- Dementia Services Information and Development Centre

30/04/2015 Evaluation of a Life
Story/Activities in
Dementia Care
course
Background
¡  Education in dementia across different health care
settings.
¡  Increase in numbers of residents with dementia.
¡  Need to highlight/stress to staff their responsibility re
the psychosocial care of the person with dementia.
Cecilia Craig
Education Officer
Dementia Services Information & Development Centre
¡  A hospital based training course was developed
titled:
‘Life Story/Activities in Dementia Care’
¡  Anecdotal evidence suggested that staff felt ‘at a loss’
as what to do with someone with advanced dementia.
¡  Written evaluations at end of course:
¡  Very positive.
¡  Limited value in informing future course development.
¡  Explore new ways of evaluating the course.
¡  Written evaluations at end of course:
¡  Very positive.
¡  Limited value in informing future course development.
¡  Explore new ways of evaluating the course.
Life story/activities in dementia course
Key Principles
Course Structure
Day 2
Day 1
¡  Overview of dementia
¡  Project
¡  Life story work
¡  Adapting group activities
¡  Activity focussed care
¡  Role of the Activities
coordinator
¡  Intro to project
¡  Personal & unique life stories are central in the
care of a person with dementia.
¡  Short, individualised activities based on these
stories & life experiences are more meaningful.
¡  Documentation
¡  Reminisce & use activities as care is given.
Project work - between day 1 & 2
1 30/04/2015 Project Work
¡  Select a resident who didn’t usually attend the
group activities.
¡  Record a few stories from their life.
¡  Develop an activity based on one particular
aspect of their life stories.
¡  Share, reminisce or help the person to be
actively involved in it.
Kathleens’ Annual Trip to Knock
Knock was a special place for Kathleen.
Positive reaction to anything to do with Knock.
She liked ‘saying the rosary’.
Aim of the study
The iPod
Sally’s Favourite Sounds:
¡ To explore a new way of evaluating the
course using the participants’ perspective of
residents’ engagement/response to
meaningful activities based on their life
stories & experiences.
Sally’s dog barking.
The sound of birds singing.
DESIGN
¡  Questionnaire
¡  Designed & based on Cohen-Mansfield et. al.’s dimensions
of engagement in persons with dementia (2009)
¡  Focus groups
¡  To provide more depth & to elaborate on the
quantitative data
¡  Purposive sample – all participants who attended
two courses = 14
Questionnaire items - 9
¡  Length of time since the activity was provided
¡  Frequency of activity provided
¡  Resident’s response to the activity:
¡  Acceptance
¡  Duration of time
¡  Attentiveness
¡  Attitude
¡  Action towards the activity
¡  Target & content of the person’s talk
2 30/04/2015 Setting & sample
¡  Large acute general hospital –
Focus groups
¡  residential care setting for elderly
¡  Two focus groups
¡  Response rate:
¡  100% (14) for the questionnaire
¡  64% (9) for the focus groups
¡  Questions referred to the responses
from the questionnaires.
(6 in the 1st group & 3 in the 2nd group)
¡  10 nurses and 4 health care assistants.
¡  All attended the course & all were female.
Timeline
¡  3 months between the 1st & 2nd course.
¡  Questionnaires & focus groups were
completed within 4 weeks after the last course.
Findings
Questionnaire
Q3 - In general, did the
resident accept the activity that
you provided?
Always
Often
Sometimes
Never
Nurse
5
3
2
HCA
1
1
2
Q4 - In general, how long did the
resident spend occupied or
involved with the activity?
Totals
6
4
4
10 - 30 secs
31-60 secs
61-120 secs
2-5 mins
6-10mins
Nurse
HCA
Totals
2
3
1
2
2
2
1
2
4
5
3 30/04/2015 Q 6 - In general, was the resident’s
attitude toward the activity mostly
positive or mostly negative?
Nurse
HCA
Q 8 - While engaged with the
activity, what was the target of the
resident's remarks?
Totals
Very Negative
Negative
Somewhat Negative
Neutral
Somewhat Positive
3
Positive
4
Very Positive
3
3
6
4
1
The activity
The resident her/himself
A staff member
Another resident
Another thing/person
11
2
1
4
Q 9 - While engaged with the
activity, what was the content of
the resident's remarks?
The activity
The resident her/himself
A staff member
Another resident
Another thing/person
10
2
Resident’s response
¡  Independence:
¡  ‘Some residents can initiate it’
¡  ‘ …someone needs to be there with her. She’ll only
put it into her mouth ’
¡  Focus:
¡  ‘… her focus is great; she was a seamstress you
know’
¡  ‘Sometimes [he] might fall asleep.’
¡  Affective response:
¡  ‘Great excitement [for him]’
Focus groups
Findings
Therapeutic
¡  Preventative:
¡  ‘Good for preventing escalation of things.’
¡  Influence on affect:
¡  ‘Totally transformed her mood.’
¡  Increases interaction:
¡  ‘One lady didn’t speak very often but appears to talk more
now …’
4 30/04/2015 Practicalities
Knowing the person
¡  Shortage of time & staff:
¡  ‘You don’t see them as a patient now …’
¡  ‘We’ll have to look at how we do things on the ward
[to make more time]’
¡  ‘We can do some of the activities while giving care.’
¡  ‘I learned so much about the person and I knew
her a long time’
¡  ‘Made me look at the person differently’
¡  ‘We are so short staffed’
¡  ‘It’s the key to everything’
Relatives’ involvement
¡  ‘Relatives helped a lot. They were really excited
about it and motivated me to keep going.’
¡  ‘Relatives feel good about being involved’
Participants’ opinions
¡  The norm:
¡  ‘We have to teach other staff now so that it becomes
the norm.’
¡  Motivation & enjoyment:
¡  ‘It’s made me motivated to do others’ life story now ‘
Other staff
¡  ‘They think that it’s only about the book – but
it’s not; it’s about what you do with it and the
activities you can develop from it’
¡  ‘Some don’t have any interest in it – they feel
they have no time.’
Conclusion
¡  Staff see the value in doing Life Story work & using it to develop
individualised activities.
¡  Teach others.
¡  Wanted it to continue it.
¡  It was also perceived as being beneficial to residents.
¡  Positive engagement with residents.
¡  Shortage of time & staff was perceived to be a problem.
¡  SMALL exploratory study but …
¡  A valuable way of evaluating the course.
¡  ‘[I] taught some of the other staff’
¡  Research – difficult to do with busy staff.
5 30/04/2015 references
¡  Cohen-Mansfield, J., Dakheel Ali, Maha. & Marx,
Marcia. (2009) Engagement in persons with dementia:
the concept and its measurement Am J Geriatr
Psychiatry April 17(4): 299-307.
Thank you!
6