“Learn to be constructively critical of your and others’ observations”


Trisha Grocott p30 FIG 1. KITWOOD PLUS Dementia care planning


programme to help carers develop insights into their practices. Third anchor: care theory is functional


when reinforced regularly to strengthen practice. This process embeds our model in


Relationship


practice. Fourth anchor: caring skills are mostly


hidden and tacit, elicited through refl ec- tion. Refl ection is used to search for solu-


Daily experience


tions to develop stronger relationships. The four anchors drive our centre to


PERSONHOOD


Actions (what)


Occupation Identity LOVE Comfort Attachment Inclusion


Interactions (how)


ensure residents have a rewarding and ful- fi lling day. They are instrumental in building a pattern of care behaviours that staff emulate in practice.


Identifying diffi culties We identifi ed two signifi cant challenges in implementing Kitwood Plus. The fi rst involved the conceptual leap


that staff must make from a model focusing on ADL to one based on quality of interactions. Kitwood Plus makes person- hood, relationships and daily experiences the priority, so ADL become supporting activities. Personhood in dementia care is the single factor that carers must maintain and promote if we are to see the person fi rst and then the condition. We facilitated this through several


in dementia care planning, namely relationships and daily experiences, sup- ported by Kitwood’s six strands. Our experience of Kitwood’s original


model confi rms that it does not focus on the critical themes above, but promotes love and affection through the strands. This is not enough; it should be built on relationships and daily experiences of our residents to be of any use. Kitwood Plus emphasises what is done and how it is done to enhance personhood. This has powerful implications for care practice. The pillar of Kitwood Plus (Fig 1) is the


quality of interaction between carer and the person living with dementia. Drugs have limited value and are mainly for symptom control. Enhanced personhood plus high-quality interaction result in pos- itive daily experiences, and can be achieved by using the STEP tools. Positive talk includes conversational life review, which is more benefi cial than reminiscence (Bohlmeijer et al, 2007). These are basic, inexpensive tools that carers can use to maximise relationships


and enjoyable experiences. When practi- tioners apply these tools consistently, they visibly strengthen care practice. Carers connect with the person fi rst


then care. It is not just about seeing the person fi rst; connecting with them is more critical to initiate the relationship to max- imise daily experience. No connection means no communication and poor care. STEP fi rst to connect, then offer care.


The anchors Palm Court established four anchors in implementing our model. First anchor: people living with


dementia need consistency and stability in their care.


Employing temporary staff is likely to


interfere with the quality of interactions. A stable workforce is essential. Second anchor: the learning culture is


a strategy for excellence. There is a strong relationship between an organisation’s learning culture and the quality of its care (Shipman et al, 2011). We have a structured in-house training


refl ective sessions on personhood, con- necting with people, quality of living expe- riences and relationships. Carers observed the amount of interaction residents were involved in and whether they were with- drawn or uncommunicative. We developed strategies to increase interactions, as a prolonged state of reduced activity or increased sadness or anxiety can develop into illness such as depression and anxiety. The diffi cult issue was that the care


plan emphasises personhood, while staff and social services were accustomed to focusing on ADL. We felt that a total removal of ADL would create uncertainty and possible confusion, so we decided to frame the care plan with actions (what carers have to do based on risk assessment and residents’ profi le) and interactions (how to be positive). We held several meetings with all staff


and shared our thoughts and framework. There was a consensus that our approach had many merits and staff supported the change of format. Through the refl ective sessions, we established a unity of purpose and a clear understanding of what helps people to live well with dementia. In prac- tice, staff recalled: “It was like learning to care again – STEP into the world of dementia.”


www.nursingtimes.net / Vol 108 No 36 / Nursing Times 04.09.12 13


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