our culture change journey - ltcam.mb.ca · purposeful interactions ... this means that residents...
TRANSCRIPT
Purposeful Interactions Our Culture Change Journey
“Relationships are not only the heart of long-term care;
they are the heart of life. And life should continue,
wherever we live.”
- Carter Catlett Williams
Seniors’ Health and Continuing Care - Saskatoon
Purposeful Interactions
• What are Purposeful Interactions?
• How are Purposeful Interactions different?
• Importance of the “Observation” experience
• Culture change journey
• Living by the “Platinum Rule”
• Overcoming challenges/evaluating outcomes
Objectives
“Long-term care is full of wonderful, loving staff. It is the system that is broken.”
- Dr. Bill Thomas
Founder of the Eden Alternative
Purposeful Interactions
“I did what I knew at the time, when I knew better, I did better.”
-Maya Angelou
Purposeful Interactions
• Making connections with each resident
• Focus on connections and relationships versus “tasks”
“[Care team members] go about doing their job – [focused] to get the work done, and don’t realize
that interaction is part of their job.” - Ken Udell, Resident
Purposeful Interactions What are Purposeful Interactions?
• Regularly checking on resident’s needs
• Providing better than expected care
“The more knowledge that the staff has about me, as a person with a life history and experiences, can
only translate into better care for us as residents.”
-Don Barrett, Resident
Purposeful Interactions What are Purposeful Interactions?
Purposeful Interactions
• Care team members may already interact regularly with residents while meeting their care needs
• The intention of Purposeful Interactions is to anticipate and individualize the response to the resident’s needs
How is this different?
Purposeful Interactions
• Places maximum possible decision making into the hands of the residents. This means that residents direct their own care. Relationships and choice are of greatest value.
• Occurs when care team members encourage independence and support residents to participate in decisions affecting their environment; their home.
• Is based on:
- Communication - Privacy
- Respect - Autonomy
- Choice - Flexibility
- Independence - Security
Resident-Directed Care
• Not all residents are capable of communicating their needs. We need to become “good detectives” to try to determine what unmet needs the person is trying to communicate.
• Care teams must commit to know each resident and their unique needs.
• Respect their individuality and honour their choices.
Purposeful Interactions Honouring Choices
Purposeful Interactions
• Acknowledge Resident Rights & Responsibilities
• Commit to resident-directed care and demonstrate that commitment in day to day work.
Care Team Commitment
“We should all know the three plagues of long-term care…I believe [care team members] are very effective
in combating these plagues. The problem is it is different everywhere” – Matt Proctor, Resident
Loneliness Helplessness Boredom
Purposeful Interactions
“Words make worlds”
“The words that we use influence how we think and how we think influences
how we act”
- Denise Hyde
What do Purposeful Interactions look like?
Purposeful Interactions
I would like to say that living in long term care can be an enriching and fulfilling experience, it can also have its low periods and everything in between for many. I want you all to know that you are important and fundamental to the health and happiness of your residents…You can make the changes and choose to be a blessing in other people’s lives. I am not saying it is easy, for some it may be very difficult, but it is possible. You can make a difference.”
- Matt Proctor, Resident
Photographs
Courtesy of
Rona
Andreas
Purposeful Interactions
• “It was good to sit back and watch, and observe how much we do good in our home, and what we need to improve, opened my eyes, will help me be a better care aide.”
• “I thought the “observation” time to be long until we discussed it later and realized that time was needed to do proper observation. The whole experience was an “eye-opener” for me.”
• “… I was amazed at how different the view of observer was compared to being a worker.”
• “I liked the observations; it was surprising to learn how some residents had no contact for over an hour.”
Participants, Purposeful Interactions,
Lakeview Pioneer Lodge, Wakaw, Saskatchewan
Observation Experiences & Reflections
Purposeful Interactions
“When someone in a position of power has
control of your day-to-day life”
“… we need to abandon the institutional model which focuses on staff schedules, tasks, and
scarcity … we need to instead create a human habitat in place of the institution where the
focus is always on the relationship with each resident, schedules are based on each
resident’s individual schedule/needs/choices, and focus is on abundance, not scarcity. Through the development of meaningful
relationships residents feel safe and secure.”
What is Institutionalization?
-Robin Kitchen, Sherbrooke Community Centre Manager for Learning and Growth
Purposeful Interactions
• What are we doing well?
• What are our missed opportunities for making connections with residents?
• What is stopping us from doing this?
• What improves the experience of work life for care team members?
