the UK the results are 2 out of every 100 between the ages of 65 -69 and this increases to 1 in 5 people aged between 85-89. In fact, any diagnosis of dementia for a person before the age of 65 is classed as a diagnosis of early onset dementia. Lifestyle and environmental factors also impact on the likelihood of dementia such as consuming a high level of alcohol. There have also been recent studies linking sports with a high level of head injuries such as rugby to an increased risk of dementia. Family history can also have an impact. While the reason for the genetic link is unclear, there is a strong connection between genetics and having a relative with dementia can increase the likelihood of a person ending up living with dementia.

Slide 12: Who can be affected by dementia?

Dementia can affect people of all ages, as discussed it is more common in older adults but there are cases of people with dementia even in their 30’s. Anyone can end up experiencing dementia regardless of their intellectual ability and ethnicity or gender. There is more woman who are diagnosed with dementia than men, however this has been attributed to the fact that women tend to live longer than men.

Slide 13: What are the symptoms of dementia?

Dementia is known as a ‘progressive’ which means the symptoms get worse over time. These symptoms include gradual memory loss. It is important to remember that it is gradual, this can make it difficult to catch in the early stages. If someone wakes up and suddenly cannot remember how to do things, this is not dementia and they need urgent medical treatment. You might notice people with dementia repeating statements or questions. For example, if you were to ask Mrs Smith if she wanted to go and have her shower now, instead of responding appropriately such as saying yes or no, she might simply respond with “do you want to shower, shower, shower”.

Slide 14: What are the symptoms of dementia?

Another symptom you might notice is difficulty in performing familiar tasks. For example, they might begin to struggle with how to use a knife and fork to eat their dinner. They may also experience difficulty in handling money. The value of money might become lost to them and be confused with how much money they have or forget to pay bills. Many people with dementia also experience a loss of initiative. While you or I might see a load of washing that needs to be folded and do it, or dishes that need to be put away, a person with dementia might see these things but not realise they need to do something about it. People with dementia often need to be told what they need to do and how to do it. I remember working with a person in their 40’s who had early onset dementia. She was able to wash her own hair but needed to be talked through the process. She would just stand under the water and it wasn’t until I said, “ok, now you need to put shampoo in your hair” and squeeze a portion of shampoo onto her hand that she would do it.

Slide 15: What are the symptoms of dementia?

A person with dementia will also experience Impaired judgement. This creates safety concerns that need to be considered when caring for a person with dementia. It might be that they will begin to cross a road without looking out for vehicles, or they could give away all the cash that is in their possession without thinking about the fact they needed to buy food. Disorientation in time and place is a common symptom of dementia, a lady I

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looked after who had become immobile used to tell me all about how she was climbing the trees and share many childhood memories as if she was experiencing it right then. Her husband had known her since they were 5 so he spent a lot of time sharing these memories with her, for him it was a memory and he knew the present day and time, but for her it was as if she was living back in her childhood. Personality changes or changes in mood or behaviour are a symptom which often causes much grief for the families. The person that they knew is changing and it can be hard to deal with. A quiet shy person might become sexually inhibited, the kind caring man would become angry and lash out. The personality changes can be very difficult for people to cope with but is a common symptom that a person is affected by dementia.

Slide 16: Symptoms of dementia

However, before these more obvious symptoms there are a few more subtle clues that a person might be showing in the beginning stages of dementia. These symptoms include problems with language as in they might forget a word, or if they speak multiple languages they might mix between the languages during the course of the conversation. People will also experience a deterioration in driving skills and in functional skills. You might see older adults parking across multiple car parks or missing a corner and hitting a post. They may also go around a roundabout the wrong way. A common initial symptom is misplacing things. I know we can all laugh and think, well that’s me, I misplace my keys all the time. However continually misplacing things, or putting things in weird locations, such as your washing in the oven is a sign that something is going on within the connections of your brain, and for people who experience dementia this is one of the initial signs. The main difference between you misplacing things and people with dementia, is you know you have misplaced them and usually will be able to find them.

Slide 17: What should you do if you see someone with these signs?

It is important to understand that dementia is not a normal part of the aging process. If you are working with a client and you have some concerns over their cognitive ability it is important that you discuss these with the nurse or your manager. It might be that there is something going on that can be reversed because you have caught it early. Or it might be the beginning of Alzheimer’s and plans can be put in place to help the person stay safe and functional for as long as possible.

There are many different types of dementia other than those mentioned here. If you want to understand these go to the Dementia Topic in the Navigation topic list.

The next segment will cover supporting a person living with dementia.

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Segment 2 – Supporting a person living with dementia Slide 1: Index

There are particular challenges in supporting a person living with dementia. In this segment we will ensure you understand your role and responsibilities along with recognising your own limitations. You will also need to be able to treat all the people who you provide care for with dignity and respect.

Slide 2: Why do you need to understand your roles, responsibilities, and limitations?

People living with dementia often feel vulnerable and will rely more on people to provide care and support as their condition worsens. It is important that you are able to support them with respect and can reassure them so that they feel safe. This will help them to maintain their independence and can continue to feel like valued members of their community as much as possible.

Slide 3: What is your role?

Your role as a support worker is to care for and provide the required services to the client. For this you need to ensure you are Following the care plan. The care plan will be the guide as to what services are required to ensure the appropriate level of care is given. This plan will include things such as assisting with activities for daily living, otherwise known as ADLs such as cooking, cleaning, showering and getting dressed. Your role will also have supporting interactions as part of the plan. This might be helping them to get ready and meet their friends for a game or ensuring you move them into the lounge room once they are ready so that they can interact with other people.

Slide 3: What are your responsibilities?

Your responsibilities include Completing the tasks in your role such as following the care plan. However, you also have a responsibility to be observing, that is observing how the client is interacting with their space, what they are able to do for themselves and any changes you notice. You need to make observations about their physical health and their cognitive abilities. Remembering that many dementias are progressive, so will be changes. You will then need to record these changes. You must keep up to date with your notes and write any changes you observe with the client.

When you have observed a change with a client, you need to report this change as well as record it. You would report your observations to either the nurse or the manager, depending on your facilities policy. This way further assessments can be done, and the plan can be adjusted if required. This means that part of your responsibility is adapting to the new needs of a client. You need to be flexible in your role and use common sense and sound judgement. If a person is struggling to get dressed but it is not in the plan, help them anyway. It might be a one-off day, or a particular piece of clothing they struggle with, but this needs to be observed and noted. They might be absolutely fine the next day, or it could be they are deteriorating and will need continued assistance to get dressed. Part of your responsibility is to also use a holistic approach with your care. We will be going into holistic care in much more detail in the next segment, but it essentially means you think about the person as a whole, all their needs, not just physical. Their other needs include emotional, spiritual, cultural, social, and mental needs which need to be met too.

Slide 5: How do you recognise your own limitations?

Another essential part of your responsibilities is to know your own limitations. Have you ever heard the saying “you don’t know what you don’t know?” This means that there are often complexities behind situations that you have no idea about. The same goes for the role of support worker. It might seem simple that you are just helping a person to get clean, dressed, fed and housework done, but as you do study more topics and gain more skills you realise just how complex this job can be. During health and safety topics and patient right topics you will have heard about ‘scope of practice’ and ensuring you do not do things that you are not qualified for, and it is for this very reason. Therefore, you need to know your own limitations and work to your capabilities and scope of practice. This includes knowing what qualifications you have and what those allow you to do and when you need to get someone else involved.

Slide 6: Is experience important?

Along with qualifications, another guide to use to know your limitations is the amount of experience you have.

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For example, if you have recently covered stoma’s and have learned how to change a colostomy bag you may be able to complete this task, however if there is any complexity to it, such as a person having a skin reaction, then you might still need assistance, where as someone who has a lot of experience may be able to deal with it easily. The same goes for working with people with dementia. Through experience you gain knowledge that improves your practice. For example, you can learn about sundowning, or late-day confusion, but actually experiencing it is something completely different. Through experiencing it you can learn how to manage and work with clients and therefore become more experienced confident and competent. The more confident and competent you are, the safer people feel around you and the care you deliver.

Slide 7: How does confidence impact limitations?

The limitations of your practice will also be determined by confidence. If you have taken the time to learn about a topic but you do not feel confident then your practice will be limited. Confidence often grows with experience, so ask a co-worker if you can observe or assist with a task that you are wanting to build more confidence in. The other area where confidence is important is if there is a person who is overconfident. By this I mean the person who thinks they can do more than they can, they are often unaware of the risks and do not realise the limitations of their practice. The goal is to be appropriately confident.

Slide 8: What is appropriately confident?

Appropriately confident means you know what you are capable of and what you can do, and you do it well, but you are also comfortable enough to understand when you do not know enough to tackle a task and ask for help. For example, recently I was offered a role that including some counselling work as an addition to nursing and social work type work, I knew I had the qualifications and skills for some of the role but had to tell them that I did not have enough qualifications or experience to competently carry out the counselling portion. It meant missing out on a role, however, if I had claimed I could do the work then I would have put myself and my clients in potential danger as I do not know what I don’t know about counselling and need to do further study in order to practice safely in this area.

Slide 9: Why do you need to know your limitations?

You need to know the limitations to keep your practice safe by this I mean that you are not working out of your comfort zone which could be very stressful. It also means that you are working within your scope of practice and are not at risk of getting fired or prosecuted for doing something you are not qualified to do. You need to know your limitations to keep your clients safe as well. If you are unsure what you are doing you can put people at risk, by lifting them badly and injuring them, or not understanding what you are seeing so you miss something important.

Slide 10: Why dignity and respect are important?

When you know your limitations and work within them you are showing respect to your client as this demonstrates you care about their safety and receiving the best care. Treating a person with respect and dignity is part of the code of rights and this includes people with dementia. It does not matter that they may not be able to tell people if they are not being treated well, but their body language will tell a person something is wrong. These are people who have had amazing lives and to treat them with anything less than respect, dignity and care is unacceptable. Our next segment will discuss how to use person centred care shows respect and dignity.

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Segment 3 – Person-centred Care Slide 1: Index

Person centred care is essential to good dementia care, in fact it is the underlying principal in the 2018 Alzheimer’s Association’s Dementia Care Practice Recommendations according to The Gerontological Society of America. In fact, person centred care is the basis for all care that should be delivered. This essentially means care specifically designed to each person. In this segment we will discuss how person-centred care came about, what person-centred care is and what your role is with person centred care.

Slide 2: How did person-centred care come about?

Person centred care is a term based on the work of the late professor Tom Kitwood of Bradford England. In 1988 he used this term to describe a philosophy of care within dementia, describing person-centred care as “implying recognition, respect and trust based around the personhood or status bestowed upon one human being by others”. Kitwood’s philosophy was the opposite of traditional western care. Historically, people receiving medical care would be told what is happening, when it is to be done and essentially gave up all their rights and submitted to what the doctor or nurse told them. If you have not seen the show “Call the Midwives” I suggest you watch it, particularly the first seasons. It is based in the 50’s and shows the juxtaposition between historical task centred care and the beginnings of seeing a person and their circumstances as a whole. You will see patients being told what is happening, even after having said it was not something they wanted and the beginnings of younger medical practitioners questioning whether the traditional way of practicing is the best approach for patients.

Slide 3: What is personhood?

Within Tom Kitwoods’ explanation, he used the term personhood. Personhood places an emphasis on wellbeing. Personhood recognises a sense of self. This means who the person is such as mother, sister, friend, Christian, dancer, the persons individuality is what makes them unique and how the person can positively interact with other people. For example, a person who danced their whole life or played an instrument will react very positively to music even with advanced dementia. This knowledge of their personhood can help you to positively interact with them by playing music for them to connect to and will enhance their sense of wellbeing that goes beyond ensuring they are clean, feed and have taken their medication.

Slide 4: What is person-centred care?

Person-centred care is a holistic approach to a person’s wellbeing. This means that with person centred care, it is not just their physical needs that are considered when addressing a persons’ wellbeing or the whole person. A person-centred model recognises that everyone is unique and individual and must be cared for according to their needs, regardless of age, race, religion, social status or disability. Think of a person you know, put their name in the middle of a page, then draw arrows out from them, one for family, one for work, sports, religion and any other thing in their life that is important to them. Start writing what you know about each of these around the topics, give each area of the person’s life a new arrow. You will begin to see they are a complex person that has many aspects to their life and these aspects can interlink and impact other areas. It might be you soon realise they don’t have much in the way of family and this is an area that concerns you, then you realise they have good friends with their reading club or sports club, they have support from their church, this brings you do discover that they have created their own family of sorts and actually have plenty of support. Or it might be you realise that support is something very lacking in this person’s life and you know this is an area that will need to be considered and given attention to.

Slide 5: How will this impact the care you give?

When you understand how the many aspects of a persons’ life impact them, you can then see how the healthcare they receive doesn’t just impact their body but their whole life. A person might be ignoring a doctor’s advice about bed rest and taking longer to heal. You could remind them each time of what they should be doing, or you could look at why they are ignoring the advice. It might be that they have to care for another loved one, so they need additional services such as someone to drive their children to school. When a person has dementia, it does not just impact their memory but their ability to socialise, plan, take care of themselves and others. This could lead to depression in their more lucid moments and feeling lonely. It is important that as support workers

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you look for ways to incorporate their world into their care. It might be that you get them ready and take them to activities they used to go to. It might be they are having a good day and can participate, or it might be they are not having a great day but the company still does them good.

