Pink poppies and black daisies

Yesterday I was lucky enough to be invited to attend the launch of a terrific new book called Living Well with Dementia by Shibley Rahman (@legalaware)

The front cover of this book, which explores "The Importance of the Person and the Environment for Wellbeing" features a beautiful tranquil photo of a pink poppy. It was during 'Shibs" entertaining presentation to launch the book that he triggered more flowery memories for myself.

Whilst exploring the concept of wellbeing (or is that well-being?) Shibley touched on the work of Professor Tom Kitwood around the concept of personhood. This instantly transported me back to the days of starting out in my first post as a wet behind the ears 'primary nurse' on a CUE unit for people living with dementia in Leeds. 

Due to a senior member of staff being unwell and myself still being on induction, and therefore not 'counted in the numbers' I was offered the chance to go to Bradford University to undertake training in Dementia Care Mapping. I dropped doubly lucky as the training was co-facilitated by Tom, who brought the whole concept expertly to life with some fine role play to underpin the theories we needed to grasp.

A year earlier Prof Kitwood had been invited to open a snoozelen room on a ward at High Royds Hosptial where my wife was deputy charge nurse. A couple of years later we actually had a very brief spell of both working on the ward (never on the same shift thankfully!) which based its whole philosophy of care on life histories and used music as a means of connecting. 

This is where the black daisies come in, as the ward was featured in an award winning documentary, which I was only reminded of earlier this week. Black Daisies for the Bride was filmed on Whernside Ward at High Royds Hospital. It followed the stories of five female patients, all of whom had a diagnosis of dementia. 

I was delighted to find the film is actually on the web, it was an unusual take on Alzheimer's but none the less led to many discussions at a time when dementia was not in the media spotlight as it is now.

One D

Having mentioned the launch of the fabulous Let's Respect Again www.letsrespect.co.uk I thought I'd pick out the One D that doesn't get anywhere near as much attention as Louis, Harry, Zayn, or indeed Dementia or Depression and that is Delirium.

Delirium can have a devastating impact on someones health and life expectancy, yet it is entirely treatable if diagnosed and treated effectively. I'm not going to attempt to dish out any medical advice nor pretend to be an expert on the condition, but I'd like to flag up some fantastic learning resources that are easily accessible and understandable.

First up there is an interview with Alasdair MJ MacLullich, Professor of Geriatric Medicine, University of Edinburgh who discusses Delirium, the risk factors, assessment and management in a podcast about the condition. http://letsrespect.co.uk/podcasts/

One of the most powerful films about Delirium is this five minute video made by Dr Andrew Teodorczuk Consultant Old Age Psychiatrist and Honorary Senior Lecturer featuring an interview with a gentleman discussing his own experience of Delirium

Dr Teodorczuk also produced a short introductory lecture for healthcare professionals which is on the excellent European Delirium Association website http://www.europeandeliriumassociation.com/news/delirium-essential-facts-a-short-lecture-by-dr-andrew-teodorczuk/ on which there are a host of other valuable resources about delirium for carers too

Have a read and a watch

Tony
@TJA_evonet

Doctor Who?

My heart sank somewhat with the news yesterday that Peter Capaldi will be wearing Dr Martens shoes in his new role as Dr Who. It prompted me to pen these few words as to why I wear Docs. It's not that I have anything against 'Whovians' or Peter Capaldi, Malcom Tucker is indeed a hero of mine but.....

I've only recently rediscovered the joy and the pain of "Docs" and it all came about because of this picture of Virginia Wade. How? Through one of the many wonderful conversations that spring up from sports reminiscence sessions. Virginia cropped up as one of the legends cards covering various sports. The conversation initially centred on tennis and Wimbledon, strawberries & cream, Dan Maskell & John Barrett, Little Mo Connelly, but then turned to the year Virginia won Wimbledon. 1977. The Queen's Silver Jubilee.

