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Kaye Ervin, Cobram District Health: Utilising volunteers to deliver person-centred care for dementia in acute care
 

Kaye Ervin, Cobram District Health: Utilising volunteers to deliver person-centred care for dementia in acute care

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Kaye Ervin, Research Fellow & Lecturer, University of Melbourne, Cobram District Health delivered this presentation at the 2014 National Dementia Congress. The event examined dementia case studies and ...

Kaye Ervin, Research Fellow & Lecturer, University of Melbourne, Cobram District Health delivered this presentation at the 2014 National Dementia Congress. The event examined dementia case studies and the latest innovations from across the whole dementia pathway, from diagnosis to end of life, focusing on the theme of "Making Dementia Care Transformation Happen Today. For more information on the annual event, please visit the conference website: http://www.healthcareconferences.com.au/dementiacongress2014

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    Kaye Ervin, Cobram District Health: Utilising volunteers to deliver person-centred care for dementia in acute care Kaye Ervin, Cobram District Health: Utilising volunteers to deliver person-centred care for dementia in acute care Presentation Transcript

    • Utilising volunteers to deliver person-centred care for dementia in acute care settings National Dementia Congress 20th February Kaye Ervin
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Background • Action research project • A volunteer in the aged care facility identified a need for volunteers in the acute care setting • Acute care staff agreed that patients with dementia presented difficulties • A previous project demonstrated good outcomes and feasibility
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Literature review major findings • Currently estimated that 50% of all people admitted to acute care have some degree of cognitive impairment [1] • There is potential for adverse outcomes for these patients in an acute environment [2] • Carers and families report widespread dissatisfaction with care for confused, older people is acute settings [3] • Nurses report challenges caring for patients with dementia in acute care, against a backdrop of time constraints and competing demands [4]
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings • Translating research into practice project funding from the Vic/Tas Dementia Collaborative Research Centre provided the necessary resources.
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings The aim of the project was to improve the emotional and psychological experience and care outcomes of patients with dementia admitted to the acute care setting, through; 1. Recruiting and training volunteers in a person-centred approach to supporting people with cognitive impairment 2. Development of enduring guidelines and policies to facilitate the recruitment, training and implementation of the volunteers for a sustainable program 3. Evaluation of the program
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Project methodology • • • • Convene an advisory group of key stakeholders Recruit volunteers through local media Train volunteers Develop policies and guidelines • Educate staff • Implement volunteers • Evaluate the program
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings The advisory group (10 members) • Research Academic, Director of Clinical Services, Volunteer, Community member, Risk & Quality Support, Nurse Unit manager, Registered Nurses x 4. • Met fortnightly to oversee recruitment, selection, training content and develop and adapt policies from a former project
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Recruit Volunteers • Articles in local newspaper and snowball effect, resulted in 12 community volunteers offering their services
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Train Volunteers • The VAG suggested appropriate content such as safe walking, meal assistance, confidentiality • Practical components included in training days such as use of wheelchairs and feeding elderly people • Principles of PCC • Training was conducted by an educator over a two day period, on site.
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Develop policies and guidelines • A previous project undertaken by Catherine Batemen at Bega Health Service provided existing policies and guidelines • Many were adapted to suit our service (referral forms, volunteer documentation, volunteer duty statement and responsibilities) • Others were developed to be service specific (consent, recruitment, patient profiles) • Very time consuming process!! But essential for sustainability
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Educate Staff • Documents developed or adapted by the VAG were explained to staff of the acute ward, and they were instructed in their use (referral forms, consent) • Posters and flow charts also instructed staff and gave contact numbers • Staff were very enthusiastic
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Implement Volunteers • Volunteers nominated attendance times 8-12.30 am and 4-7pm Monday to Friday • For the initial 2 weeks of implementation the research academic was on site for support and to ensure consistent practices • Then available by phone
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Volunteer role • Check for referrals • Complete a patient profile • Utilise the resource box to engage patients in activities • Assist with walking, meals, physio • Chat • Document their activities, what worked, what didn’t • Liaise with staff