Slide 6: How does this differ to task centred care?

This is vastly different from task centred care which is about completing the tasks assigned in an efficient manner. The key here, is that to truly give person centred care, you have to get to know the person. While you first care for them it may be quite task focused, but as you ask questions and get to know the person, observe what they struggle with, get to know their dreams and goals, you can move from task centred care to person centred care. This is not to say that you do not get the tasks done in an efficient manner, but you also think about the persons wellbeing. It might be that you alter the time you see a person to ensure they can make their trip out. You might also help them through the shower and take an extra minute to apply lipstick as you know they are having friends to visit. It might even be as simple as playing a song they love in the room they are in while you are cleaning. So, as you can see task centred care is about getting the tasks done, while person centred care is about taking care of the persons wellbeing.

Slide 7: What is your role?

Your role is to provide quality care that is specific to the persons needs and respects the wishes of the person you support. This means you need to be following the care plan that is set out as there would have been a lot of time and effort gone into assessing the needs of the person and finding out what the person wants. As time goes on and you get to know the person you might add to the plan or alter it after discussing this with your manager. As dementia is a progressive illness you might realise that the plan is no longer meeting the persons needs and further assessments might be required. So you need to report and adjust to the changing needs of the person. Person centred care is not about what is easiest for you as the support worker, you are not the person at the centre of the care, they are and therefore what you do must be of benefit to the person.

It is important to understand from a person-centred approach how responding to holistic needs can promote a person’s health and wellbeing. The next segment will discuss holistic care and what makes up holistic care.

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Segment 4 - Holistic approach Slide 1: Index

In this segment we will cover what areas of a person’s life is assessed when using holistic care, holistic care in Maori culture, and using holistic care in practice.

Slide 2 – What are the areas of a persons’ life that makes up holistic care?

The concept of holistic health is that many dimensions of a person must be viewed as an integrated whole. This means that as a profession, health care workers understand they need to ensure not just the physical needs are taken care of for a person to experience wellness but that many areas of their life are considered and recognised as being just as vital to wellbeing. The physical, social, emotional, mental, cultural and spiritual aspects of a person make up an integrated whole being and each of these have specific needs. In the following slide we will address each of these and how they might impact wellbeing.

Slide 3: How does physical aspects of a person impact wellbeing

The first is the most obvious which is a person’s physical wellbeing. This is where they previous model of care was focused on. So, this might be an injury or illness and how they impact on their ability to carry out their life. It might also be their general physical health such as being obesity or underweight, diabetes or other conditions that affect their circulation and respiratory function. So, it is anything that impacts on the physical body that impacts a persons’ wellbeing. In the case of dementia, it is the physical impact on the brain of neurons not working properly that then impacts on the person’s ability to function within their life.

Slide 4: How does the cultural aspects of a person impact wellbeing?

As we know from previous topics culture is about a persons’ race, gender, beliefs, and anything that enables a person to identify with a group of people. A persons’ wellbeing can be affected by their culture in that if they are unable to connect with people of their culture it can cause them to feel isolated and depressed which has a significant impact on their wellbeing. For example, if a person has come from another country but has found people of the same ethnicity and they can connect they are far more likely to feel connected and supported, but if they are unable to connect with those people anymore, they can feel isolated and vulnerable. Culture might impact on diet such as being a vegan or culture might leave you predisposed to particular illnesses such as pale skinned people are more likely to get melanoma, people from the pacific islands are more likely to experience heart issues. For many years’ homosexuals were significantly more likely to get HIV. As we remember from previous segments, women are more likely to have dementia and dementia is also much higher in older adults.

Slide 5: How does the spiritual aspects of a person impact wellbeing?

Spiritual beliefs can have an impact on a persons’ wellbeing. For example, research has shown that people who are connected with a spiritual belief are more likely to discuss feelings of being at peace when they are at the end stage of terminal illness. Spiritual beliefs can also bring a connectedness to people by attending services and meeting others. Spiritual beliefs can also impact the choices people make about the health care services they receive. For example, people who are Jehovah’s Witness will refuse a blood transfusion, Jews have particular days where they will not eat. Some Christians will refuse medication choosing to pray and believe for healing. Other people who a spiritual opt to only use herbs and vitamins as opposed to pharmacy medication. Peoples beliefs need to be respected, it is their choice and they have the right to refuse medication or treatments.

Slide 6: How does the social aspect of a person impact wellbeing?

Humans are innately social creatures. Research has proven that if people are isolated, they are less likely to have good health outcomes. Loneliness is linked to depression, so it stands to reason that a person’s ability to socialise will impact on their wellbeing. As support workers we need to ensure we are doing our bit to help people socialise, be it getting them ready to go out on trips if it is in home care or making sure they can get down to the lounge to interact with others if you are in residential care. People with dementia still need to be able to socialise, it may even slow down the illness if they are able to work the cognitive parts of their brain required to socialise with others.

Slide 7: How does the emotional aspects of a person impact wellbeing?

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The emotional aspects of a person are the feelings part of a person. You may have heard the words optimist or pessimist? This is to do with how a person sees the world, an optimist will see the beauty and the hope, a pessimist will see all that is wrong. A persons’ body responds to the way they think and act. It is known as mind/body connection. If a person is more of a pessimist, they are more likely to see the negative aspects of their health which will negatively impact their wellbeing. However, a person that is an optimist will look for the good in their situation and therefore have a better health outcome.

Slide 8: How does the mental aspect of a person impact wellbeing?

Mental health incorporates emotions, but it is also more than that, it is your overall mental wellbeing and cognitive ability. The mental aspects of a client is of particular importance when they have dementia. The mental health of a patient refers to anything to do with the psychology of the brain, such as mental health issues like depression, bipolar and schizophrenia. Cognitive ability is to do with processing, problem solving and learning. If a person has psychological issues or cognitive issues it will impact on their wellbeing as it impacts on their ability to function and look after themselves.

Slide 9: How does this compare to Maori models?

In New Zealand we are a bicultural nation which means we also need to address Maori ways of practicing healthcare. The holistic approach is similar to a health care model commonly used to explain Maori beliefs of health. This model is called Te Whare Tapa Wha.

Slide 10: What is Te Whare Tapa Wha?

Te Whare Tapa Wha is a model of care designed by the late Professor Mason Durrie. It is the cornerstone of care for Maori health and used to explain the beliefs that Maori hold around wellbeing. It is in the form of a house. The belief is that you need all the walls of a house to be functioning and strong for the house to stay standing. The house is a person and the walls are the different aspects of a person that need to be well for a person to be whole.

Slide 11: What do the walls represent?

The walls represent Taha tinana which is physical health, which is the physical body being well. Taha Wairua which is spiritual health, this can be likened to the spiritual and cultural aspects of holistic care. Spirituality is very important to Maori with many believing that physical illhealth is a sign that the spirits are unhappy, which is why many Maori struggle to access healthcare as they feel great shame. Taha hinengaro which is mental health. This is similar to the emotional, mental health aspects of holistic care and Taha Whanau which is family. Whanau is of great importance to Maori. Maori believe you need to be connected to your roots, your family in order to be well, this is similar to the social component of holistic care. As you can see there are many similarities between Te Whare Tapa Wha and holistic care, so it is very important to practice from a holistic perspective when working in New Zealand.

Slide 12: How do you put holistic care into practice?

This leads to an understanding that a persons’ holistic needs must be met in order to maximise their health and wellbeing. You might be worried that this means you will need to spend a lot longer with each person to practice holistic care, but it is not about how much time you spend with a person you support, but rather about how that time is used so use it effectively. For example, you can use the time they are praying to clean in another room, you can ensure they are seated with people to socialise with after their shower, you do not need to be their socialisation. It is simply about making sure a person’s needs are met and figuring out how to do that in a meaningful way. For example, if you are working with a Muslim person you will know there are certain times that they pray. You would not sit around waiting for them to finish, you would shower a different client and then come back to the person once their prayers are finished to help them with their cares. It is about making sure you respect the other elements of their life, not just focusing on their physical cares.

Slide 13: How do you put holistic care into practice?

Being aware of the effect of holistic needs on wellbeing will influence the care and support you provide. When you understand how important the other aspects of a persons’ life are, it will influence how and when you do what you do and to advocate for them to have their needs met, such as feeding them in the lounge area instead of their room, it might be less convenient but is really important. Overall, person-centred care means being

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more flexible about the way services are delivered. This requires a “needs-led” service that is based on what the persons’ needs are at a particular time so that these needs can be met in the most effective way possible. This can be difficult to do if you are simply looking at funding, but it is possible when you are creative and dedicated to giving the best care possible to clients.

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Segment 5 - Individualised care and support Slide 1: Index

Individualised care and support are the foundation of person-centred care. It is built on a person’s abilities and strengths rather than on any deficits, budget, or deadlines. In this segment we will examine what individualised care and support means, how you give individualised care and how this impacts the organisation.

Slide 2: What does individualised care and support mean?

Individualised care and support means treating a person with respect and understanding while carrying out a plan that is tailored to meet their needs and value what is important to them. Over the next few slides we will look in detail at what it means to give individualised care and support. Throughout this you can reflect on the care and support you give clients and you will recognise times where you have done a great job of giving care and support in a way that is unique to the person you are caring for. You might also recognise times where, perhaps your care and support has been more task orientated. This is OK, it is a learning process and realising where you could have been better is a good start to improving your practice.

Slide 3: How can you treat people with dignity, respect and understanding?

Treating people with dignity, respect and understanding is a basic necessity to care. It is part of the code of rights that you treat people with respect. As we have discussed in previous topics treating people with respect means you treat them in the manner you would want to be treated or have your family member treated. It is about being courteous and accepting that what is important to them needs to be treated as important to you. For example, if they want to be ready for church service, then even if church is not something you care about, or even could be against, you make sure they are ready for the service because it is important to them. To treat someone with dignity means to make someone feel safe and secure, putting them at ease. For example, treating a person with dignity would be covering the parts of their body you are not cleaning if they are having a bed bath, shutting the door to the bathroom so they have privacy. It is also about not making them feel embarrassed or ashamed in front of other people or if they have an accident. To treat someone with understanding means you have taken the time to learn their perspective on what is important to them or what they believe. Understanding is a form of respect and care that underpins all holistic care. This is because to be understanding means you have gotten to know the person, their needs, goals, desires, strengths and this is the basis for individualised care or holistic care.

Slide 4: How to give individualised care - listening and acknowledging

In order to give respect and understanding, we need to know the clients we work with. This is done by listening and actively acknowledging what is important to each person. We have covered listening in our communication topic, if you have not already done this topic, please make sure you do so after this. Listening is about focusing on what the person is saying, sometimes it is good to paraphrase what you believe you have heard to ensure you have received the right message. When listening it is important to acknowledge what the person is saying, by encouraging the person, using open questions and giving feedback on what they have said. This is actively acknowledging the person. For example, a person starts telling you off for being late. You listen by focusing on them and what they are saying, you can show you are listening by paraphrasing what they have said “you are mad because I was late which caused you to miss going to bridge”. You can then actively acknowledge what is important to the person by saying “I’m really sorry I was late. I forgot that today you had bridge and I know how much it means to you. I will make sure it is in my diary to come earlier next week”.

Slide 5: How to give individualised care - strengths and abilities

Another aspect of treating people with respect is recognising their strengths and retained abilities. Strengths based practice is a model of practice that originated in social work but is becoming widely accepted as best practice in all care-based professions. It is about understanding that no person is complete deficits, everyone has skills, talents and beliefs that can be worked with and built upon. A person with dementia will still have skills and abilities that can be worked with, they need to be able to do as much for themselves as they can for as long as possible. With recognising a persons’ strengths comes offering choices to people within their capabilities. This gives a sense of autonomy and control within their life. It could be deciding whether or not to join in on an outing, choosing what they wear, if the facility they live in does options for food then choosing what they eat.

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Slide 6: How to give individualised care - privacy

Respect is a part of the code of rights and therefore mandatory, so is maintaining the persons privacy during care and support. This means that you cannot discuss their case with people, and you cannot post pictures or stories of them on any social media. Within each persons’ individual care plan, you will need to consider privacy. Some people will have family and friends they are very open with and will discuss what is going on for them, however you will still need to maintain privacy. Others will be very private and not wish for anyone to know their private information, you will need to be extra vigilant here. It is a good idea to chat with clients and listen to them to understand their perspective around privacy and what information they are happy for you to share and to who. This can be more difficult with people with dementia when they have an Enduring power of attorney, but you need to make every effort to respect your clients by respecting their privacy.

Slide 7: How to give individualised are - service of a high standard

The code or rights also states that you need to give service of an appropriate standard. This can be hard to measure as different people have different expectations. This is where you need to understand your client and what is important to them so that the service you are giving is what they need and want. Making sure that services are of a high standard meets the persons expectation and helps the person live a meaningful life. You can best give the appropriate standard service when you give individualised care.

