Mirror Reflective learning at work

MIRROR

Reflective Learning at Work
Exploiting Apps to Support Dementia and Residential
Care

© MIRROR Project - Co-Funded by EU IST FP7 – www.mirror-project.eu

Event Agenda
1.
2.
3.
4.
5.

Introduction of Mirror, reflective learning and app sphere
The Digital life history app and manager
The Yammer App extended with reflective learning
The 3D Virtual care home App for carer training
The CaReflect App with proximity sensors to provide
evidence about care activities to reflect on
6. The Carer App for challenging behaviour
7. Adoption, exploitation and funding options
8. Collaborative buffet lunch for further discussions


MIRROR
How technology can help care home
staff reflect and learn
Ian Turner
Chairman RNHA


Registered Nursing
Home Association
▪
▪
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1000 small and medium Care Homes in membership
Based in Birmingham with 10 staff
20,000 staff checks on DBS per annum
Roadshow of current issues annually
Represents members with government, regulator
and other professional bodies


The Mirror Project
▪
▪
▪
▪
▪

Theme “Reflective Learning”
Four year EC funded project
Middle of the final year
Collaboration of various european universities
Testbeds also include european partners, eg italian
emergency services and german neurological clinic


Why Dementia Care and
Reflective Learning?
▪ Healthcare can offer limited support for dementia
being task / intervention based
▪ Social Care “enabling” is the dominant model
▪ That enabling requires staff to understand the
behaviour of the individual
▪ Requires staff to be a detective to reflect on
information known about the person


Caring for those Living with
Dementia
▪ In the late stages of the disease all the medical
model can offer is sedation
▪ Task based care will usually lead to confrontation
between resident and carer
▪ Supervision and enabling care is the aim
▪ Care Planning is not just task / issue based


Care for those Living with
Dementia
▪ Carers need to know as much about the person in
order to understand the behaviour and preferences
of the individual
▪ Gentleman wakes at 4am every day
▪ Devon lady becomes agitated in early evening

Currently record life history on paper but life histories
only started on admission


Dementia
▪ Memory from this morning will be minimal, if at all,
which means the person will not remember the last
meal or drink
▪ They will not remember their visitors or probably
where they are living
▪ Long term memory will be much clearer
▪ Boredom and inactivity can result
▪ Need to start data capture on diagnosis


Care for those Living with Dementia

▪ A range of “meaningful activity” is required
▪ Activity cannot be restricted to 2-5pm on weekday
afternoons
▪ All care staff must be responsible for such activity in
partnership with activity staff
▪ A part time secretary
▪ Childcare remembered
▪ Swimming for a resident



▪ We need a range of therapies:
▪
▪
▪
▪
▪
▪
▪

Music
Doll
Complimentary therapies, eg reflexology
Garden based
Hobby based
DIY – the man’s shed
etc


Dementia
▪ Staff cannot be “robotic” in delivering care to those
living with dementia
▪ Staff must think about how to approach residents
▪ Staff must see the whole person they are caring for
▪ Staff must think about why residents are reacting to
them in a particular way



▪ NICE have set an English standard for dementia
which concentrates on diagnosis and early stages of
the disease with some elements applicable to the
later stages.
▪ My three major factors for later stages are
▪ Life Histories
▪ Meaningful activities, and
▪ Reflective practice


The Carer Role
▪
▪
▪
▪
▪
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Demanding role
People skills are vital
Values are central
Person centred
Technical skills can be taught
Staff training is significant effort


Standards in Social Care in
England
▪ Regulatory standards – 360 of them in Essential
Standards of Quality and Safety
▪ Just about to start another set where the inspectors
judgement will be about is the service safe, is it
effective, is it caring, is it responsive to people’s
needs, and is it well led?
▪ This will be the fourth major upheaval in ten years


Standards in Social Care in
England
▪ Whilst these standards are not prescriptive (and will
not be in the future) this means that everyone has
got a different angle / statement / value
▪ Take medication, is it zero tolerance to recorded
administration, zero tolerance to medication not
being available or some other measure. Compare
with general compliance.


Standards in Social Care in England

▪ Consequence is
▪ Staff nervousness of not doing the right thing
▪ Lack of confidence in many homes
▪ Different views and performance levels being demanded
by regulators, commissioners, environmental health or
safeguarding staff
▪ Hence providers need to be very clear to staff about the
standard of performance expected of them, which is a
challenge


Information Technology in Care
Homes
▪ Generally restricted to the manager and
administrator
▪ Typically payroll and accounts
▪ If care plans are stored electronically they will not
be available to care staff outside office hours
▪ 98% of Care Home had internet access 3yrs ago, but
access very limited


Social Care and Information
Technology
▪ We are at the data capture stage in the sector
overall
▪ Systems are percieved as for the administrator and
manager
▪ Outside MIRROR - medication is a good example –
the first systems are just coming into use
▪ Infrastructure, eg WiFi, in most homes, not
available


Issues Arising from Research
▪ There is little formal reflection in most homes
(“too busy”), but widely accepted as needed.
▪ Significant change in acceptance of care staff to
technology. Now, often ahead of management!
▪ Many care homes lacking IT infrastructure, with
poor provision for carers, and hardly any for
residents, but the demand is coming.
▪ A need for care staff training, including how to
help and mediate the technology for residents.

