Replacing the chemical cosh with compassion

As I looked back for info on Everybody's Business yesterday, I re-read this part of my post about 21 years of nursing.

Armed with this new knowledge, my next post was managing a unit in a dementia care home. It remains one of my favourite times looking back. It was a small, 16 bed unit that pretty much relied on dishing out Thioridazine & Diazepam to keep the residents 'quiet & content' or chemically coshed. I was lucky enough to be able to recruit some great care assistants and a couple of new RMN's to replace the old team who chose to move on and we agreed on a vision to work towards. We opened doors to the beautiful rear garden, we ended the routine of night staff getting people up on a morning, meals were available when people were hungry & we all spent time talking, sitting or playing activities with the people living in the unit. Within three months we saw significant reductions in prescribing of medication and after six months we'd eradicated all psychotropic medication. None of it was rocket science.

At the time it didn't feel like we were doing anything out of the ordinary whatsoever. We systematically reviewed each residents medication with their GP, identifying whether there was any evidence of what was being administered was having any positive therapeutic benefit. In most cases the answer was a resounding no, when people had previously moved to the home, the previous regime had accepted that was pretty much a prescription for life. In reviewing meds, we agreed individual plans for a managed gradual reduction if this was appropriate.

As a team we examined how the routines and regimes of the unit were driving care, as opposed to care needs guiding the actions we took. Simple stuff, removing the anxiety of what time people should get up or go to bed, looking at mealtimes and nutrition, inviting relatives to visit at these key times to help out rather than 'avoid coming because it was a busy time for staff'.

We didn't have a budget for 'training'. Instead, what we created was time to have discussions about the care, about how staff felt about the residents they were working with (we had a simple allocation system with primary nurses, associate nurses, HCA's etc) and given a chance to air any concerns via scheduled clinical supervision.

"None of it was rocket science". it wasn't, but what was it? What was the 'Essence of Care' that made a difference in that team? Whilst it may be tricky to capture this in one word, I've enjoyed reading the work around compassion and the question as to whether it can be taught., a question posed by @Ermintrude2 on kindness and compassion http://fightingmonsters.wordpress.com/2014/01/12/on-kindness-and-compassion/ I think, that is the one common trait in all of the team possessed and a reason they chose to work where they did. They cared about 'their' residents, they each had unique skills they brought to the team, they took pride in their work and the unit, they connected with relatives and welcomed visitors, encouraging them to become involved in the 'care' whenever appropriate and whenever relatives were comfortable to do so. But above all each and every member of the team showed compassion to residents, relatives but also for their fellow workmates.


Tony Jameson-Allen
@tja_evonet