Slide 8: How to give individualised care - fully supported and informed

Giving individualised care also means that the person is fully supported and informed. Ensuring that people experiencing dementia and those who care for them are kept fully supported and informed can be challenging as dementia is progressive, yet the person can have really good days where they are lucid and functional. In order for people who have dementia and the people that care for them are fully supported, you need to make sure that people who support a person living with dementia are trained and supported in their role. You, a support worker needs to be trained so it makes sense that family who are helping to care for their loved one also need to be trained. Likewise, they will also need support as it can be emotionally draining to need to care for a loved one while also watching them change and become a different person to the one, they knew and loved. To ensure that people are fully informed you need to make sure you are telling the person what you are about to do and why, for example helping them to get changed, they need to be told that you are going to remove an item of clothing, this will reduce the likelihood of them becoming agitated or distressed about what is happening. Please remember that they still need to consent so part of being informed is giving consent to the tasks being carried out.

Slide 9: How your experience enhances care?

Support carers can use their expertise and experience to improve the care and support that is offered. It can be difficult to see yourself as an expert, particularly around doctors, nurses and occupational therapists, however the more you work with a client the more you become an expert in their abilities, strengths and struggles. Along with this, the more experience you gain the quicker you will be able to pick up on subtle cues that someone is struggling or in pain. With your experience and expertise, you will be able to advocate for the needs of your clients. You will be the first to realise when they need additional support or their support needs change. If you do this then you are giving them excellent service and care that continues to cater to their needs.

Slide 10: How does this affect the client?

The quality and efficiency of the service provider also determines the support the person living with dementia has. If the client has an inexperienced support worker, then things can be missed that an experienced support worker with more training may pick up. This includes the quality of the staff and teamwork the client has around them so effective communication with the person, their family and other members of the multidisciplinary team will occur. It also means that the quality as well as effective documentation that records and informs all members of the support team of the day-to-day changes experienced by the person. The better these aspects are the less likely that things such as an underlying infection will be missed. It is also beneficial to the person living with dementia as it helps the person to feel accepted, listened to, understood, informed, emboldened (especially in making decisions and choices) and empowered when being looked after someone who is competent

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Slide 11: How does this impact the organisation?

Organisations that use a person-centred approach are more likely to retain and recruit suitable people who enjoy their role and work more effectively. Research shows that a person who are working in a good environment are more productive and stay with the organisation longer. Having highly skilled staff who work in a meaningful way for the client improves the reputation of the facility or agency which in turn grows their business.

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Segment 6 – Personal plan index Slide 1: Introduction

So far, we have covered what dementia is, your role and responsibility in caring for someone with dementia and what person-centred care is. Now we will look at how you apply person centred care in a practical sense within your role. Personal plans are central to person-centred care or holistic care. This segment will cover what a personal plan is, how it improves individualised care and what is in a personalised plan.

Slide 2: What is a personal plan?

A personal plan is a document created for each person who is or will be supported by your organisation. It describes and explains the services and support that the organisation has agreed to provide to the person based on their needs. For example, Mrs S might have assistance for showering required while Mrs T might have assistance to become more mobile. Each organisation has its own format for the personal plan, but the outcomes are similar.

Slide 3: How do you determine the needs of a person?

A personal plan is developed after the needs of a person have been assessed by a Needs Assessor who is has a health-related qualification that is employed by the DHB. They could be a nurse, social worker or occupational therapist. The type of support a person will need will be determined by the need’s assessor in conjunction with a multidisciplinary team involved with the client such as doctor, nurse or social worker. The client and the clients’ family will also be involved to work out the needs of the client. For example, a person might need support with some of the chores around the house but are capable of others. A personal plan will state the support will be for the chores that the person cannot do for themselves or need support doing. An effective plan will be holistic, considering all the aspects of a person discussed in segment 4. For example, the plan might also contain instructions such as to have the person ready by a set time and help them get to their social club or religious meeting.

Slide 4: What is a personal plan called?

Different organisations may use different names for personal plans, but they do all contain the same general information. Some agencies will refer to it as a Service plan or care plan. Others will call it a personal care plan or lifestyle plan. While others will name them as support plan or individual development plan. The title doesn’t matter so much but the contents of the plan do. For simplicity of learning we will continue to use personal plan throughout the following segments.

Slide 5: How does a plan Improve Individualised care?

Every person’s personal plan will be different because of the individual needs of that person. It is developed in conjunction with the client and is what the person wants and needs. A person-centred approach focuses on a person’s individuality. This means that factors such as relationships, needs, communication, feelings and abilities are considered. A holistic personal plan and takes a view of the person’s situation as the starting point for determining the type and level of support to be provided. Therefore, it is not just the physical needs of the person that is considered. A personal plan that is tailored to meet the unique needs of the client will improve care as it addresses their needs but also allows for autonomy over what they can do. Could you imagine what it would be like if every person received the exact same care in terms of tasks performed? There would be clients who would have needs left unmet and clients who would be frustrated as they are having things done for them that they can do for themselves. Any progress a person makes should also be documents.

Slide 6: How to use an individualised care plan

It is also important for people who have dementia to have individualised care to monitor changes in ability. As we remember from segment 1, dementia is a degenerative disease which means a persons’ ability will decline over time. As a support worker you do not want to be doing things, they could do themselves as it will mean they lose the skill even faster, but you also need to be aware of declining ability and work with the client, whanau and multi-disciplinary team to keep the plan current and effective according to the needs of the client. In this way they will receive an improved care plan as it tailors care to their needs as they alter.

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Slide 7: What is in the personal plan?

Now that we have covered why a plan is important, we will address what is in the plan. The plan is a profile of the important information about a person. A plan will outline the person’s needs, deficits and abilities. This is the things that they cannot do for themselves along with what abilities they have retained and may specify the tasks as services to be provided in order to support the activities of daily living (ADL’s). This covers the physical needs that a person has.

Slide 8: How is the emotional and mental needs covered in a plan?

Along with catering to the physical needs of a person you also need to ensure you are meeting their emotional and mental needs. Much of this can be done with including information about the person such as their preferences. Preferences may include the name the person prefers to be called and recognises, what they prefer to do throughout the day such as spend time watching TV or being outside in the garden, where they prefer to sit, for example if they get along well with particular people, they could sit with them at dinner time. Preferences such as how they would like to be dressed and which foods or drinks, they prefer should also be noted. This meets the emotional and mental needs as it allows for autonomy and helps the person to feel at their best doing the things they love. I know of an elderly lady who had dementia who had never worn pants, she had always preferred dresses or skirts. When support workers tried to put trackpants on her she got very distressed, but she was not able to articulate why. The support workers discussed with the family that she got distressed during getting dressed. When the family saw they were trying to put pants on her they realised that they should not have brought pants for their mother. So they continued to provide skirts instead and the staff ensured she had a blanked on her legs to keep her warm instead. As a result, she no longer got distressed during getting dressed.

Slide 9: How is the spiritual and cultural needs covered in a plan?

Personal plans should also discuss the persons cultural and spiritual needs. This might be assisting to get to services or observing religious holidays. It might also note any food requirements in order to adhere to their beliefs. Sometimes it might mean providing space to pray. Putting on religious music in their room that comforts the person might also be noted in the plan. I’ve known many clients who had CD’s with Hymns or other religious songs on that clients have enjoyed listening to.

Slide 10: How are the social needs meet in a plan?

Information about social needs will also be included in the plan such as how they communicate and interact with others. For example, languages spoken or any difficulties they may have. This Information may include what assistance they need to interact with others. The plan should also note the things that interest them, such as sports, hobbies or groups and how they can be engaged in these interests.

Slide 11: What else is covered in the plan?

The personal plan should also include information for staff on how they can best communicate with the person at different times of the day. For people with dementia they can often be more lucid in the morning. Alongside the personal plan will be background information where applicable, such as major key events like the death of a spouse or child or history of abuse or if they served in the war. A risk assessment or personal risk plan, particularly if the person is known to wander off or become violent. Also, practical information such as equipment used and instructions on maintaining a safe environment.

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Segment 7 – Using a personal plan Slide 1: Index

The previous segment covered what is in a personal plan and how they assist the client, this segment will address how you use the personal plan. In this segment we will cover how the personal plan describes tasks to be performed for the person. We will also cover why you need to read the plan to provide support along with your role in reporting and your responsivities to completing task.

Slide 2: What the personal plan tells you

The first part of your role is when you have been assigned a client your role is to read the personal plan before you start working with them. As you look through your client’s personal plan you will find the information that you need to know in order to give them the best care. This is the information discussed in segment 6 which is about meeting the physical, social, mental, emotional, spiritual, and cultural needs. As you start working with a person you might also observe the person and identify other tasks or cares that need to be in the personal plan. This could be that something may have been overlooked or it might be because the person had deteriorated in their abilities.

Slide 3: Why do you read the personal plan?

You need to read the plan, so you know what needs the client has. If you do not know what is in the personal plan, then you do not know what tasks need to be completed and when, therefore will not be able to give appropriate clear to the person. You also need to read the plan so you are familiar with it, you do not want to be reading the plan as you are with the person as it makes the care much more clinical and you may miss an opportunity to connect. You also need to know what is in the plan so that you can plan your work efficiently. For instance, if you have not read the plan and decide you will do a home visit at 11 you may have missed that the person needs to be ready by 9am to get to a meeting or appointment.

Slide 4: How do you provide support?

Once you know what you need to do for clients you need to make sure you are doing all the tasks required. There may be days that have more tasks or there may be tasks that you do not enjoy but these are the clients’ needs and the tasks need to be completed. It is important to remember though, that you should only be doing what the person cannot do for themselves and should not do things they are able to do for themselves. These are the boundaries of the job and it is important that you stay within your boundaries.

Slide 5: Why do you need to provide the support described?

You need to do all the tasks set out so that all the clients’ needs are met, a task may seem inconsequential or unimportant to you, but they need to be done. You also need to let the client do what they can do for themselves, this is so they can maintain autonomy and you can observe what they can and cannot do for themselves, this is particularly important for people with dementia as you need to determine any decrease in ability.

Slide 6: What is your role to help meet stated goals?

Each person will have goals that they want to achieve, your role is to support the person to meet any stated goals, it might be that their goal is to work on their physical conditioning and need assistance to remember to exercise and what the exercises are. It might be that they want to do the tasks themselves but need help in the form of someone talking through the steps of the task to remind them, or it might be assisting with parts they find difficult. Whatever their goal is, you need to help person to achieve their goals.

Slide 7: Why do you help meet stated goals?

Helping a person achieve goals is an important and rewarding part of the job. Working towards a goal builds connection between yourself and the client. It also helps the person with their cognitive and physical function to work towards achieving goals. If a person has things to work towards, they are more likely to be motivated to keep up their skills and gain new ones. Working towards goals is also good for their emotional and mental wellbeing as it builds confidence and encourages autonomy.

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Slide 8: Why do you need to check progress?

A part of helping people towards achieving their goals is to regularly check their progress towards those goals, this is to determine if what you are doing is working, it is also a time to assess abilities and if the goals the person is wanting to achieve remains achievable. For example, if a person has the goal of maintaining independence in their home and can still do things like work the oven then they are achieving their goal, however if they have deteriorated in their skills and can no longer keep themselves safe, such as forgetting to turn stove off then it may be time to consider other options.

Slide 9: Why do you need to check progress?

It will also be a time to determine if new goals need to be set, it might be that now a person has support in place they are coping well, and it is realised that with a bit of prompting they are more capable than originally thought. You also need to regularly check progress to determine if a plan is still effective for person, this is about determining if the plan is still relevant and meeting the needs of the client. There may be aspects of the plan that need to be altered as the persons abilities change, or as their interests change. A person might have gained a new interest they would like to explore further or lost interest in attending a group as it no longer meets their needs.

Slide 10: When do you report changes?

Along with your roles, you also have responsibilities to the clients and to your organisation. One of your responsibilities is to report changes. When you identify a change in a persons’ ability, interests, health or wellbeing, you need to report these changes to your manager or nurse. This should be done as soon as practical, especially if it concerns their physical health. The person you support is relying on you to advocate for them, as many people lose the ability to advocate for themselves as their dementia advances. It might be that you let the nurse know the person stated they were not feeling well and didn’t want to get out of bed. When the nurse goes to see them, they might happily get out of bed, or it might be that the nurse sees them, and it is in fact a medical emergency. It might be that you discuss with your manager that the person seems to be losing interest in a hobby and you agree together to keep a watch on their general behaviour or demeaner. Remember it is not your role to determine why a person is changing or how important the information is, it is your role to report changes.

Slide 11: Why should you report changes?

You need to report changes in order to keep your client safe. It is not only your job but a requirement of your job. Simply put, failure to report changes can put your clients in danger, however reporting changes can ensure you give best care to client. Without reporting, appropriate changes and supports cannot be put in place to best support and care for the people you work with.

Slide 12: What else do you need to report?