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Project evaluation • Limited to qualitative evaluation due to the small sample size • Anecdotal reports of improved patient outcomes (reduced falls)
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Evaluation • All staff invited to undertake an interview by posting an invitation in pigeon holes accompanied by the interview schedule • Staff interviews (16 eligible staff during the two week time period of interviews) • 93% response rate • Audio-taped interviews conducted in the workplace at an agreed time by the research academic
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Data Analysis • Audio-tape transcribed and analysed collaboratively by the research academic and an independent researcher experienced in qualitative research • Identified key words and recurrent concepts
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Findings • Improved time management for other tasks • Increased patient stimulation • Increased patient safety • Extension of the program
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Improved time management for other tasks • ….I find it’s a real relief for my staff because they can go and do the jobs that they need to do without having to spend so much time with one person. What’s been good is that it’s freed up out time to continue with our other work and we’re happy to know that the patients are being looked after. • …those patients are quite disruptive often and they take up a lot of our time just redirecting and the things that volunteers do is engage them, and keep them occupied so that we’re not spending excessive time with them. That gives us time to go on with our other work.
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Increased patient stimulation • • • We don’t have time to do what they do. They spend one on one time with people who really need their company. The volunteers help them pass the time. Reading the newspaper to them, it keeps them more focused on everyday situations, where the nurses don’t sit there and do that with them. They don’t have time to do that and I think all those things are worthwhile. We can’t read newspapers to them or anything like that. It’s just good that volunteers can come in and help and spend quality time with patients, explain things that they might get confused about and reinforce things that they might forget…..it’s good continuity because they have the same volunteer for a long period….having the same person to talk to, I’m sure it helps.
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Increased patient safety • We are a small, busy hospital, we can be very busy and it just really helps with the higher risk patients, and its also a great support and comfort for them as well. • We can get on with our work knowing those people are safe, where before it was a constant concern, you know, like “will they fall out of bed while I’m in the next room?’. Now we have peace of mind that that won’t happen.
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Extension of the program • We are a seven day a week, twenty four hour service after all. Their confusion doesn’t stop at five pm Friday. We’d like it too but it doesn’t. After having volunteers here all week, we really feel it on weekends now. • Weekends would be good and visiting people who don’t have dementia, just those who are lonely or have no one visiting.
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Conclusion • Volunteers are a valuable resource to benefit patients with dementia by providing cognitive stimulation and improved patient safety through the constant presence at busy times.
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Sustainability • Driven by the volunteers with minimal staff input •Volunteers phone in daily to ascertain if they are required •Staff complain loudly if no volunteers are available •Monthly volunteer meetings to discuss issues of concern •Extended to other patients
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Implications • Volunteers are a rich, but under utilised resource in health service settings • Process can be easily replicated for any service size • Staff, volunteers, patients and families benefit
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings References • • • • [1]Yates, M., Theobold, M., An all of hospital program to improve the awareness of and communication with people with cognitive impairment, linked to a bedside cognitive impairment identifier. . Neurobiology of Aging, 2010. 25. [2]Borbasi, S., Jones, J., Lockwood, C E. , Health professionals’ perspectives of providing care to people with dementia in the acute setting: toward better practice. GeriatricNursing, 2006. 27: p. 300-307. [3]Jurgens, F., Clissett, P., Gladman, J., and Harwood, R. , Why are family carers of people with dementia dissatisfied with general hospital care? a qualitative study. BMC Geriatrics, 2012. 12(57). [4]Jones, J., Borbasi, S., Nankivel L, & Jockwood, C. , Dementia related aggression in the acute sector: is Code Black really the answer? . Contemporary Nurse: A Journal for the Australian Nursing Profession, 2006. 21: p. 103-115.
    • Utilising volunteers to deliver person-centred care for dementia in acute care settings Ervin, K., & Moore, S. (2014).Rural nurses perceptions of a volunteer program in an acute setting: Volunteers delivering person-centred care for patients with dementia and delirium. Open Journal of Nursing. 4. (http://wwwscirp.org/journal/ojn/) Further discussion or questions?
    • © Copyright The University of Melbourne 2008