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Dawn Collins, Assistant Director of Nursing, Norfolk and Norwich University Hospital NHS Foundation Trust

Background

The setting for the initiatives is Elsing Ward, which provides acute medical care for elderly patients in a 37 bedded ward. The ward is one of six elderly care wards, and is where the majority of elderly patients with dementia are placed.

The work was undertaken to trial a number of initiatives to improve the care of patients with dementia, and to enhance the skills of nursing staff.

Aims

• To improve staff awareness and knowledge of caring for patients with dementia.
• To provide a safe environment for staff and patients.
• To provide personalised care based on the specific needs of patients with dementia.

What did you do? 

Dementia awareness training – provided in liaison with Mental Health Trust staff at the Julian Hospital. Elsing Ward staff were training in dementia awareness through the “Shining the Spotlight” programme.

Prevention and Management of Aggression (PMA) Training – trial of PMA training for staff on Elsing Ward, to support them in the safe provision of care and the management of episodes of aggressive behaviour displayed by many patients, associated with their dementia.

Pabulum Blue Book – trial the use of Pabulum Blue Books to support the provision of personalised care for patients with dementia.

‘This Is Me’ implementation across the ward.

Appointment of a Registered Mental Health Nurse into the trained nursing staff establishment.

The provision of lunchtime groups to allow small groups of patients to eat together to promote eating and socialisation. Implementation of red tray, jug and beaker schemes.

Carers Café established and piloted for a year.

Establishment of Dementia Intensive Support Teams (DISTs).

What changed?

PMA training – staff who experienced an incident involving an aggressive patient following the training, reported an increase in confidence in their ability to deal with the incident, and the breakaway techniques taught on the course proved useful.

‘This is Me’ and Pabulum Blue Book – these proved to be a useful tool to help support staff in meeting patients’ individual preferences, and staff developed a summary sheet to accompany the tools, so that key information was easily available to all staff.

The appointment of a Registered Mental Health Nurse into the establishment has increased the knowledge and educational resource on the ward.

The lunchtime groups increased the intake of food by dementia patients and increased ability to socialise. The lunch groups were run by occupational therapists and volunteers.

The Carers Café evaluated really well and provided support to carers; this was done in partnership with the Norfolk Carers Forum.

Advice for others

PMA training – the trial was delivered through soft funding, and in liaison with the local Mental Health Trust PMA training unit. The practice could be sustainable, depending on availability of ongoing funding.

Pabulum Blue Book – the resources in terms of the Blue Books used during the trial were donated by AgeUK. The practice would be sustainable if the Blue Books were obtained and completed prior to the hospital admission, as the completion of the books during an admission is time consuming. The books are available free of charge to families, but health care providers would be charged a nominal fee for each book.

‘This is Me was provided by the Alzheimer’s Society

The lunch groups were a great vehicle for utilising volunteers and carers. Following on from this we have begun developing a group of volunteers dedicated to working with patients with dementia. We have started working towards developing competencies via training and support.

Carers Café evaluated well, but moving forward the concept of a ward based approach will be trialled next year.

Other initiatives in the development stage are around improving the ward environment, establishing competencies for MDT and providing training to meet needs.

Working towards supporting carers better, 24 Hour Carer Policy now ratified and in place.

Policies and procedures are currently being reviewed to ensure that they are fit for our increasing population of people with dementia.

We are about to start research into the effectiveness of Cognitive Stimulation Therapy (CST) in an acute hospital setting.

For further information please contact Dawn Collins at dawn.collins@nnuh.nhs.uk

See other examples at Dementia - best practice examples.