Along with reporting changes to the client, you also need to report anything that has an impact on the delivery of the personal plan. This might be that the persons’ equipment needs maintenance or is not working properly such as their wheelchair or bathroom hoist. If you notice that the hoist needs maintenance but do not report it, then you might end up with a situation where it breaks while the client is in it or stops working which means the person cannot shower. It might also be that they go to bridge every Thursday afternoon and it is announced that bridge is moving to a Wednesday, therefore transport needs to be re-negotiated. Life is ever changing and what impacts one person can have a flow on effect. For example, you are working with Mrs Smith, you work with Mrs Smith four mornings a week and Mrs Smith’s daughter comes in on Fridays to dress her and take her to the supermarket. Mrs Smith’s daughter informs you that her role at work is changing and she is now available on Wednesdays not Fridays to take Mrs Smith for the day. This needs to be reported as Mrs Smith will no longer require you on Wednesday but will require someone on Friday, if you move to Friday it will impact on your other clients that you normally see on Friday morning. So, as you can see, you need to notify managers of any changes so these can be accounted for to ensure people have the correct care. You will also need to report goal achievement and / or progress. As you will be aware, or you will become aware, funding is very important to ensure clients are able to receive the care required. To ensure funding is continued you need to be able to demonstrate the value of what you do. Therefore, you need to report on achievements, progress and declining abilities so that the appropriate funding is allocated to the person. You are also obligated to report any risks, this is in order to keep everyone safe. Risks include safety if the person can get aggressive or if they have a family

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member who is aggressive. it might also be if the area they live in feels unsafe. Risks also include if there are pets on the property especially dogs or if there is maintenance that needs to be done such as lose paving that people could trip on. Risks might include if the person is prone to wandering off. If you can identify risks and report these then plans can be put in place to keep yourself, your client and co-workers safe.

Slide 13: What are your responsibilities?

One of your responsibilities is to carry out designated tasks in the plan. The whole point of the plan is to ensure you are supporting a person to have their needs met. If you do not carry out the tasks on the plan, then the person is not having their needs met. Similarly, if you do more than the plan asks then you are taking away their persons autonomy and, also taking away time that you could have been helping someone else have their needs met. We have all had clients that we have got along well with and clients that we have struggled to connect with, but this does not mean that the clients we struggle to connect with are less deserving of care than the clients we enjoy.

Slide 14: What are your responsibilities?

An important responsibility that you have as a health care professional is to work within the code of rights. Care Training Online has whole teaching sessions on the code of rights so I will not cover them here, but if you are not familiar with the Code of Rights and what rights your client has, I strongly encourage you to make that your next topic of learning. The code of rights must be upheld, you could lose your job if you don’t. People with dementia still deserve best care and to be afforded these rights, even if they have a failing memory and may not be able to make a complaint, their family can, and you, as an ethical professional should ensure you are meeting these rights regardless of the risk of complaint. A note on confidentiality. The information in a personal plan is confidential. This means that the information is private, and you cannot share it with anyone. Therefore, the personal plan must not be left lying around for other people to see. You must not discuss it with anyone other than the person you support or your supervisor unless you are authorised to do so.

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Segment 8 – What is a life story? Slide 1: Index

When working with older adults, particularly those with dementia it is important to remember they are not just the elderly person you see before you, they have led a whole life full of experiences prior to meeting you. Some of these experiences have had a profound effect on them as a person, so it is good to understand their life story. This segment will discuss what a life story is, who can tell you a life story, and what a life story can be used to do with the care of clients.

Slide 2: What is a life story?

A life story reflects the details of a person’s life before the person was diagnosed with dementia. This is a shorter version of a memoir where a person tells their life story in detail sharing many memories.

Slide 3 What does a life story include?

The life story captures some of the facts of a persons’ life, such as if they got married, who to, how many marriages. If they have children, how many and who they are, including grandchildren. It also covers key events in their life such as if they were in the war or if they travelled around the world, what career they had and anything else that had a significant impact like religious beliefs or immigration. An example might be a gentleman who was married at 19, his wife and himself had 4 children and have 10 grandchildren. He was a canon loader in the war and worked in a factory for years before becoming a manager. His wife passed away 4 years ago of cancer, 2 of his children live nearby and visit often while the other two live in Australia. The life story would be longer than this and could explain that he now is hard of hearing and jumps at loud noises. He gets frustrated when people don’t do what he asks of them. This could all be linked back to his time in the war and the type of work he did.

Slide 4: What can a life story do?

The life story helps the support worker understand the client they are working with better. It is part of the personal plan as it helps a support worker to find ways to interact with a person in a way that has meaning to them. For example, a person may have been very involved in a sporting club so you may be able to connect with the person over the sport, or they may have been involved in theatre so you could discuss that. It might also help you determine the things the person may connect with and be interested in, such as coming to the lounge to watch a rugby game or for music time. It provides detailed information about the persons history, behaviours, likes and dislikes, along with information related to their past before they were diagnosed with dementia. For instance, understanding that a person went to war might explain why they get very jumpy or aggressive when they hear a loud bang.

Slide 5: Who can tell you a person’s life story?

If a person has lucid moments or not too advanced in their dementia, they will be able to tell you stories themselves that give you an insight to their past. It can be very fascinating to listen to their stories and adventures and it helps you build a rapport with them. I have really enjoyed chatting to clients as I brush their hair or during changing a dressing and finding out where in the world they have been and lived and the adventures they have had. When a person is unable to communicate, a family member or spouse may be able to supply personal information for the life story. I have also experienced times when they have had a lifelong friend who would visit, during the visit they would chat and laugh sharing memories of their adventures which can give an insight into their past and their personality.

Slide 6: How can a life story impact care?

The life story helps support workers, managers, and other people to appreciate the roles a person has played in life and the contribution they have made. It can be very easy to work with elderly and forget that they have done incredible things in their life. I remember caring for a person and one day she showed me a group photo, I suddenly realised I had seen this photo before, in one of my textbooks! We had been learning about something this person had achieved and now I was caring for her. Understanding a person’s life story can provide information that gives a great foundation for supporting a person living with dementia to engage in daily activities by understanding what they had enjoyed before being diagnosed. This is to help support workers

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understand the person’s unique history and why certain things are important to them. Each person places different values and importance on the activities and events recorded in their life story.

Slide 7: Who is a life story available to?

A life story should be made available to the people who work to support a person living with dementia. A person’s story is private and while it is helpful for people to read a person’s story to understand them better; it should also be treated as confidential just as the clients care notes would be. This means that only the people who are able to access the clients’ daily notes should have access to the clients’ life story.

Slide 8: What a life story document is not?

It’s not a legal document like clinic notes, power of attorney and other legal documents, as what is in it would not be entered into court as evidence. However, it is still important; it is the person’s story and therefore should be treated with respect. It doesn’t include progress notes as it is historic information not current information or planning for the future.

Slide 9: What is a life story document?

Life stories are usually paper documents of the history of a person. It may include photos that may help to stimulate feelings or memories for the person. It will also include significant events and people in the person’s life which will help you understand who or what the person may be talking about. Sometimes the person has written it themselves as a type of memoir, other times the family might write it for them. Some cultures such as Maori, share stories verbally and it is not uncommon for them to sit and share memories together and it might be that you write them down afterwards.

Slide 10: What can a life story be used to do?

If you know a persons’ story you are more likely to feel connected to them and be able to give more accurate and appropriate care for the person in terms of their likes and dislikes, for example the person may get very grumpy when you sit them in the lounge to watch tv or talk to others, then on finding out their personal story you realise they were a keen outdoors person and actually they might be much happier sitting in the garden or helping weed the garden. A life story might also explain patterns of behaviour. If a person does a particular thing in a certain way or gets anxious at a certain time it may be because of their past experiences. For example, they may randomly talk about things that don’t make much sense until you realise it was connected to their past work. They may be anxious if they are not up and dressed early and this is a result of being at work by a certain time each day and it is ingrained into their body clock. I remember a man who was a tailor who used to go around feeling fabrics in the facility. Or it might be behaviour such as, jumping at loud noises as a result of war, or panic if a male nurse assists them to shower due to past sexual violence. In this way a life story can be used to avoid triggering trauma. It also helps to remind support workers of the life experiences of the person living with dementia. You always need to be mindful that a person has a whole story behind them, they may have been involved in many things, or been an expert in their field of work. They may be a mother, sister, aunty, friend, or co-worker. They are many things to many people not just a person with dementia.

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Segment 9 – Features of a life story Slide 1: Index

In this segment we will cover the features of a life story. A life story is a short document that highlights key events and other things that are important to a person. It is a way for support workers to understand the people they work with better in order to give the most appropriate care for that person.

Slide 2: What are the features of a life story?

The features of a life story are made up of 6 main areas, the first three of these are the family relationships and dynamics, a persons’ spiritual preferences, and their cultural values and traditions.

A persons’ life story is also made up of important places to them, their employment, and roles throughout their life along with Leisure activities and community involvement, however as this is a large topic these will be covered in the next segment.

Slide 3: What are the features of a life story

It also includes how the features impact the person, why it is important to their life story along with the impact these features have on their daily routine.

Slide 4: What are family relationships?

Family relationships include anybody that has a connection to the person and considered family. This might include ‘blood relatives’ such as who their parents were, their siblings, and what has happened to family members over recent years, for example if they are still living and where. It might also include adoptive family details and biological family details if known. If the client got married or had a long-term relationship it would include when the person met or married their significant other, information about their children and grandchildren and any deaths of significant people in the persons’ life.

Slide 5: How can family impact the person?

This will give support workers an understanding of who is important in a persons’ life, for example the support worker would know who a person is to the client when they are talking about them. I had a client who would sometimes cry and call out a name, we learned that this was the name of her child who had died when he was a young boy. This information allowed us to treat her with compassion and understanding, knowing that she was still grieving the loss of her child. It will also help to understand the number of visitors they have and why, for example if you know they have no living family then they might be lonely and additional social supports be in place. Family is an integral part of every person, who a person is connected to impacts how supported, loved and cared for they can feel. You will have clients that have big families around and are celebrated and have regular visitors and you will have clients who are lonely and isolated.

Slide 6: Why is it important to note family in the life story

Helps to understand the person’s family relationships and their importance to the person living with dementia. It also allows you to follow and assist in these relationships as the persons condition progresses. For example, you will know who the people are in photos and can help them to remember. You will also be able to help prepare them for visitors, for example “Mavis, your son Bill is here to see you”. You will also have information to know who to contact and who not to. Understanding any tricky family dynamics within the family will help you avoid causing distress to the person or family. Sometimes families get along well and work together to support the person with dementia. But there can also be times where there is clearly the “boss” in the family who makes the decisions or argues about what the best care would be. These need to be navigated carefully so that the client is well supported and loved and not the victim of family fallouts.

Slide 7: How does family impact their daily routine?

Well, family will impact daily routine as they may become an integral part of the support system. For example, a lady I cared for when she was at the end stages of dementia, her husband would still come every lunch time to feed her and spend time with her. We knew he would do this and would provide him a lunch to ensure he ate and was cared for, but also knew this meant we did not have to provide a support person to feed her lunch. We also knew there were certain family members who would come and visit on certain days so we could ensure the

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lounge was ready for them and the client is prepared for their visit. Having a consistent routine helps the client with dementia to retain familiarity.

Slide 8: What are spiritual preferences?

A persons’ spiritual preferences are also important to note in a life story. These may be a religion that they follow or may be strong beliefs and values. Previously in New Zealand it was generally held that there were Christian and non-Christian, however in today’s multicultural society many more religions are being followed, accepted and understood such as Muslim, Buddhist, Catholic, Jewish and many others. It is also understood that spiritual beliefs do not stop at religion, but that a person can have spiritual beliefs outside of religion and that these need to be respected. So essentially this includes any practices a person follows for spiritual reasons. I could include things like being a vegan for spiritual reasons, certain exercises like yoga or tai chi or meditation. These all need to be noted in a persons’ life story so that they can be supported to continue to carry out their religious or spiritual practices.

Slide 9: How can spiritual preferences impact the person?

A person will be impacted by their spiritual preferences as it will influence what they want to do, when and how. For example, a person may want to continue to attend their religious meetings or follow traditions such as when and what they eat. It may also have an impact on their connection to their family through traditions and beliefs. Such as a family member might want them to continue to observe Ramadan but as their dementia progresses, they might no longer understand and become angry if food is withheld or they might want to continue to observe Ramadan but due to their health it is no longer recommended. These are all considerations that need to be made when working with a client. Some beliefs or practices like Yoga and tai chi, which are excellent forms of exercise for older adults, may make some people may feel uncomfortable as they believe it is a spiritual practice and therefore goes against their spiritual beliefs.

Slide 10: Why is it important to note spiritual preferences in the life story

It is important to note spiritual beliefs as it will help Identify any religious practices that are important to the person so you can support them to participate in those practices, such as helping them get to services, providing space to pray or for spiritual reflection. It also is an opportunity to ensure their food meets requirements. It is also important to note their values and beliefs, this can help to match the right support worker with the right client for example you would not want to have either the client or support person feeling uncomfortable or unsafe due to cultural or belief clashes,

Slide 11: How does spiritual preferences impact their daily routine?

Understanding the persons spiritual preferences can help the support worker to understand the clients’ needs and to assist the person you are supporting to reduce stressful or anxious situations as their condition progresses. For example, you can take them to the garden to meditate if this is something they like to do. If they are someone that has built their spiritual beliefs into their daily routine such as praying at certain times of the day or reading their bible, then you can assist with this. Also having music on that they connect to such as old hymns can help a person feel secure and connected which will reduce anxiety and music has been proven to help with cognitive functioning for people with dementia.