Current Position
▪ All MIRROR apps were received positively by
homes and staff.
▪ Now second round of testing in residential care
homes. Again, positive responses, particularly
among new and inexperienced staff.
▪ New & novel apps for staff are seen as a
refreshing change. They won’t replace traditional
training, but can have a part to play.
▪ MIRROR believes that, at last, the time for
technology in residential care homes has come.

NHS Number
▪ Department of Health wishes to encourage the
collection and use of NHS Number to facilitate data
exchange between all parties.
▪ Currently only asking for collection and storage of
NHS number
▪ Validation rules at
http://systems.hscic.gov.uk/nhsnumber/stafffaqs.p
df


The Digital Life History App


The Digital Life History App
Tablet-based app providing resident life information
▪ Paper-based storybooks difficult to update and share
▪ Existing digital solutions insufficiently flexible

Key app features
▪
▪
▪
▪

Life history information updates by carers and relatives
One-stop for information, videos and external links
Supports reminiscence through stories with residents
Guiding personal care on myhomelife care values


The Digital Life History App:
Architecture and Evaluation

Carers

Carer

Resident life
Resident life
history
history
information
information
database
database

Relatives
Resident life
history manager

Server
Server

Resident life
history app

Early use in one residential home
▪ Digital Life History Manager used to document full
resident life histories from physical books

Resident

The Extended Yammer App


Extended Yammer App
Replace paper notebook with
mobile app
▪ Adapt enterprise microblogging as prototype
▪ Direct in-situ care note entry
on mobile device
▪ Direct access to all care
notes about resident
▪ Real-time supervision of care
progress
▪ Integration with electronic
care record systems

Extended Yammer App Architecture

Exported
care notes

Carers

Resident care
Resident care
record
record
database
database
Care note
reflections
Device
Device


Server
Server

Extended Yammer App Evaluation
Used effectively in residential homes
▪ Carers able and willing to use app during and after shifts
▪ Increased number and detail of captured care notes
▪ Some increases in number of reflections about care

Important contextual factors
▪ Fitted with flexible care work practices
▪ Used before shift to prepare for care activities
▪ Perceptions of relatives sometimes negative

Future app evolutions
▪ More explicit support for reflection about residents
▪ Contextualise care notes in digital life history

Virtual Care Home App
• 3D game for the health
and care sector to train
carers deal with difficult
dialogues and stressful
situations at work
• To facilitate the
reflection process
during the training and
to giving users a virtual
tutoring support during
the gameplay.

Virtual Care Home Components

Serious Games

User Tools for reflection

3D Virtual Care Home
Mini Games
Branching Stories
Virtual Tutor

Wizard tool for content
Self-evaluation;
Global feedback;
Graphic comparison;
Learning diary.


The CaReflect App and Proximity
Sensors


CaReflect


33

Architecture

▪ CaReflect
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Configures Sensores
Visualizes Data for Carers
Overview for management
Runs on a PC

 Sensors
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Small and light weight
Robust casing, no buttons
7 days on one battery
No further infrastructure
required

2-3m (7-10ft)

34

Summary
▪ Measure and Quantify Care
 Wearable sensors
 Visualize contact times

▪ Current state – after test in two care homes
 Very positive feedback, e.g. initiated group discussion
 No privacy concerns but various benefits are envisioned
 Neglect monitoring
 Evidence to relatives

 Preparing for next study
«CaReflect does not try to provide the answers but
helps to ask the questions»

35

The Carer App


Carer App
Personal support to resolve challenging behaviour
with creative thinking that personalises care
1. Other, less-constrained worlds to resolve case
2. Analogical cases to transfer ideas to resolve case
3. Previous dementia cases to reuse ideas to resolve
case

Case base of good practices
▪

Natural language descriptions of successful care
work

Simple audio-recording of ideas
▪

Structure, playback and export care plans to share


Carer App Architecture

Case-based reasoning
Case-based reasoning
discovery service
discovery service
Analogical reasoning
Analogical reasoning
discovery service
discovery service
Carers
Creativity prompt
Creativity prompt
generation service
generation service
Server
Server


Good care
Good care
practice xml
practice xml
repository
repository

Carer App Evaluations
Used effectively in residential care homes
▪ Carers used retrieved dementia cases over others
▪ Generated, played back, improved and shared audio ideas
▪ Led to care improvements attributed to recorded ideas

Important contextual factors
▪ More app use outside of shifts – time and space
▪ Align app use with care home values, practices

Future app evolutions
▪ Integrate idea generation with digital life histories
▪ Enhanced web support for collecting good care practices

Third-Source Funding Options


Third-Source Funding Options
1. Knowledge Transfer Partnerships
▪ Fund 50-67% of project for 1-2 years
▪ Product development, service rollout
▪ Incremental proposal process

1. Collaboration with Charities
▪ For example Leverhulme Trust,
Joseph Roundtree Foundation,
Dementia Action Alliance

1. Bilateral Development Projects
▪ Seek University resources to support


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