That transported me instantly back to my Mother busy covering plastic chip trays with silver foil to string along the front of our house between union jack flags and more trays painted red, white and blue. She even decorated the garden with silver foil in an effort to win best decorated house in Northallerton...a bid which was met with utter disdain by my older brother who was in his teens and heavily into music....in particular a new movement in music that appeared in 1977....yes whilst the house looked like a celebration of all things regal and royal, the music that pumped out of one window were the dulcit tones of Johnny Rotten et al. God Save the Queen......

I must have been reflecting back on that when on a rare shopping trip I headed into Schuh to try find some new work shoes and there they were...Docs! It was 1979 when I was 'allowed' to buy my first pair. Despite the shop assistant kindly warning me I may feel a little discomfort for a while I had to buy them! I confess my brain had conveniently forgotten just how much discomfort breaking them in entails but after a couple of months of bleeding heels and hobbling I've finally been rewarded with the comfiest pair of shoes in the world.

Thanks Virginia

Tony
@tja_evonet

Let's Respect Again

Dementia, Depression and Delirium. The 3 D's

The Let's Respect (Let’s respond to every challenge therapeutically) campaign was launched back in 2006 by the national older peoples' mental health programme to provide much needed educational resources to help raise awareness, knowledge and understanding in the acute general hospital environment of older peoples' mental health needs.

Following the launch the toolkits were distributed initially to every acute general hospital in England, but awareness of the resources soon meant copies of the toolkit were winging their way to all corners of The Globe. 

In addition to the printed materials, I had the great pleasure of being involved in producing a number of podcasts and videos featuring older people, clinicians and educators who shared their expertise in the 3 D's.

I'm delighted to see that through the vision and determination of Nadine Schofield, Let's Respect Again has been launched with many of the resources now made available once more, including the said videos http://letsrespect.co.uk/podcasts/ and I'm honoured to have been asked to act as an advisor to this community interest company.

We hear the mantra repeated so often about not reinventing wheels, so hats off to Nadine and very best of luck in taking this valuable work forwards once more!

Tony
@TJA_evonet

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

Everybody's Business - Nine years on

This week we have heard calls around the need to refresh the National Dementia Strategy for England. I don't recall reading about the strategy nor it being referenced in the media for the best of a couple of years, with the focus seemingly being on the Prime Minister's Challenge on dementia. It almost felt like someone's electronic diary had flashed up a warning reminder that the NDS 'ends' in 2014. I look forward to seeing work carried out to produce a much leaner version, that will hopefully contain less than 17 key action points this time around...

Strengthening the Involvement of People with Dementia and their Carers was a toolkit produced in partnership with people living with dementia and carer organisations for the strategy, I wonder how many people are aware of its existence? It can still be found on a few websites and many of its key actions are as relevant as ever http://dementiapartnerships.com/resource/strengthening-involvement/

The National Dementia Strategy references England's wider strategy for Older Peoples' Mental Health. Everybody's Business was published by the Care Services Improvement Partnership in 2005. Rather surprisingly this remains the most recet version of any national strategy around the subject.  In 2007 the Health Service Journal  reported:

........it is often assumed people with dementia must be cared for in specialist residential homes, even though most people with this diagnosis live at home in their communities, supported by families, neighbours and mainstream services.

CSIP has found that services supporting adults of working age, such as befriending or outreach services, stop when an individual reaches the age of 65. Ageism is alive and well unfortunately, despite the provisions of standard one of the national service framework for older people.

The Department of Health has recently announced that it will be developing a dementia strategy over the next year. Again, it will not be producing new policy but focusing on how to implement what we already know needs to be done.

This is great news. CSIP is playing its part in developing the strategy and providing implementation support through its national and regional resources. However, we will also continue to work on behalf of all those older people with other mental health problems, such as delirium and depression, to make sure services meet their needs. Read the full article at HSJ http://www.hsj.co.uk/resource-centre/older-peoples-mental-health-at-csip/198331.article#.UtLD2c9hDWw

It is great news that there is to be a refresh of the National Dementia Strategy, perhaps it is also time to revisit what is Everybody's Business, after all, we are told that 25% of adults over 65 will develop dementia, which means 75% won't, but they may live with or develop a number of mental health conditions.....

Tony Jameson-Allen
Twitter @TJA_evonet