Slide 12: What cultural values and traditions are included

Along with understanding a persons’ spiritual preferences is the understanding of their cultural history. The life story should include information about the cultural aspect of the persons’ life. This includes the values, celebrations and traditions that are important to them and their family. For example, if they celebrate Hanukkah or Christmas, Chinese New Year, Matariki, then they should be supported to keep celebrating these. There may also be ways of doing things that are very important to the person and their culture and this should be respected. The food they eat or are not permitted so you might ask family to bring in some special food. By understanding their cultural or ethnic history might also help you to support the person in the best way. By being aware of the cultural or ethnic history may also help you to be aware of triggers to avoid, such as if the person came as a refugee from a country at war.

Slide 13: How can cultural values impact the person?

By understanding and respecting cultures, a person can be culturally comfortable, this can be a great way for a

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support worker to provide stability and structure in daily activities and is crucial to supporting the person. For example if a person is used to spicy foods and when they come to a rest home are given bland food they may stop eating, however if they are provided spices to add to their food or their family is allowed to bring foods in to share with their loved one then this will encourage the person to continue eating. If a woman is used to covering up due to her beliefs and then is put in a short sleeve shirt this could cause her distress so by understanding it is important to her to remain covered and helping her to put on appropriate clothing she will remain comfortable and secure. A persons’ cultural beliefs will impact how they want to be cared for and when you understand these they will feel understood and respected.

Slide 14: Why is it important to note cultural values in the life story?

It is important to note a persons’ cultural values in their life story as this will indicate Care preferences which need to be written in their Care Plan and adhered to, such as what they eat and what they wear. It can also help you appreciate and understand choices that they or their family might make. For example, a person who is a Jehovah’s Witness may turn down a blood transfusion as in their beliefs a transfusion makes the body unholy and it is against Gods will to receive blood into the body.

Slide 15: How does cultural values impact their daily routine?

It will also help influence their daily routine for example if they like to be showered and dressed early before morning prayers or need to be ready by a certain time to be taken to a service. It might also impact the times a person eats or has cares done. For example, during Ramadan they must eat the morning meal before dawn then having nothing to eat or drink until the evening meal. It might also determine their preference for how they spend the day, for example they may not wish to be involved in some of the activities that are on due to beliefs or they may prefer to spend the day in the garden meditating or in their room listening to hymns.

Slide 16: Conclusion

A persons’ family, their beliefs and culture are intrinsic to a person. Everyone will have a story to tell about their family and culture. Everyone’s story will influence and impact on their care. The next set of topics are around places that are important to a person, their career and leisure activities. These topics will vary in importance and size dependant on their experiences.

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Segment 10 – Features of a life story – continued

Slide 1: Index

In this segment we will continue discussing the features of a life story. To recap, A life story is a short document that highlights key events and other things that are important to a person. It is a way for support workers to understand the people they work with better in order to give the most appropriate care for that person.

So, in this segment will discuss, how places, employment and leisure activities in their life story impact on a person and finally discuss why a life story should be written.

Slide 2: How can places impact the person?

Places represent experiences and cultures which impact on a person. During times of confusion if a person wanders off, it may help to know where to look. For example, if they were discussing an experience and became confused, they might try and walk to a location that is connected to the experience or represents the location. It might also depict the amount of support they have for instance if they have moved and do not have much family around anymore. Or if they have moved to be closer to family but the area is not familiar to them, they can become easily confused when they are out. This is particularly important for people with dementia as they often go back into memories during periods of confusion as their long-term memory is more vivid than their recent memory.

Slide 3: What is important to note about places?

The life story will capture information about places that are important to the person, often starting with where they were born, this may be that they have lived or grew up. Was it in the same area all their life? Have they lived in the same country or have they immigrated from somewhere? Where a person grew up and went to school should also be noted. Knowing about places that are important to the person such as special vacation spots or where they were stationed in the war.

Slide 4: How do places impact their daily routine?

You can use places that are important to them to help you to develop a rapport with them. For example, you could ask stories about their adventures overseas or if they have been to the same place you have then you can discuss this. You could also use this knowledge to support the person through a behavioural struggle for example if you know that they are struggling to orientate themselves you could help them through this by finding out where they think they are and help with validating them. The more you know about a person and their life experiences the easier it will be to understand them.

Slide 5: How does employment history and roles impact on care?

It can help to document previous work history or roles within the community that the person has held. How much information to include will depend on how the person values the roles that they had during their working life. For example, if a person has academic standing such as completing a PhD this should be documented as they might prefer to be known as Dr or have Dr placed on their documentation. Usually the life story will describe some employment role, such as the type of career they had, or if they were a stay at home parent will give an indication what is important to them and things to talk about. It will often be the most recent one or the one that was most important to the person. It is important to remember that unpaid or paid. Remember voluntary work is significant to add in the life story as well, as it helps to fill out the picture of what is important to the person. For example, if the person was a justice of the peace or if they were involved in a community group.

Slide 6: How does employment and roles impact the person?

It is important to know the persons history so that you can understand behaviours. For example, if a person has worked in gardening or farming will likely prefer to be outside. If a person is used to getting up early for work, they will likely continue to want to get up early. Often a persons’ employment history becomes a part of their identity and helps you understand who they are. When a person is no longer able to do this role, it can cause a sense of grief, or can take some time to adjust. If a person was a well-respected academic or high-level management to then be unable to care for themselves can cause anger and frustration.

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Slide 7: Why is it important to note employment history or roles in the life story?

By understanding the previous roles, a person who has dementia had in their career, employment or volunteer work could help you relate to them. In the last slide it was mentioned that knowing the person helps you to understand their behaviour, this understanding provides context to how the person might respond to different experiences or situations.

Slide 8: How does employment impact their daily routine?

A persons’ employment history may impact their daily routine. For example it may influence how they like to spend their day, whether they like to be kept busy or not, whether they prefer to be indoors or outdoors and how social they like to be. It may also dictate how they like their daily routine, for example a person who prefers to shower at night due to doing a highly physical job may prefer to continue to shower at night after retirement. A person who is used to being up early may continue to get up early.

Slide 9: Leisure activities and community involvement

Along with a persons’ employment history and volunteer work, a person may have also belonged to clubs or had community involvement. A persons’ leisure activities and community work can be just as important to them as they employment history. Depending on the client, leisure activities and community involvement can be quite extensive. It can also include the status they held in the organisations or clubs they belonged to or community involvement they had

Slide 10: What leisure activities and community involvement are included?

Any leisure activities that was important to the person should be included. It may be sporting clubs or social clubs. For example, a client may have been heavily involved in a sport, playing it as a younger person, coaching or umpiring and being an integral part of the club. Often when people have been involved in clubs for a number of years it becomes their social circle and an important part of their identity. Leisure activities could include social clubs such as a wine club or activity based clubs such as bird watching. A club will generally involve people who have a common interest. Often people have held positions of authority or influence that has helped shape them who they are. As clubs often make up such an important part of the persons life it is important to document them

Slide 11: How can leisure activities and community involvement impact the person?

Leisure activities and community groups impact the person and their care for a few reasons, for example if they have been involved in sporting groups it may impact their health. They may be more fit and healthy, but it may also explain that bad knee. It may also impact the person as it can influence their social connections both the current level of support they have and demonstrate their ability to connect and socialise with others. If a person has been incredibly social, they may naturally be able to connect with other residents in a home more easily than people who have lived a fairly isolated life. Of note there is increasing research around dementia being linked to head trauma, particularly for those who have played rugby.

Slide 12: Why note leisure activities and community involvement in the life story?

As with the other areas of a life story, knowing a persons’ interests in terms of hobbies and activities will help the support worker know the person they are working with. The support worker may be able to find common ground of interests or be able to talk to the person about their interests to connect with them. This is the area, that even more than the other aspects of a life story, will clue the support worker into what activities the person might like to do. For example, if they were part of a trivia team they might enjoy watching some of the trivia shows on TV, or if they were involved in sports they might be keen to try other outdoor activities.

Slide 13: How does leisure activities and community involvement impact their daily routine?

Knowing about their activities and community involvement will tell you a lot about the persons interests which is very useful information about the person you support. Staying engaged in activities is a fantastic way of keeping a person stimulated and helping maintain cognitive ability. The more you are able to help a person stay interested in the activities they were involved with the longer they can stay connected to their social circle and own identity. Maintaining these connections will help keep a familiar routine which is really important for people who have dementia.

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Slide 14: Why write a life story?

As you can see from the last two segments there are many aspects to a persons’ life that helps create their life story. It is important to write this down so that future support workers can understand why work is being carried out the way it is. It also is a way of maintaining the clients voice around the type of care they might respond to when their dementia makes it difficult for them to have a say. It does not have to be a novel, just short points of key events and interests in their life. The next segment will discuss supportive interactions. Using a persons’ life story to understand them will help enhance any supportive interaction you give.

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Segment 11 – Supportive interactions Slide 1: Index

Previous sections have covered how you can get to know the clients you work with by using a personal plan and a life story. Now that you know your client, you can use this for supportive interactions. This section will cover what supportive interactions are and what makes up a supportive interaction.

Slide 2: What are supportive interactions?

Supportive interactions it a term used to describe having a good relationship with people we support, their whanau and your co-workers. It is about having a level of professionalism to maintain skills and an ability to build a good working relationship with the people around you.

Slide 3: What are supportive interactions made up of?

Supportive interactions are made up of three main aspects. These are Supportive communication skills, social interaction and physical interaction.

Slide 4: What does supportive communication include?

The way you communicate in a supportive way includes being helpful, such as working with the person to achieve a goal, being thoughtful and considerate, which means you think about the other person, how they would like to be treated and what needs they may have. Supportive communication is also communication which is companionate and empathetic which is about showing concern for the person and understanding their feelings.

Slide 5: What does supportive communication skills include?

Positive communication is not about being bubbly and happy but communication that benefits the person and the relationship. For example, knowing that Mr Smith loves his rugby, you can talk about the game on Saturday night. This is positive communication. It shows you know and care about Mr Smith and his interests. Our interactions are not just limited to the client. You also need to also be supportive towards whanau and friends as this can impact the client. If you are kind to Mr Smith but then rude to his daughter this can negatively impact their relationship or cause confusion to the client. The family need to know their family member is safe in your care, therefore you need to ensure you are respectful and communicative towards them which means to be talkative, outgoing and informative.

Slide 6: What does supportive communication skills include?

Supportive communication skills are not just limited to how support workers speak to clients and their family, but it is also about creating opportunities where a person is able to express what they want or need. For some people it can be very difficult to voice their wants and needs, but as a support worker it is your role to encourage them and provide space for them to be able to do this. You can imagine that coming into a facility, after been independent for many years can be quite daunting, therefore it is important to make sure they know that they still have choices and control over their life. It is also important they know they have the ability to contribute to discussion and interaction. This could be about making decisions related to their health or wellbeing. It might also be that there are opportunities to contribute to planning outings or activities.

Slide 7: What does supportive communication achieve?

When you use supportive communication, you can help the person orientate to time and place, such as saying hello and goodbye when you start and finish a shift, saying good morning, afternoon or evening also helps the person orientate themselves to time. By using supportive communication, you are also assisting with cognitive abilities for example encouraging the person to continue to make decisions for themselves such as what to wear and discussing interests helps them to maintain communication skills.

Communicating in positive manner also helps maintain self-esteem and independence. When a person feels they have control over themselves and situations they feel more confident. You also help maintain self-esteem and independence when you treat the person with respect. Have a think about times when you were spoken to rudely or condescendingly and how it made you feel. Then think about times where people were kind towards you and seemed to genuinely enjoy your company and care about you. You most likely felt better about yourself

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in the second scenario. This is how you need to treat your clients.

Slide 8: What are social interactions?

While communication has an important part to play in positive interactions, we also need to have a focus on the social interactions our clients experience. Social interactions are the actions or events that occur between people or groups of people. So essentially, every time you communicate with someone it is part of a social interaction. It is important for the clients you work with and your co-workers, that when you are interacting with them that you are not passing judgement on what they do, their beliefs and experiences as this helps people feel valued and safe.

Slide 9: What is included in social interactions?

Social interactions are more than just communication, it includes social contacts such as who the person enjoys being with and how many people they interact with. It is also their relationships such as with family and friends, and social activities for example whether they participate in group outings or events happening in the community or facility or choose to not be involved.

Slide 10: How can you support social interactions?

You can support social interactions by understanding spiritual or cultural needs, this way you can help support people to participate in practices which builds self-esteem. You also need to be aware of preferences, especially around culture and personal values. When we know what a person is interested in, we can tailor social interactions to be support their needs. For example, if you know there are a few men who are interested in the rugby you can organise the screening of a game in the lounge for them, this way they can enjoy each-others company experiencing a shared interest. You can also support positive social interactions by role modelling this behaviour. For instance, if you have a family who are dis-empowering a person by making all the decisions for them you can role-model empowering them by asking the persons opinion in front of the family to demonstrate they are able to do this. For example, asking the person what they would like to wear in front of the family encourages them to realise they can still make this decision.

