Dementia care
supporting and guiding. Tom flops back into his chair but still has his gaze focused on the television. Nigel, Angela’s husband arrives. He
takes time to say hello to Angela and the other ladies in the group before standing stiffly in front of the television to take off his coat. Nigel sits next to Angela, with his back to Tom, talking volubly to his wife about the garden, the dog and the weather. A staff member brings drinks and stands in front of the television chatting. Nigel continues to talk loudly so that
Angela can hear him. There is another burst of vacuuming. Tom picks up his walking stick and shouts across the room to a staff member to get him a drink as “nobody has asked me what I want all bloody day”. The staff member looks across at me and says; “See, I told you he was difficult.”
A familiar tale Does the scenario detailed in the case study sound familiar? I often see a person living with dementia labeled as ‘challenging’ or ‘disruptive’. Yet when we step back and see things from the perspective of the person it is clear that they have been dismissed or constrained within an environment that does not support their needs. In the debrief that afternoon we talked
about ‘what worked’ and ‘what didn’t work’ for Tom, staff and others focusing on the experience of people being brought together in the TV lounge. ‘Working’ or ‘not working’ is a person centred thinking tool that helps to look at a situation from different perspectives to support a person to do more of what
they want and identify areas for change.2 Table 1 shows a simple breakdown of the conversational threads that emerged when I asked staff to think about the morning from different perspectives. It was interesting to hear staff
question each other about why people were brought into the relatively small space of the TV lounge. It soon became apparent that it was partly because they felt they had to, and partly for staff convenience. The TV lounge is close to the dining room, the toilets and the kitchen. It is easy for staff to “keep an eye” if people are grouped in that place. Interestingly, although staff stated
that they were concerned that Tom was disruptive, they continued to sit others near him. When asked to reflect on this staff said that all of the ladies needed help, so it was easier for them to be together. The TV lounge was out of the way and not many people used it, so it was considered okay to group ladies there who needed more support. Critical questioning and reflection
helped staff to realise that people were being brought to the TV lounge because, well, they have a TV lounge. Tom’s meaningful experience was disrupted when others were brought to the space. Staff attributed his outburst to “his dementia”, when in fact it was an understandable expression of how frustrated he must have felt. Many of us, I am sure, would react in a very similar way if people had repeatedly walked in front of our favourite show.
Conclusion The case study highlights that it is not enough to build new spaces, or to
Creating the space is not enough. We need to rearrange our thoughts about the use of space
rearrange furniture to maximise space in existing settings. Creating the space is not enough. We need to rearrange our thoughts about the use of space. Critically we need to reflect on who the room and the space, belong to. It belongs to those that pay to live there and not to those that are paid to work there. TCHE
References 1 School of Dementia Studies, University of Bradford. Dementia Care Mapping. [
www.tinyurl.com/hnr7rq8].
2 Helen Sanderson Associated. What’s Working/Not Working. [
www.tinyurl.com/jmtp52y].
Tanya Clover
Tanya has been involved in supporting organisational change across the health and social care sectors for over 20 years. Utilising her extensive knowledge of the practical application of person centred care models she has a proven record of success in directly influencing the experiences and outcomes for people living with dementia. Previously a practice development consultant and trainer for the University of Bradford School of Dementia Studies, she remains an accredited Dementia Care Mapping trainer for the university.
The ultimate toilet seat for a dementia care setting Introductory offer - Save 10%*
- - Cast metal, soft-close hinges
*Buy online using the discount code ‘Ult100’ Offer ends March 13th 2017
(2017)
24
www.thecarehomeenvi ronment .com • January 2017
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44