• How do we know residents are experiencing interactions in a positive way?
What is our Current Culture?
Purposeful Interactions
Four P’s: • Positioning • Personal Needs • Pain • Proximity of Personal Items
How to Implement Purposeful Interactions
Purposeful Interactions What do Purposeful Interactions look like?
Smile
Observe
Interact
Closing Interaction
Purposeful Interactions
• “Treat others how they would like to be treated”
• The Platinum Rule means we need to ask, listen, and deliver care that is guided by each individual resident’s needs and preferences
Living by the Platinum Rule
Purposeful Interactions
• Right Now Homes immediately began modelling and mentoring quality interactions, seizing every opportunity. Immediate positive feedback to staff recognizing and appreciating caring connections and individualized care in the moment.
• Soon Examining bathing, individualized time to awaken/retire, explore options for meal wait times, and practice customer service principles.
• After Research and Planning Improvements to the welcoming process for new residents, implementation of relaxed breakfast and flexibility around shift expectations.
Identified Actions
Purposeful Interactions
• Resistance to change
• Rigid schedules and routines
• Informal culture • Peer pressure • Focus on task vs relationship
• Engrained within the institutional model of care
• Availability of resources
Barriers & Challenges
Purposeful Interactions
• Engaged Leadership
• Educated care team members • Initial and continued involvement of
Residents/Families • Self awareness of the home’s current culture
and actions for improvements • Concrete actions to address barriers/challenges
Keys to Success
Purposeful Interactions Evaluation- Antipsychotic Use
0%5%
10%15%20%25%30%35%40%45%
FY 15-16 Q1
FY 15-16 Q2
FY 15-16 Q3
FY 15-16 Q4
FY 16-17 Q1
FY 16-17 Q2
FY 16-17 Q3
FY 16-17 Q4
FY 17-18 Q1
FY 17-18 Q2
FY 17-18 Q3
Manitou Lodge Antipsychotics
Provincial Average Manitou Lodge Target
LAUNCH FEB 2017
Purposeful Interactions Evaluation- Antipsychotic Use
0%5%
10%15%20%25%30%35%40%45%
FY 15-16 Q1
FY 15-16 Q2
FY 15-16 Q3
FY 15-16 Q4
FY 16-17 Q1
FY 16-17 Q2
FY 16-17 Q3
FY 16-17 Q4
FY 17-18 Q1
FY 17-18 Q2
FY 17-18 Q3
Mennonite Nursing Home Antipsychotics
Provincial Average Mennonite Nursing Home Target
LAUNCH MAY 2016
Purposeful Interactions Evaluation- Bladder Continence
0%5%
10%15%20%25%30%35%
FY 15-16 Q1
FY 15-16 Q2
FY 15-16 Q3
FY 15-16 Q4
FY 16-17 Q1
FY 16-17 Q2
FY 16-17 Q3
FY 16-17 Q4
FY 17-18 Q1
FY 17-18 Q2
FY 17-18 Q3
Quill Plains Centennial Lodge Bladder Continence Worsened
Provincial Average Quill Plains Centennial Lodge Target
LAUNCH OCTOBER
2016
Purposeful Interactions Evaluation- Bladder Continence
0%
5%
10%
15%
20%
25%
30%
35%
FY 15-16 Q1
FY 15-16 Q2
FY 15-16 Q3
FY 15-16 Q4
FY 16-17 Q1
FY 16-17 Q2
FY 16-17 Q3
FY 16-17 Q4
FY 17-18 Q1
FY 17-18 Q2
FY 17-18 Q3
Samaritan Place Bladder Continence Worsened
Provincial Average Samaritan Place Target
LAUNCH MAY 2016
Purposeful Interactions
“There has been a significant change in the culture. I do notice a big change in that I see staff speaking with residents, and it makes me feel good to know they are engaging my mom even though she may not be completely aware. As family, it takes some of the sadness away for us. Human touch and voice are so integral as people go deeper and deeper into dementia.”
- Roxane Grambo, LTCAC Family Advisor
Positive Experiences
Purposeful Interactions
• Lynda Blevins, RN, BN
Supportive Care Projects Coordinator
Seniors’ Health & Continuing Care – Saskatoon
Saskatchewan Health Authority I 306-655-2497
• Jan Berger, RN, BSN
Supportive Care Projects Coordinator
Seniors Health and Continuing Care – Humboldt Saskatchewan Health Authority | 306-682-1236
Contact Information & Resources