Slide 11: What is physical Interaction?

Physical interactions are another factor of positive interactions. Physical interactions are actions within environment. What this means is what kind of behaviour a person uses and way a person responds to their physical abilities and their surrounding environment. For example, how a person responds to decreased physical ability and how they cope with things like using a walker to get around, along with aspects like navigating stairs and slops. How you interact with a person can impact their ability to cope with these changes or their willingness to tackle obstacles.

Slide 12: How to support physical interaction?

We have discussed three components of positive interactions. One of the ways you can support physical interaction is to spendng one on one time with clients is essential for supportive interactions. This is the time where you can concentrate on building rapport, understanding their needs and wants along with supporting and encouraging a person. During one on one time you should try to make time to talk and affirm people you work with.

Slide 13: What impact does one on one time have?

Child development experts discuss the importance of connection before correction, which means if you concentrate on connection there are better behaviour outcomes. The same is for adults and older adults, if you want the person to be able to trust you then you need to connect with them. They need to feel included and valued and this comes from spending time with them. One on one time is the perfect opportunity to listen to what a person has to share. It also helps give an opportunity for them to express feelings, needs and emotions. Above all one on one time shows respect.

Slide 14: Why supportive interactions

Positive interactions are the way to communicate so people feel respected and cared for. It is important to remember each person living with dementia is a unique individual and will have different needs and preferences to others. In order to properly care for people, you need to be empathetic and promote independence. You can

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use personal plans and life stories help provide you with information you need to be able to interact effectively. You can now use this information to impact the way you interact with people while doing their daily cares, which is the next segment in this topic.

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Segment 12 – Assistance with daily living activities Slide 1: Index

One of your top priorities when supporting a person living with dementia is to keep them fit and healthy, both physically and mentally. This segment will address the tasks you will need to do in order to give good care including monitoring health, carrying out care, and daily tasks that might be done. It will also discuss how to assist with personal cares, elimination, nutrition, mobility, and sleep.

Slide 2: Why monitor health?

Monitoring a persons’ health, particularly as dementia progresses, is important as they may no longer be able to identify certain health risks themselves. For example, they may struggle to identify what they are feeling is a high temperature or chest pain. As you carry out daily tasks you must look for signs and symptoms of a deteriorating condition like pain and discomfort so that you can help elevate the pain or discomfort. You also need to ensure that you work to make the persons’ life more enjoyable. This is done by working holistically to make sure that not only their physical needs are being met but also their emotional needs.

Slide 3: What is your role?

When working with a person who has dementia you may be tasked with helping a person carry out routine daily activities or ADL’s as they are known. When you do this, you need to ensure it is with as much client autonomy as possible. When the person maintains autonomy, they feel a sense of being respected and that they still have control in their life. It also helps retain cognitive ability for as long as possible. The role of a support worker is significant as you have a responsibility to properly care for a person living with dementia.

Slide 4: How so you carry out the care?

Providing support to carry out daily activities must be done with respect and consideration. This means you treat the person the way they want to be treated, supporting their autonomy and thinking about their needs and preferences as you complete cares. It must also be in accordance with their personal plan. As you will remember from previous segments, person plans are tailored to meet the needs of the person in a way that is respectful and meaningful to them. You must stay within your scope of practice, this is to keep both you and the client safe. Care must also be within your companies policies and procedures. Company policies are written to help keep everyone safe and to ensure the job is being done correctly therefore you need to make sure the way you do cares are in accordance with policy.

Slide 5: What daily tasks might you do?

The tasks you will be involved with are personal hygiene cares. You will need to give assistance with urinary and bowel cares and ensure nutrition and fluid needs are being met.

Slide 6: What daily tasks might you do?

You will also assist with mobility needs and ensure the person is comfortable and has enough sleep.

Slide 7: What personal hygiene cares will you do?

Personal care aims to support the person to maintain a clean and healthy body. This includes cleaning their body, which might be showering the person or supporting them to shower themselves, or it might be giving the person a sponge bath. Mouth care is also important, but it can be easily forgotten or overlooked. Mouthcare could include helping the person to brush their teeth and gums, or it might involve cleaning dentures according to the denture guide. Hair and skin care routines also need to be maintained which means brushing hair and moisturizing the body, which is a good time to check the skin for any bruising, marks, tears or redness. As part of the skin care you need to check their nails and keep them trimmed. Some people might also like to have their nails painted. You will also be involved in Dressing a person, this might be supporting them to dress themselves or dressing them if they are unable to dress themselves at all. Remembering to have the person chose their outfit while also ensuring what they are wearing is appropriate for the weather and the occasion. For more information on personal hygiene cares you can complete the personal cares topic available to you through care training online.

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Slide 8: How do you assist with urinary and bowel elimination

You will also be involved in assisting the person to go to the bathroom in time to use it to avoid being incontinent. This might be supporting a person to physically go to the bathroom or assisting in changing incontinence pads. Report any potential signs of urinary infection. You will also need to ensure they are clean afterwards. Avoid constipation by keeping a record of their bowel movements.

Slide 9: Why do people with dementia struggle with toileting?

People who have dementia might struggle with toileting due to not recognising the need to go to the toilet or having difficulty in getting to the toilet due to physical issues such as mobility. It could also be they might have cognitive issues which might mean they do not recognise a toilet. In order to properly care for a persons’ toileting needs you need to have an understanding of how the urinary system and bowel system work, if you are unsure of this you can go through the incontinence topic which covers this and will give you a greater understanding of how to support someone with incontinence. Incontinence is the loss of control of the urinary system or bowels. While not all people with dementia suffer from incontinence, but some may struggle with this issue.

Slide 10: How do you support a person with nutrition and fluid needs

You will be responsible for supporting a person to eat and drink. Fluids and hydration care involve ensuring the person is getting enough fluids. You might need to encourage and remind them to drink water throughout the day or let the nurse know if you have concerns that they are becoming dehydrated. You will also need to make sure the food they are eating is cultural and physically appropriate. This means making sure they are eating according to their beliefs such as some cultures do not eat beef, or a person might be a vegetarian so the food needs to ensure the person is getting a nutritionally balanced diet will accommodating these preferences. You also need to make sure the food is physically appropriate such as is it meeting their nutritional needs, can they physically eat it, or does it need to be mashed?

Slide 11: How does dementia impact nutrition?

Most people with dementia lose weight in the later stages of their condition or if they are constant wanderers. It is important for their health and wellbeing to encourage them to eat as much as possible, this might involve checking they are able to eat the food easily, the food is tasty and looks appealing. Monitoring food intake is vitally important. Also making sure there are no cognitive issues like, forgetting how to use a spoon so don’t assume if they are sitting looking at their plate that they are not hungry. If you start them off, they will be able to continue eating. Also be aware of wandering as people who wander excessively will need high calorie and more snacks to maintain any weight so give extra snacks or food supplements and larger meals. Again, care training online offer in depth topics around nutrition and fluids so please read this topic for further information and understanding of this topic.

Slide 12: How is mobility affected by dementia?

Mobility and coordination are affected by dementia as it progresses due to damage in the brain. As the disease progresses and people become more frail, they can begin to lose their ability to walk confidently and even lose their ability to walk all together. During this time, they may be becoming slower or clumsier and may struggle to hold or carry things, this can be a very frustrating time for a person as they struggle to do things they used to be able to do with ease. A persons’ decreasing ability might happen quickly or it might be slow.

Slide 13: What is your role to support a person’s mobility

Your role will be to observe signs of decreased mobility or mobility issues and report to the Registered Nurse. Once you have identified changes in a person’s mobility you will need to adjust your care to meet the changing needs of the client. It might be that you are walking alongside the person, then helping them to use a walker and eventually pushing them in a wheelchair. Their ability to walk distances will decrease and their confidence will also decrease. You can support them by ensuring they have any aids to support them and to encourage them to use the aids. You can also guide and assist them so they can maintain confidence and mobility as long as possible.

Slide 14: What is your role to support a person’s mobility?

It is important that during this time where they are frustrated and losing confidence that you show them respect

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and help maintain their dignity. It is also good to receive advice and support from professionals such as occupational therapists and physio therapists on how to best support and care for people and their mobility decreases.

Slide 15: How do you provide comfort?

As a support worker you also need to be thinking about a persons’ comfort. This includes both their physical and emotional comfort. People struggling with dementia may not be able to communicate when they are in discomfort by telling you, this is why you need to be observant and watch body language, they will tell you by wincing or tensing with certain movements that they are in discomfort or pain. They might be uncomfortable for multiple reasons such as injuring themselves during a fall, or a medical condition, or it might be they have been sitting or lying in the same position for too long. A person might feel emotional discomfort by being around too many people or being in an unfamiliar area. This is where knowing your clients and their life story can help as it might indicate situations or cues that would make them feel uncomfortable and you can support them during this time.

Slide 15: How is sleep impacted by dementia?

Dementia can affect a persons’ ability to rest and sleep. Many people experience changes in their sleep patterns such as increased napping during the day and decreased sleep at night. Research has shown that people with dementia, particularly Alzheimers become increasingly confused as the day goes on, this is known as sundowning.

Slide 16: What is your role in supporting a person to sleep

Your role is to watch for signs of tiredness and support the person to rest when they need it. This might be noticing they are tired so taking them from the lounge to their room where they can have a nap. It is also important to know about sundowning and the increased need for support during this time. Decreased sleep will have an impact on a persons’ ability to cope and can lead to behavioural issues, so it is really important to support your clients to get enough rest for their own wellbeing.

Slide 17: What is your role in providing care

Each person you support with personal cares has their own life experience this includes their culture, needs, feelings, likes and dislikes. All people, regardless of illness or impairment, must be treated with respect and dignity. You need to support and encourage their independence.

Slide 18 What is your role in providing care?

You also need to protect their privacy as much as possible. This is really important. When you provide personal care, you need to think about why you are doing the task and how you are supporting the person. This may include ways you encourage independence and how this will benefit the client.

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Segment 13 - Observing and carrying out clinical tasks Slide 1: Index

When working with people living with dementia it is important to ensure you are completing observations and clinical tasks. This segment will address assessing a person’s condition, how you gather information, what changes you might observe and what the clinical tasks are that you will undertake.

Slide 2: What you need to do?

During your cares you will be responsible for observing the person all the time. This is about what you see such as heavy breathing, wincing in pain or bleeding. You will also need to record any findings according you’re your organisations policies on documentation. A big part of your role will be monitoring which is using tools and equipment to gather information and noting changes and you will also be reporting what you have observed and monitored to others such as your manager, co-workers and nurses.

Slide 3: What is observing?

As I have just mentioned, observing is about what you see. Without even realising it you are observing things every day, for example what a person looks like or in general life, what the weather is doing. Observations that you make will be about the person and the environment around them. There are also medical observations you might make. The observations you make about the person are things such as are they dressed appropriately for the weather, are they dressed at all? What is their walking and mobility like? Is it different to how it was yesterday or last week? You will also observe their skin for example are their tears, is it dry, are they clean? You will observe their environment, is it tidy or messy? How hygienic is it? Is the room set up well for the person’s needs? Is it warm enough? Clinical or medication observations are often referred to as “obs” and you might be asked to “take someone obs”. You need to be properly trained for this task. Medical obs are things such as taking someone’s temperature or blood pressure or counting their respiratory and heart rates.

Slide 4: What is recording?

When you have worked with a client you need to record what you have observed. This means you write down what you have seen or done. There might be an obs chart where you record the persons clinical observations. This will generally have a graph where you plot the numbers you have recorded, this then tells us a story as such about the person, for example you will begin to identify where their blood pressure range normally sits and if the recording you have taken is different or the same as previous recordings. You will also record your observations in the clients notes. This is where you will note things such as if they were shuffling more or if you came into the room and they were struggling to dress themselves. You write down the things you noticed about the persons abilities and needs, and this is how information is recorded. It is also about informing other support workers and the registered nurse about any changes in the person so appropriate care can be provided.

Slide 5: What is monitoring?

Monitoring happens when there are medical tasks that need to be carried out to assess a person or a situation. You might be asked to monitor a person’s blood pressure twice daily as they are on new medications. It might also be a person has diabetes and you therefore need to support them to or by monitoring their blood sugar levels. If a person has had issues with their bladder you might be required to monitor their fluid intake or output.

Slide 6: What is reporting?

Some people may believe that recording or documenting the information is the same as reporting. This is not accurate. Recording the information is a part of reporting but not the whole thing. It is about letting someone know of the changes you have observed or found. It means a person will be looked at quicker than waiting for the registered nurse or manage to read the report you have written. So reporting is when you notice a change and let someone know. You need to adhere to the policies and guidelines of your workplace around reporting. Often it is a case of if you notice a change let the nurse know and the nurse will evaluate the course of action. Sometimes it might be that you contact your manager and they will determine the course of action. For example, if you notice the person has suddenly got a temperature, you would then tell the nurse and she would assess the person to determine if a doctor should be called in or if the person should be monitored. It is

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important to the safety of your clients that if you see a change you report it.

Slide 7: Why do you need to observe, record, monitor and report?

