Introducing Namaste: a care programme for people with advanced

Introducing Namaste: a care programme
for people with advanced dementia at the end
of life
Min Stacpoole RN, BA(Hons), MSc,
Nurse Researcher, Care Home Project Team,
St Christopher’s Hospice
Overview of lecture
Background to end-stage dementia & its
challenges
Elements of Namaste Care programme
Research project
Implementing the programme
Quality of EoLC for people with
dementia
Studies in UK & USA suggest end stage
dementia patients in acute hospitals,
psychiatric wards and nursing homes
experience high levels of ‘suffering’ >
60%, majority receiving sub-optimal end
of life care
(Lloyd-Williams & Payne 2002, Mitchell et al 2009, Aminoff & Adunsky 2004,
Sampson et al 2006)
People with dementia in hospital
receive…..
• More inappropriate interventions
• Less symptom management
• Fewer referrals for specialist palliative
care
• Less recognition of their spiritual needs
• Families are asked to make decisions in
times of crisis
(Morrison & Siu 2000; Sampson et al 2006)
Challenges in EOLC for people
with advanced dementia
 Poor recognition of dementia as a terminal
illness, failure to plan while the person has
capacity
 Even with a plan, family or care staff may panic
and hospitalise
 Professionals unskilled at symptom assessment
where there is little communication from the
resident/patient
 Difficulty in recognising the dying phase
 Quality of life? Social and spiritual care?
What does palliative care offer to
people with dementia?
Future planning (including DNACPR
and no hospitalisation)
Family support and information
Pain and symptom management
Integrated care pathway for last
days
Bereavement support
“ You matter because you are you,
and you matter to the end of your life,
and we will help you not only to die
peacefully but to live until you die.”
Dame Cicely Saunders
Health Professions Press
Amazon.com
joycesimard@earthlink.net
namastecare.com
Namaste
“To Honor The
Spirit
Within”
namastecare.co
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namastecare.com
NAMASTE CARE PROGRAMME
“entry criteria”
o
o
o
o
o
o
o
MMSE 0-7
Non-ambulatory
Sleeps a great deal of the time
Limited vocalization
Total care
Unable to actively participate in
activities
namastecare.co
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The Power
Of
Loving Touch
namastecare.com
namastecare.co
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namastecare.com
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Namaste Care Programme
 Best practice dementia care
 creating quality of life for the person
 Best practice end of life care
 providing comfort, dignity and a good death
 Support for residents, family and friends and
care staff
 Cost neutral –
no new staff, no new space
7 days a week / before and after lunch
Systematic review of nonpharmacological interventions for
reducing agitation
The only interventions with moderate
efficacy were:
Sensory interventions
Aromatherapy
Thermal bath
Calming music
Hand massage
(Kong et al 2009)
NAMASTE CARE - KEY ELEMENTS
o
“Honouring the spirit within”
o The presence of others
o Comfort
o Sensory stimulation: 5 senses
o Sight, touch, taste, hearing, smell
o
o
o
o
Meaningful activity
Life history
Care staff education
Family meetings
o Care of the dying and after death
What is the evidence for Namaste?
Analysis of the minimum data set before and
after 30 days of the programme showed:
 some decrease in withdrawal
 some increased social interaction
 some decrease in some delirium markers
 a trend for decreased agitation
(Simard and Volicer 2010)
An action evaluation of introducing the
NAMASTE CARE programme in care
homes
AIM:
To evaluate the introduction of the NAMASTE
CARE programme in six dementia care homes
with nursing and establish whether the
programme improves the quality of end of life
care for residents and their families, and
improves staff job satisfaction
Objectives
 To establish whether NAMASTE CARE reduces
agitated behaviour and reduces the levels of
pyscho-tropic medication being given
 To establish whether the introduction of NAMASTE
CARE reduces inappropriate hospital admissions
for resident with end-stage dementia
 To explore the effect of introducing NAMASTE
CARE on family perceptions of care
 To reduce resident and family isolation
Objectives
(contd….)
 To collaborate with care staff and families to
understand which elements of NAMASTE CARE
are transferable to UK care homes
 To collaborate with care staff and families to
develop a dementia specific end of life care
educational resource for wider dissemination
Implementation of Namaste Care by
Professor Simard:
An introductory workshop for all CH
managers & key champions
introducing Namaste Care
Visited each CH twice
In-house training about Namaste Care
(all staff)
In-house demonstration with residents
Each CH received 2 copies of
Namaste Care book
Namaste Care worker specifically
allocated to people with advanced
dementia
Greater awareness of change in
individuals
Improved symptom assessment
especially pain
Immediate response to agitation
Recognition of dying
Create the environment – NH C
Creating the environment
Gather supplies
Tidy the room and dim the lighting
Open lavender room diffuser
Play soft music
Nature videos
Music and film
Namaste morning
 Welcome To Namaste
 Each person is touched as they come into
the room
 A quilt or blanket is tucked around them
 Extra pillows or towels used to position
 Placed in a comfortable lounge chair
 Assessed for pain/discomfort
Welcome to Namaste
Namaste morning (contd…)
As appropriate –







Wash hands/face & apply lotion
Shave a gentleman
Manicure nails
Brush/tidy hair
Personal likes, lipstick, hair ornaments etc.
Massage – head, hands and/or feet
Help with extra nutrition when awake
Hand massage
Hydration &
food treats
Friends: dolls and life like
animals
Nature and the seasons
through the senses
Apron – with different textures
Memory box
Stimulation with appropriate DVDs
Namaste day
Give them a friend! As life-like as
possible, not “childish”
Use the SENSES
Flowers and seasonal reminders
Waking up for lunch (20 minutes prior to
lunch)
Afternoon variations
Namaste closes
Case studies
Advanced dementia/end of life care
& the Namaste Care programme
Entry to Namaste triggers a family
conference
Acknowledges disease progression early
Establishes comfort and pleasure as the
aims of care
Ultimate goal is peaceful, dignified death
Any questions?
Thank you
m.stacpoole@stchristophers.org.uk