You need to do observations, recordings, monitoring and reporting as these are all essential parts of your role in order to keep your clients safe and well. For example, if you do not take a persons’ temperature you might miss that they are fighting an underlying infection until they are obviously sick. However, if you do note a spike in temperate you can begin to assess what is going on and help the person before they become critically unwell. You will need to be able to respond to the changes in the person you support. For example, if you notice their blood pressure is not what it normally is you can report this to the nurse or support them to see a doctor. You will also need to be able to record and report any changes that you Identify as the person may need treatment and this can only be done if the doctor or nurse knows there is a problem. So, it is to provide timely care or treatment for the person

Slide 8: How do you do observe, record, monitor and report?

You will need to make sure the observations and monitoring of the person you support is done according to the health professionals’ instructions and company policies. You may also find out what you need to do at handover from one shift to another. You will need to have been properly trained on how to do use the equipment and carry out the tasks involved with doing observations and monitoring of a client in some instances. You will need to have enough knowledge that you can notice changes in the person. Because you will work with them frequently, you will get to know them and their normal. The changes might be to their clinical observations or there might be changes in their mental state or ability to cope with daily life activities. You will also need to review the persons personal plan.

Slide 9: How to assess a persons’ condition?

As part of your role is to know your clients ‘normal’ so you know when they are experiencing changes. This means you need to become familiar with their condition. For example, is the condition they have permanent? We know dementia is permanent, but they may have other conditions going on too, for example they might get urinary tract infections, this is not permanent, however some people are more prone to urinary infections and therefore require more frequent checks. Is a persons’ condition terminal? For example, does your client have a terminal illness such as cancer alongside dementia. Is their condition unstable or stable? We know that with dementia people can have lucid moments and then moments of increased confusion. A person is also more likely to be confused at the end of the day.

Slide 10: What to assess in a persons’ condition

You also need to know if what the person is experiencing is part of a healing process for example skin around a healing wound can often be itchy. Is what the person is experiencing part of the disease process or is it something else? There are aspects of dementia that we know is part of the normal progression but we also know that things won’t happen overnight, if a person is significantly less mobile than they were the day before it would indicate that something else is happening where as a slow decrease in mobility is likely the result of the disease progression. Is it part of a normal aging process? While dementia is becoming more common as people age is it not a normal part of aging. Similarly falls are not a normal part of aging, however decreased muscle tone is a part of normal aging.

Slide 11: How you gather information

You will use your senses to gather information and these are what make up your observations. Firstly, there will be things that you see such as the person shuffling or a bruise. There will also be things that you notice through touch such as if a person feels cold or hot. You will also take note of the things you hear, for example a chesty cough or slurred speech. You will also notice things through what you smell such as if a wound is infected it has a smell to it, diverticulitis which causes diarrhoea has a particular smell to it.

Slide 12: What changes you might observe?

You might notice changes which need to be reported such as a person in pain or if you notice bruising, swelling, cuts or grazing. You might also observe that a person seems more unsteady on their feet than usual or has slurred speech. These are all physical things that you will notice so you need to listen to what the person is saying, what do you see with your eyes, how the things feel to touch so you can report any changes or things

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that are different.

Slide 13 What changes you might observe?

Other changes you might notice are emotional or behavioural changes. If a person appears more tearful than usual or lacks interest in doing things, they usually enjoy then this might indicate somethings is going on and needs further assessment. Behavioural changes happen with people experiencing dementia, they might become more aggressive or they might become more sexualised in their behaviour. So, any changes in behaviour are really important to note as it may be a change in the disease, or it could be indicating some health condition that could be treated like and infection.

Slide 14: What clinical tasks may you undertake?

The clinical tasks that you undertake will be determined by the needs of the client. They will be based on previous observations, recordings, and reporting’s. For example, you will not need to complete the task of measuring urine output for all clients but for one or two it will be an important task that needs to be carried out. Some of your clients might need nebulisers or injections, others will need dressing changes and wound care. The clinical tasks will need to be carried out in conjunction with giving support for activities of daily living and you need to ensure you are properly trained for the clinical task before you attempt it. While you are completing your clinical tasks, you will also be observing and reporting the outcomes of the tasks such as what the urine output is or how the wound is healing. You will find what to do either in the Personal Plan or as instructed by the doctor or registered nurse. Following on from observing, recording, monitoring, and reporting is how you respond to changes that you observe. This will be covered in the next segment.

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Segment 14 - Strategies for responding to changes Slide 1: Index

In this segment you will learn how to respond to change. Throughout each working day you will be faced with a range of circumstances and situations where you will use your skill sets in observing, monitoring, recording and reporting. These were discussed in the last segment so this segment will focus on how you respond to the changes you identify, risks their causes and how to identify risks, how to isolate, eliminate or minimize risk, barriers and how to overcome them.

Slide 2: How to respond to change

Whenever you identify a change in a persons’ mental or physical condition you need to respond appropriately. This is done by identifying the risks, you will also need to react to the change positively. As part of responding to change you will also need to communicate to the person about the changes and provide information to the necessary people such as health professionals involved in their care along with their family and whanau. These tasks will be discussed in more detail in this segment.

Slide 3: What causes risks?

When you are observing a person and their environment you will also be identifying risks to that person. For example, if they have started shuffling you might decide that the floor rug is now a risk for the client to trip on, so you have identified a falls risk. The environment in which a person lives needs to be continually assessed so that people can be kept as safe as possible. Risks are events, objects or environmental factors that have the potential to cause harm that you observe.

Slide 4: How to identify risks?

Risk can occur in a number of ways and is anything that could harm the support worker, person living with dementia or anyone else living or visiting the property. For example, if you are in the community the file will state whether there are dogs or animals on the property, which is because there have been experiences of people being bitten. This has shown that animals are a risk to people coming onto property. Risk is also working out what could potentially happen and taking steps to reduce the risk or minimize it. For example, on trips out people with dementia often where a name badge with a contact phone number on it, this is because people have wandered off from trips before.

Slide 5: What action do you take?

In order to manage a risk, you need to be able to identity safety issues and then report it so that safety measures can be put in place. If you do not let people know about a risk then it cannot be fixed, for example if you see a flooded area but do nothing about it then someone could slip over and hurt themselves. However, if you see a flooded area and tell people, along with taking action then the area can be cleaned and avoid people getting hurt. Managing a risk is also known as responding to a risk. In other words, you need to respond or take action to isolate, minimise or eliminate risks. A risk is not managed unless an action has taken place.

Slide 6: How to isolate risks

Depending on what the risk is you can either eliminate it or minimise it, but often the first step is to isolate it. To isolate a risk means to remove or set apart. The word isolate comes from the Latin insulates which means “Made into an island” You isolate a risk in the first instance to minimise the potential harm. This might mean putting out signs and closing off an area until a spill can be cleaned up. It might also mean isolating a person with a contagious illness. Sometimes you will isolate the risk by eliminating it straight away.

Slide 7: How to eliminate or minimise risks

In the example of the floor rug you would isolate the risk by removing the rug therefore eliminating the risk. Elimination means to completely remove or get rid of something. Some risks can be removed or eliminated such as objects that can cause a trip or fall or you clean up the water spill on the floor. Other times you cannot completely eliminate a risk and therefore you need to take action to minimise the risk. Minimise means to contain or reduce something to the smallest possible about or degree. This means you need to problem solve and work out how you can reduce the risk. For example, if a person is unsteady on their feet, you might minimise the risk of falls by giving them a walker to hold onto and be alongside them to support them. You could

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argue that a wheelchair would minimise the risk further, but this also needs to be counterbalanced by what is best for the client and their wellbeing which is to keep them as mobile as possible for as long as possible. Likewise, if you hold chemical in the facility, you store it in a locked cabinet.

Slide 8: How to react positively risks

When you are monitoring changes, you will identify risks which need to be addressed, however you will also be recording and monitoring changes from a wellbeing perspective. You will minimise risk for the persons wellbeing and respond and make appropriate changes to the care they receive to ensure they are living the best quality of life possible. How you respond to this change can have an impact on the care they receive and how they respond to the changes. Therefore, it is important that you respond to the changes positively. This does not mean you act excited or be happy about the changes, but that you respond in a way that is going to create the best outcome for the client. Responding positively would be organising a walker and supporting them down the hall when they are unsteady on their feet as opposed to just putting them in a wheelchair because its’ easier for you. If you respond to the changes in a loving, thoughtful way the experience for the person will be more positive than if you react negatively enhancing their feelings of frustration or upset. So you need to monitor the risk, make changes as necessary, keep assessing and adjusting to get a positive result

Slide 9: How to communicate to the person

You need to communicate to the person, for example telling them “I can see you are struggling a bit today with your walking, how about I get a walking frame to help you” instead of just getting a walker and putting it under their face and telling them to use it. It is best practice to communicate what you are about to do so that the person understands and doesn’t get a fright or distressed. You will also need to communicate about changes to the plan. As this will impact on their daily care and routine it is important to make sure this is well communicated as people with dementia often struggle with routine changes so you need to alleviate or ease any confusion to the client.

Slide 10: How do you provide information?

It is important to involve the person living with dementia, as well as their family in the process of care. It is increasingly recognised as being significant in support a person and giving the best quality care. With this knowledge, we can then understand the relevance of a support worker using effective communication and the value of giving quality information to the person they are working with and their family. Alongside the family and person, it is also important to share information with the healthcare team to provide the best understanding of the person’s needs and wants in order to give them comprehensive care.

Slide 11: What are the barriers to providing information?

Sometimes, it can be difficult to ensure the family and client have all the relevant information due to barriers in communication. Barriers to communication could be due to the persons cognitive ability, for example as the persons dementia progresses their ability to understand will decrease. It is still important to talk to them and tell them what is happening, such as “we are taking you to the shower”. Barriers might also be due to language difficulties, such as the person having English as a second language, or you having English as a second language and having an accent that some people might struggle to understand, particularly if their hearing ability has decreased. Literacy barriers might also be an issue, as a person ages their eyesight deteriorates making it difficult to read any information that has been written down. If there are barriers to communication, they need to be overcome as conflict could occur due to confusion and miscommunication.

Slide 12: How to overcome barriers

The person and their family still need to be involved at all times, so it is up to the support workers to find ways to overcome the communication barriers they are facing to ensure the family and client have the information they need. For example, for a person with cognitive issues it may be that they cannot retain or understand the information, this means that for bigger decisions and changes the information needs to be given to the family so they can make the best decision for their loved one. For day to day cares however, for example you want to stand them up and walk them to the shower; it is all about the tone of voice used. A person is going to feel a lot safer and more comfortable, and therefore willing to go with you if you keep your tone of voice gentle, friendly, warm and caring. However, if you burst into the room, speaking loudly and authoritarian like then they are more likely to feel intimidated or fearful and less likely to want to do whatever it is you are asking of them. Also

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maintain eye contact, if culturally appropriate. Many people have to see you face and lips moving to understand what you are saying. Standing behind them only increases confusion.

Slide 13: How to overcome barriers

Likewise, if a person has English as a second language you need to overcome this, for example there might be a staff member who speaks the same language as them, they can translate information to ensure they understand, or you can get a translator in. For commonly used information you might have a list of phrases written in both English and in their native language to help guide you. When I worked at an A & E clinic this was a quick and effective way to communicate. We had sheets for various languages that had a list of questions on one half of the sheet such as “are you experiencing chest pain?” that would be translated into their language on the other half of the sheet so they could point and either shake or nod their head and we could quickly and effectively triage them. You might also use pictures with words underneath if they are hearing impaired or have cognitive issues. During planning meetings, you can discuss with colleague’s effective strategies they have used to communicate with people when faced with a barrier.

Slide 14: How to overcome barriers

You need to ensure when you are talking to people and giving important information that you have allowed enough time as you don’t want to get part way through giving the information then realise you need to be somewhere else. Ensuring you have enough times means you do not rush through the information. Rushing through information means that valuable information could be missed or lead to confusion and coming to a decision that is not going to be the best for the person. The information you give about the person’s current care, their medications and plans along with changes identified need to be clear and accurate so that everyone understands what is going on. The information also needs to be concise and relevant, this way the person will be able to make the best decision possible. You need to check that the people you are giving the information to understand the information you have given to avoid miscommunication. The next two segments will go further into communication as it is such an important topic when looking after people with dementia.

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Segment 15 – Barriers to communication Slide 1: Index

Communication is about sending and receiving messages between two or more people. Communication happens as people exchange and interpret information. They will use varying methods to convey their message. Communication can become more complex when faced with barriers such as decreased cognitive ability with dementia. This means that sometimes communication can be misinterpreted or more difficult to understand.

So, in this segment we will look at verbal and non-verbal communication and how dementia can impact the ability to understand communication. This segment will also address other aspects that can be a barrier to communication.

Slide 2: What is verbal communication?

Verbal communication is the most obvious form of communication as it is the use of language and words to convey a message. It is common for Dementia to affect a persons’ verbal skills. This may be a confusion or mixing up of their words or the general decrease in ability to speak. A person may have understood what is said but have difficulty in expressing their response. A person may also get stuck on a word or idea making it difficult for them to express themselves. It is the support workers role to give time for a person with dementia to express themselves and to make every effort to understand what it is the person is trying to say. A person with dementia will also struggle with expressive communication which is to do with putting a sentence together in a way that makes sense.

Slide 3: What is receptive communication?

Receptive communication will also be a struggle. This is about organising their thoughts and producing sounds and speech. This makes verbal communication really difficult and frustrating for both the person with dementia and the person trying to communicate to them. You may need to repeat what you have said a few times for them to process the information. A person might also revert to their native language. If a person has learnt multiple languages throughout their life, they may use the language they have learnt in their childhood or jumble up different languages together in a sentence. As people lose their language skills, they will seek other forms of communication to get their message across.

Slide 4: What is vocalisation?

Vocalisation is one way that a person will try and communicate if words are failing them. Vocalisation is how you use your voice. It is the tone and pitch in your voice. For example, if a person is frustrated, angry or in pain but do not have the words to convey this then they may yell and scream. We have all seen a young child throwing a tantrum at the supermarket or shops somewhere. This is often seen as a child being naughty or misbehaving, however what it actually is, is a little person who does not have the words or the ability to decipher what it is they are feeling, that tantrum is often a “I’m tired, bored, hungry, angry, frustrated”. They are using vocalisation to express how they feel as they do not have the words. Similarly you may have experienced a client yelling but are incomprehensible with their words. They are trying to express themselves the only way they can. Moaning, sighing, or repeating a word are all forms of vocalisation.

Slide 5: What is non-verbal communication?

Non-verbal communication is the way in which we communicate without our voice. So this is made up of body language, facial expressions and gestures. Body language is the way in which we hold our body, for example if your arms are folded it can suggest you are feeling defensive or in need of protection. Facial expressions can also show how you feel about something, for example if you are smiling this would indicate you are happy, if you are frowning then you would appear confused or upset. Gestures are movements you make with your hands to get a message across, for example you would wave to greet someone or give the thumbs up signal to show something is good.

Slide 6: What helps nonverbal communication?

In order for people with dementia to read non-verbal cues or for you to read their cues there needs to get good lighting. If a place is dark or shadowy it can mask the facial expressions given therefore it is important to make sure that there is good lightening where you are speaking to a person so they do not misunderstand your

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intention. It can be easier for people with dementia to process and understand non-verbal communication than it is for them to understand verbal communication. You can use gestures such as pointing to an object to help a person understand your verbal instructions. Touching and holding their hand can also help to keep their attention and to help them to feel safe and cared for.

Slide 7: Factors that impact on communication

People with dementia often experience a limited attention span which means long, or in-depth conversations are very difficult for them to process or remain interested in. When communicating with people who have dementia it is best to keep it to one point or one step at a time. Instructions need to be simple and clear so don’t use too many words.

Slide 8: Factors that impact on communication

Short term memory problems also affect people with dementia, so they forget what you have said. This means that they may repeat something multiple times, or it might be that they have understood an instruction at the time, then forgotten it when they go to do the task. To help the person you might need to repeat the instruction as they are doing the task to help them remember. Forgetting the name of an object is a common experience for those with dementia. This means their communication will become confused as they cannot name what it is they or you are talking about so they will try and describe it or give it an odd name so the person they are talking to may be unsure what they are talking about. You will need to work out what it is the person is talking about, it might mean pointing out objects or recalling something that happened during your time to work out what it is they are saying.

A person might struggle with communication if their senses are overloaded. This can happen if there is additional noise around such as other people talking or the TV or radio on in the background. They then struggle to distinguish between the noises and the person talking to them.

Slide 9: Factors that impact communication

If you try to communicate with a person when there are too many distractions around, they may not be able to process what you are trying to say so ensure there is not too much going on to distract them. People with dementia may require more time to process and respond when communicating so don’t rush them for an answer or response. You will need to be patient and allow them time to process what it is that you have said and respond to you. As dementia progresses the persons’ ability to communicate will decrease and this will cause frustration and upset for both the person with dementia and their family so an inability to express themselves will impact on their communication. You will need to rely on their vocalisation and body language more to understand their needs, for example they will still experience pain, they will not be able to tell you it hurts but they will still wince, their body will tense and they may move their hand to try and protect what hurts.

Slide 10: How to use communication aids

Communication aids can be used to help a person with decreased senses such as hearing and vision. However, these aids are only effective when they are functioning properly. A hearing aid that is turned off, or if the battery is dead will not have any affect. This means you need to make sure they are turned on, the battery is working and filters are clear of wax. This also means their ears need to regularly cleared of wax too as the ear piece prevents wax from draining from the ear and it clogs the hearing aid.

Similarly glasses that are ill fitting or the wrong prescription or the lenses dirty or scratched will not benefit the person so make sure they are cleaned with a microfibre cloth at least once a day and never put the glasses with the lenses on a hard surface as it will scratch them. Communication aids can be difficult for people who struggle with dementia as they may know something is not right but may not be able to communicate what it is. As a support worker you need to be checking that communication aids are functioning and fit for purpose. Clearly hearing aids that are not turned on and the battery not working hinders a person. Also glasses that are not fitted properly, dirty, have scratched lenses and not the right prescription for the person vision also hinders a person. So, look out for signs that the prescription needs to be changed, such as squinting, or moving writing closer or further away.

Slide 11: How to choose a communication partner

A communication partner is someone who has known the person for a while such as a partner or child and is

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significant to them, who can help them to communicate. This person is someone who the client feels safe with and has a good rapport with and prefers to communicate with. The communication partner is someone who helps them to communicate and make sense of what is going on in their world and environment. This person is able to encourage the client to engage in social conversation as they can understand what they are trying to say due to past experiences and interests. A communication partner will use both verbal and non-verbal communication to help the person to express their ideas and opinions.

Slide 12: How culture and background impact communication

A persons’ culture and background will impact the way they communicate. People with dementia may express themselves in a way that connects to their culture and background. Many cultures have different customs or traditions about the way they speak or communicate. For example, in some cultures the person looks down while someone they are speaking to you as a sign of respect. There are also generational cultures, for example men who went to war were conditioned to be racist, it was a way of dehumanising the enemy, so you might find that older men can be quite overt in their racism when they experience dementia as they lose their ‘filter’ of what is appropriate to say and not so their life experiences may influence communication. Age also impacts the way people communicate and expect to be communicated to. It is important that you still treat an older adult with respect, regardless if they are experiencing dementia or not. For some cultures it may be more appropriate to ensure you have someone of the same gender working with a person. For example, a Muslim woman is not supposed to be touched by a male other than family. Some woman and men simply prefer to have someone of the same gender looking after them.

Slide 13: How a person life story can help with communication

Throughout this topic we have discussed how important a life story is and how the use of a life story within a care plan can impact the care given to a person. This is true too for communication. Using the life story effectively you can identify who will be able to communicate with the client most effectively such as loved one, particular worker, particular gender and also how to best communicate for example if the person responds really well to pictures or if there are particular words or phrases that help them to remember tasks. The last segment in this topic is next and it will discuss how you can use effective communication to support your clients.

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Segment 16 – Communication skills Slide 1: Index

When a person communicates, they use both verbal and non-verbal communication which affects the way the message is sent. This will either result in a positive or negative message being sent or received. Positive interactions can help reduce stress and anxiety. This is particularly true for clients who live with dementia. Dementia brings about a set of challenges for effective communication. This segment will address effective communication skills when working with people experiencing dementia.

Slide 2: How to communicate effectively

When you are working with people it can become easy to make assumptions about what you think is best for them or what you think they want in any given situation. You may even think it is helpful to the person when you make assumptions as it takes the pressure off them having to communicate. However, it is important that you do not assume you know that the person wants. You need to continue to ask them so that they can have as much autonomy as possible, it also helps them maintain communication skills. You also need to avoid giving orders. People need to be reminded of what they can still do, not be told what they can’t do. During our day we make many choices, it is a part of how we know who we are and what we like. We would not like it if someone dictated our lives to us. People living in facilities with dementia already have many choices taken away from them, they are told what the meals are, and the TVs are often set to particular stations, therefore it is important that we give them as many opportunities to decide as they can cope with. For some people it might be giving them two options to choose between and that is enough for them to cope with, others will like to decide as much for themselves as they can.

Slide 3: How to communicate effectively - coercion

You also need to avoid coercion. Coercion is persuading someone to do something by force or threats. It is a form of bullying. People with dementia can often feel overwhelmed or confused, your job is to protect them in that state, not abuse them in that state. It can be easy to convince a person to do what it is you want rather than take the time to work out what it is that they want to do. You also need to ensure you are not patronising in your approach, this means that you respect a person and avoid talking down to them. Talking down to someone is when you treat them like they are inferior to you. You need to ensure the care you give is not bulling, demeaning, patronising or authoritative, but rather calm, compassionate and respectful

Slide 4: How to communicate effectively - respect

While a person with dementia may struggle with memory issues, they have still lived a full life with amazing experiences and gained knowledge. This needs to be respected. They are not little children and do not need to be spoken to like a child. “Talking down” to a person is disrespectful, even if they can’t express their frustration and hurt at being disrespected, they will still feel it. When you treat a person with respect this will come through in your tone of voice, gestures and facial expressions as well as the words and this will be picked up on by the client and help them to feel safe and cared for. We also need to respect their preferences, it may not be what we would have decided but it is their life and their right to have their preferences respected.

Slide 5: What is positive communication?

Some ways that you can ensure you are communicating effectively with someone is to get their attention from the beginning to avoid startling them. This can be done by approaching them from the front and using their name when you call to them. When you are talking to them Face the person, if it is culturally appropriate to do so then make eye contact and if you can be that the same eye level when you are talking, this unconsciously tells a person they are equal to you, when you stand over a person it tells them you think you are more important or powerful than them. Be gentle and calm in your demeanour. Sometimes it is easy to feel rushed in this role and if we take that feeling of rushed into the persons’ space and can increase their anxiety. Before you go into a room you should stop, take a deep breath and slow your pace down so that they can pick up on your feeling of calm. Remember, people with dementia rely on body language to gauge a situation so if you are feeling stressed or angry that will come through in your body language.

Slide 6: What is positive communication?

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You can also use gentle touch to help get or keep attention. Touch is a way of drawing a person to you, so a person is more likely to stay focused on what you are saying if you are touching their hand while you say it. It is also a way you can show care and warmth to help a person feel safe. Eliminate distractions, as mentioned in the last segment, people with dementia can get distracted easily or feel overstimulated easily, therefore it is important to have no distractions when you are talking to them. This might mean having to pick your times carefully, as if they are enjoying a TV show they might not like you turning it off to tell them something. Remind people of upcoming events, for example reminding Mrs Smith that her daughter is coming to visit so it would be a good idea to get dressed, if she becomes flustered during the process of getting dressed remind her again that her daughter is coming to visit, this will help them to retain the information and to focus on why they are doing a task. Music and singing have been proven to be highly effective methods of communication with people experiencing dementia. It has been researched and shown that even people who struggle to put a sentence together can remember lyrics and sing along with songs they connect to from their past. This can be a great way to connect with a client.

Slide 7: How to give Instructions

When giving instructions keep them short, clear and one point at a time. This will help decrease confusion. Use familiar ideas. This is about using the same language each time a task is done, it is not helpful if one person calls something a scrubbing brush and another calls it a “doofer” there needs to be clear language that the person is familiar with for tasks and objects. Allow time if people feel rushed it can cause them to feel more confused. They will need time to process the information and respond to it.

Slide 8: How to ask questions

When you need to ask questions, it is a good idea to keep the questions simple. This means the questions is short, direct and the person is able to give simple answers to. If you need to repeat the question, try and use the same words as it can help them to process the questions easier instead of having to process new words. Sometimes a person might just be having a bad moment and it can be helpful to try again later when they might be doing better cognitively.

Slide 9: How communication is a partnership

When you are working with a client you should be aiming to develop a partnership with the person you are supporting. This means that you get to know their preferences and work together to achieve common goals. You will learn the persons retained abilities and involve the person in what they can do. This is a way of showing the person respect and helping them retain as much autonomy and skills as possible.

Slide 10: How to promote social interactions

As you get to know your person you will also be able to help them with social connections. You can do this by making sure you introduce the person to other people for example if you are seating them at the table with others. As you begin to know their interests or hobbies you can provide opportunities for them to discuss their hobbies with others for example if you know they enjoy rugby you could take them to the room where rugby is playing and introduce them to others watching the game where they can cheer the team on together. You can also ask them about their activities or interests such as if they are knitting you could ask them what they are knitting.

Slide 11: How to promote social interactions

You can also help them retain memories by asking about the photos in their room if they have any and encourage them to talk about their families and friends. You might also find out what they did as a career and bring in articles or books about their old work or interests. For example, if they were an architect, they might enjoy looking a pictures or books with different styles of buildings. If they like bird watching, you could get books with various birds in for them to enjoy.

Slide 12: How to promote positive interactions

The most important thing you can do is to ensure your interactions are positive. People can tell when you are being fake or pretending to care and it is not helpful to their wellbeing. Ensure you are calm. If you have just had a stressful moment, then take time to breath and calm down before you work with the next person as they will feel your stress and it will negatively impact your time with them. Ensure there is good light so the person can

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accurately see your facial expressions and gestures to help understand your communication. And above all, with everyone you interact with, be respectful, genuine and caring.

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